bluuebunny/crossref_metadata_2025 huggingface dataset:
A CASE OF MELORHEOSTOSIS WITH CUTANEOUS HAEMANGIOMA AND LYMPHATIC VESICLES
Authors: Hall R.
Published: February 2018

A case of melorheostosis is described in which more than one limb was affected. It was associated with increased length of the right leg, lymphatic vesicles in the right groin, ossification in the subcutaneous tissues of the right thigh and a cutaneous haemangioma of the right side of the trunk.
TENDON GRAFTING
Authors: Brand Paul W.
Published: February 2018

1. Tendon grafts, in order to survive, have to develop a blood supply from their immediate environment. This causes adhesions.

2. Their final range of movement is therefore a sum of the length to which these vascular adhesions will stretch, and the range of movement of the normal tissues to which the tendon has become adherent.

3. Thus it is important that the tendon graft should lie in a bed of yielding material, and that no unyielding structures should be divided in the same wound. When possible, blunt tunnelling between short transverse incisions is the method of choice for placement of grafts.

4. The most crippling adhesions are those that grow from an imperfectly sutured cut end of tendon, leaving it unsatisfied. A new method of tendon anastomosis designed to prevent such adhesions is described.

5. A tendon grafting technique for intrinsic paralysis of the fingers in leprosy, using a radial extensor of the wrist as the motor and the plantaris tendon as the graft, is described.

6. A study of 861 fingers after the operation is presented.

7. The importance of re-education after operation is stressed.
SIMPLICITY OF APPROACH TO TREATMENT OF THE INJURED HAND
Authors: London P. S.
Published: February 2018

1. The success of any method of treating the injured hand is to be measured by the use that is made of the remnant.

2. Careful, prompt surgical treatment of the wound will usually allow prompt healing.

3. Skin-grafts, internal fixation of fractures and the eking out and rearrangement of tissues that have escaped injury have an important place in primary treatment.

4. Many hands so treated are ready for use after one operation and within a few weeks of being injured.

5. Reconstruction in several stages should not be carried out unless it offers a reasonable prospect of improvement that will be useful to the particular patient.
THE CRUSHED CHEST
Authors: Sillar W.
Published: February 2018

1. Anterior segment injuries are shown to be more dangerous than lateral segment injuries, and an explanation for this is offered.

2. A common pattern in anterior segment injuries is described.

3. When this pattern is present the application of a plate to the sternum is a useful procedure.

4. Six cases are quoted in which the application of a plate to the sternum was effective.

5. A plate has been designed for the purpose.
OSTEOGENESIS INDUCED BY VESICAL MUCOSAL TRANSPLANT IN THE GUINEA-PIG
Authors: Makin M.
Published: February 2018

1. In the experiments undertaken autogenous vesical mucosal transplants were made in guinea-pigs. The transplanted mucosa proliferates and forms a nodule. Central necrosis of the nodule and the secretion of the proliferating epithelium combine to form a cyst filled with a viscous fluid.

2. Before the cyst is well defined some of this fluid diffuses into the sub-epithelial connective tissue, producing areas of tissue oedema which later are transformed into translucent hyaloid islands. With further condensation of the collagen fibres, these areas are converted into primitive bone. The hyaloid islands act as a bone precursor. Bone always formed in the wall of the cyst within thirty days except in cases of sepsis or death of the transplant, when there was no osteogenesis. Homografts of vesical mucosa were found unreliable in their capacity to induce bone.

3. The results of the histochemical investigation and radiographic diffraction of the hyaloid areas suggest that the proliferating mucosa is the source of the inducing agent.

4. Bone can be induced only in sites where a primitive vascular connective tissue is growing and where there exists an adequate blood supply.

5. The rapid rate of osteogenesis can be seen in the radiographs of induced bone in radial defects. The electron-microscopic study of the induced bone at three weeks confirmed that osteoid had been formed so quickly that calcification had not yet taken place.

6. The relationship between the bone induced by transplanting vesical epithelium and the formation of urinary calculi is discussed and their common origin postulated.
INTERMITTENT BONE CHANGES AND MULTIPLE CARTILAGE DEFECTS IN CHRONIC STRONTIUM RICKETS IN RATS
Authors: Storey E.
Published: February 2018

Continuous strontium administration first induces typical "rickets" in young rats receiving adequate calcium phosphorus and vitamin D but later the widened cartilage spontaneously calcifies intermittently leaving transverse bands consisting largely of osteoid tissue in the metaphysis; in addition to intermittent calcification bone changes indicate that skeletal growth is not uniformly progressive.

Subsequently areas of the epiphysial cartilage fail to calcify and localised defects develop; among these are wedge-shaped metaphysial osteoid tissue masses, "invagination" of the epiphysial plate to form multiple nodules of cartilage with proliferating cells in the middle and hypertrophic ones at the periphery, perforation and fragmentation of the epiphysial plate with formation of large cartilage nodules. Multiple cartilage nodules of different sizes appear in the epiphysis, metaphysis and bone shaft.

Most bone margins are lined by osteoid seams which only slowly calcify and concomitantly resorption is decreased so that the rate of remodelling of the skeleton is diminished. This type of process may help to explain the results of treatment of osteoporosis by strontium administration.
SURGICAL TREATMENT OF CEREBRAL PALSY
Authors: Pollock G. A.
Published: February 2018

1. Thirteen years of experience in charge of treatment in a Residential School for Cerebral Palsy, and a review of 466 operations performed on children handicapped by this condition, form the basis for this attempt to frame the indications and contra-indications for operation.

2. A brief description is given of the more commonly performed operations, with an indication of the results that are likely to be obtained.

3. Orthopaedic surgery has a worth-while contribution to make in the treatment of cerebral palsy. When the cases are selected with care, when the appropriate orthopaedic measures are skilfully performed and when the patients are adequately supervised afterwards, the benefits of surgery are greater than those provided by any other treatment, and they are achieved more quickly.

4. The desire to improve and the "inner urge" of the patient to succeed may be the most important single factor in his rehabilitation.
EXPERIENCES IN GROWTH RETARDATION WITH HEAVY VITALLIUM STAPLES
Authors: McGibbon Kenneth C. , Deacon Alfred E. , Raisbeck Clifford C.
Published: February 2018

1. The authors have found epiphysial stapling a satisfactory and helpful procedure for correction of limb length discrepancy and recommend its use as described.

2. The use of a spring caliper for absolute radiographic location of the epiphysial plates and the use of two Vitallium staples each side is recommended.

3. Suggestions for avoiding injury to the epiphyses are outlined.

4. The experience of stapling operations in seventy children is reported. Forty-four of these patients have completed growth.
EARLY DIAGNOSIS AND TREATMENT OF CONGENITAL DISLOCATION OF THE HIP
Authors: Barlow T. G.
Published: February 2018

1. A simple test more sensitive than Ortolani's for the diagnosis of instability of the hip in the new-born is described. It takes only a few seconds to perform and can be quickly taught to doctors, nurses and midwives.

2. About one infant in sixty is born with instability of one or both hips. Over 60 per cent of these recover in the first week of life, and 88 per cent in the first two months. The remaining 12 per cent are true congenital dislocations and persist unless treated, giving an incidence of 1·55 per thousand.

3. Treatment with the type of splint described begun within the first week is simple and effective, and gives a hip clinically normal long before the child begins to walk.

4. The concept of a pre-dislocation phase should be abandoned.
PROTECTION OF THE BLOOD CLOT IN HEALING CIRCUMSCRIBED BONE DEFECTS
Authors: Melcher A. H. , Dreyer C. J.
Published: February 2018

1. Penetrating defects were cut in the femora of twenty-five albino rats. In fifteen of the animals the defects in the right legs were protected with cellulose-acetate shields while those in the left legs were unprotected and allowed to heal as controls. In the remaining ten animals the defects in both legs were protected with shields made of homogenous organic bone.

2. New bone was found to proliferate into the concavity of the shields in most of the animals and this protruded beyond the contour of the femur. The development of the protuberance appeared to depend upon the degree to which the shield was adapted to the femoral surface.

3. The cellulose-acetate shield was not removed by the host, but the homogenous organic bone was actively resorbed; multinucleated giant cells were associated with this process.

4. There are indications that the maintenance of the protuberance is dependent upon the continued presence of the shield. Exostoses protected by intact cellulose-acetate shields have been recognised up to eighteen months after operation.

5. The function of the shield in the formation of the bony protuberance is thought to be two-fold, in that it protects the haematoma from invasion by non-osteogenic extra-skeletal connective tissue, and that it governs the size of the haematoma and prevents its distortion by the pressure of the overlying soft tissue.
FRACTURES OF THE NECK OF THE FEMUR IN CHILDREN
Authors: Ratliff A. H. C.
Published: February 2018

A study of a collected series of femoral neck fractures in seventy-one children observed for one to nineteen years shows:

1. This injury is rare but occurs in children of all ages from three to sixteen years old.

2. The fractures may be classified as transepiphysial, transcervical (the commonest), basal and pertrochanteric. Displacement was frequent.

3. The fracture usually followed severe violence, especially falls from a height or motor accidents.

4. Complications were frequent and included avascular necrosis, delayed union (seventeen cases), non-union (seven cases) and disturbances of growth at both the upper and lower ends of the femur.

5. Avascular necrosis occurred in thirty patients (42 per cent). Three patterns of necrosis are described : diffuse, localised and confined to the femoral neck. The radiographic appearances of avascular necrosis after this fracture are different from those of pseudocoxalgia (Legg-Calvé-Perthes' disease).

6. Non-union did not occur after adequate primary internal fixation or after primary subtrochanteric osteotomy.

7. The management of an undisplaced fracture presented no great problem and the results were good. A plaster spica is recommended for treatment of this fracture. Exceptionally, avascular necrosis developed.

8. Treatment of the displaced fractures (forty-nine cases) was less satisfactory. A good result was obtained from primary treatment in only fifteen patients.

9. The value of different methods of primary treatment is discussed, including manipulative reduction and immobilisation in a plaster spica, manipulative reduction and internal fixation, and primary subtrochanteric osteotomy. Manipulative reduction and immobilisation in a plaster spica is not recommended.

10. Salvage operations were required in nineteen patients. Late subtrochanteric osteotomy is of value in the management of some of these problems.
SPONTANEOUS FRACTURES OF THE FEMORAL NECK
Authors: Jeffery C. C.
Published: February 2018

1. Aching pain in the thigh, hip or buttock in an elderly person should lead to radiological examination of the hip region. In patients who have been subjected to irradiation for pelvic neoplasms a spontaneous fracture should be strongly suspected and the patient kept under close review, even if the first radiograph is negative.

2. Patients with spontaneous fractures of the femoral neck can be satisfactorily treated by Smith-Petersen nailing even when symptoms have been present for as long as sixteen weeks and displacement for eight weeks. Osteotomy is unnecessary if adequate reduction can be obtained.
FRACTURES OF THE PELVIS INVOLVING THE FLOOR OF THE ACETABULUM
Authors: Pearson J. R. , Hargadon E. J.
Published: February 2018

Eighty patients who sustained a fracture of the floor of the acetabulum are reviewed, and the mechanism of the injury was investigated by clinical and experimental studies. The results of the injury in fifty patients are presented, with an account of the three clinical types of acetabular fracture.
PARALYTIC DISLOCATION OF THE HIP
Authors: Jones G. Blundell
Published: February 2018

1. Forty-eight paralytic dislocations of the hip have been studied and twenty-seven operations for correction of valgus deformity of the femoral neck have been done.

2. The differing features of dislocations occurring in poliomyelitis, cerebral palsy and meningomyelocoele are considered in relation to management after operation.

3. Early recognition of subluxation is essential to a successful varus osteotomy. An angle of 105 degrees rather than the 120 degrees previously recommended is advisable for children under the age of five.

4. Redislocation is most likely to occur in meningomyelocoele in which muscular imbalance is greatest, and in later cases where the acetabulum has become shallow by growth without the femoral head within it. It has not occurred as a late complication after weight bearing has been established, from a recurrence of valgus deformity.
POPULATION STUDIES IN DUPUYTREN'S CONTRACTURE
Authors: Early P. F.
Published: February 2018

1. Surveys of a working community, of a group of elderly people, and of an urban population show an incidence of Dupuytren's contracture among men varying from 0·1 per cent in the age group fifteen to twenty-four, to 18·1 per cent in those aged seventy-five and over; and among women from 0·5 per cent in the age group forty-five to fifty-four, to 9 per cent over seventy-five. It is estimated that in the population aged fifteen and over in Lancashire and Cheshire there will be 4·2 per cent of the men and 1·4 per cent of the women with some degree of palmar contracture.

2. There appears to be no relationship between the type of occupation and the incidence or severity of contracture in men, except that among those engaged in light manual work the proportion of mildly affected hands is higher, and of bilateral contracture lower, than among either non-manual or heavy manual workers.

3. Evidence is provided that rheumatoid arthritis, past polyarthritis, osteoarthritis, cervical spondylosis and Paget's disease occur no more often in those with Dupuytren's contracture than in other members of the community.

4. Examination of the patients in an epileptic colony confirms a strong association between Dupuytren's contracture and epilepsy. Knuckle-pads, plantar nodules and periarthritis of the shoulder are all more frequent in epileptic than in non-epileptic patients with Dupuytren's contracture. Epileptics also show a higher proportion with bilateral contractures and a greater tendency to a symmetrical pattern of contracture in the two hands. A strong constitutional factor, probably genetic, thus operates in persons with both diseases.

Nevertheless, the frequency of a positive family history of contracture is lower in the epileptic cases, and reasons for this are discussed.

5. From the limited material available in the literature there would appear to be an inverse relationship between the population of certain countries and the prevalence in them of Dupuytren's contracture. The possible significance of this is briefly discussed.
A DISSERTATION FROM THE EARLY EIGHTEENTH CENTURY, PROBABLY THE FIRST DESCRIPTION OF POLIOMYELITIS
Authors: Rida Amin
Published: February 2018

The oldest texts describing infantile paralysis (Underwood's 1789 and Salzmann's 1734) are reviewed and discussed. Salzmann's case report is likely to be a description of acute anterior poliomyelitis and is documented by details of the history, clinical picture and postmortem findings.
MUSCLE FUNCTION IN THE FINGERS
Authors: Stack H. Graham
Published: February 2018

1 . The extensor assembly of the fingers consists of the central tendon joined by three pairs of components: a) the retinacular ligaments, which link the movements of the interphalangeal joints; b) the "wing" tendons, a lumbrical on the radial side, and usually a palmar interosseous on the ulnar side; c) the phalangeal tendons, usually dorsal interossei.

2. The retinacular ligaments are relaxed in full extension of the proximal interphalangeal joints and are, in this position, unable to extend the distal joints fully. This is because the interphalangeal joint surfaces are eccentric.

3. The pull of the wing tendons alters the shape of the extensor expansion and transfers the pull of the long extensor tendon from the base of the middle phalanx to the base of the distal phalanx, thus enabling full extension of the distal joint to be powerfully achieved.

4. The action of the lumbrical muscle, as an extensor of the interphalangeal joint, is demonstrated by a diagram showing its site and length in the various positions of the finger, calculated from the known excursions of the tendons. This is consistent with the observations on action potentials.

5. The phalangeal tendons of the dorsal interossei have a bifid insertion, a) into the phalangeal tubercle at the base of the proximal phalanx, and b) into the transverse band, and hence to the central tendon. The muscle acts at one or both of these attachments, according to the positions of the metacarpo-phalangeal and interphalangeal joints, in its varying functions of flexion, abduction and hyperextension.

Finally an explanation of the deformity of clawing in ulnar palsy is given.
A COMPARATIVE STUDY OF FRESH AUTOGENOUS AND PRESERVED HOMOGENOUS TENDON GRAFTS IN RABBITS
Authors: Cordrey Lee J. , McCorkle Hugh , Hilton Emmett
Published: February 2018

Comparison was made between the behaviour of fresh autogenous grafts of rabbit tendon and that of homogenous grafts inserted after the graft had been preserved for approximately one week, either in ethanol or merthiolate or by lyophilisation.

Regardless of the method of transplantation or preservation, a viable tendon-like structure of compact connective tissue bundles longitudinally oriented was eventually present at the sites of the grafts, with ingrowth of fibroblasts and capillaries from host to graft. The period between transplantation and recognisable viability of the grafts varied from less than one week for the autogenous transplants, to from three to five weeks for the preserved grafts.

Either autogenous or homogenous grafts will take in rabbits.
LATERAL FLEXION INJURIES OF THE CERVICAL SPINE
Authors: Roaf Robert
Published: February 2018

1. Evidence is presented that certain types of cervical spine injury are due mainly to lateral flexion forces.

2. These injuries are often complicated by a brachial plexus lesion as well as a lesion of the spinal cord.

3. It is not always easy to detect the brachial plexus injury when the patient is first seen.

4. In the cases reviewed there has been little or no recovery of cord function, and the existence of a brachial plexus injury has, of course, made rehabilitation much more difficult.

5. The practical importance of recognising the mechanism of this type of injury is that treatment which will cause further separation of the vertebrae is inadvisable.
HEREDITARY ONYCHO-OSTEODYSPLASIA
Authors: Duncan J. G. , Souter W. A.
Published: February 2018

1. A brief historical outline of the gradual recognition of hereditary onycho-osteodysplasia is given.

2. A family, three members of which show the characteristic changes, is reported.

3. Forty-four families exhibiting the syndrome have been collected from the world literature; the whole series comprises over 400 affected persons, details being available for only 252 of them. The latter group has been analysed in order to find the relative incidence of the individual anomalies comprising the syndrome and of the different combinations in which they occur. It is suggested that the pelvic anomalies occur more frequently than has previously been believed.

4. An account is given of various other abnormalities recorded as occurring in association with the main tetrad of lesions. With few exceptions they are regarded as coincidental.

5. A brief account is given of the genetic factors involved.
HEREDITARY MULTIPLE EXOSTOSIS
Authors: Solomon L.
Published: February 2018

1. Hereditary multiple exostosis has been studied in fifty-six patients and their relatives. In most cases previous records were available and the progress of the disease could be traced over many years.

2. The characteristic lesions are described and the complications encountered in the present series of cases are noted. The disease is inherited in approximately two-thirds of the cases and invariably produces detectable lesions in the heterozygote.

3. The cartilage-capped exostoses are confined to the endochondral skeleton where their incidence is closely related to the growth potential of the sites involved.

4. An attempt has been made to explain the curious distribution of the exostoses, and the likely theories of the pathogenesis of the disease are discussed.
THE "OBSERVATION HIP" SYNDROME AND ITS LATE SEQUELAE
Authors: Fernandez de Valderrama J. A.
Published: February 2018

1. The term "observation hip" refers to a form of hip disease affecting children and adolescents, the most significant features being the transient nature of the symptoms and the absence of a bony or cartilaginous lesion on radiographic examination.

2. With a view to determining the possible sequelae of the disorder, twenty-three patients aged between two and fifteen years at the onset of the condition were studied fifteen to thirty years later.

3. Varying degrees of coxa magna, osteoarthritis or simple broadening of the femoral neck in the "observed" hip joint were found in the radiographs of twelve of the twenty-three patients studied.

4. This analysis suggests that the " observation hip" syndrome is the result ofan inflammatory process ofthejoint due to varied etiology, whether from injury or infection. The developmental and degenerative changes which may occur are a consequence of hypervascularisation of the bone. Thus changes may develop without necessarily producing the epiphysial necrosis characteristic of the first stage of ischaemia in Legg-Calvé-Perthes' disease.

5. The persistence of this stage of hypervascularity, and therefore the possible outcome of the transient synovitis, may be conditioned by the age at onset of the pathological process, the severity of the condition, and the duration of the symptoms and signs.
PERSISTENT JOINT LAXITY AND CONGENITAL DISLOCATION OF THE HIP
Authors: Carter Cedric , Wilkinson John
Published: February 2018

1. General joint laxity affecting more than three joints was found in 7 per cent of normal schoolchildren. Similar laxity was found in fourteen of a random series of forty-eight girls, and in nineteen of twenty-six boys, with non-familial congenital dislocation of the hip. Such laxity was also found in four of seven girls and five of seven boys with familial (first degree relative affected) congenital dislocation of the hip.

2. It is concluded that persistent generalised joint laxity, which is often familial, is an important predisposing factor to congenital dislocation of the hip in boys. It is less important in girls, except perhaps in familial cases, as in girls there is an alternative temporary hormonal cause of joint laxity.
LUNATE AND PERILUNAR DISLOCATIONS
Authors: Campbell Rolla D. , Lance Eugene M. , Yeoh Chin Bor
Published: February 2018

1. A study of fifty patients with dislocations of the lunate bone or perilunar dislocations has been made. The period of observation was adequate in thirty-eight.

2. The injuries generally occur in young or middle-aged men after unusually severe trauma.

3. Associated injuries are frequent, and the most common of these is damage to the median nerve.

4. In one-third of the cases the nature of the lesion was not initially diagnosed or the initial treatment was inadequate.

5. A dislocated lunate bone may be replaced even at a late stage and even if the displacement is severe so long as there is some soft-tissue attachment. The anterior approach may safely be used for the replacement.

6. The lunate bone may be removed without involving the necessity for arthrodesis of the wrist.

7. Open reduction should be employed for trans-scaphoid dislocations whenever exact realignment and good fixation cannot be achieved by closed methods.

8. Excision of the proximal row of the carpus gives the possibility of salvage of a reasonable degree of function, and may be preferable to arthrodesis or removal of only part of the proximal row.
ACROCEPHALOSYNDACTYLY IN SINGAPORE
Authors: Pillay V. K.
Published: February 2018

1. Five new cases of Apert's syndrome are presented, and the general features of the disease are discussed and correlated with these. The bony changes in the elbow and the delay in ossification are striking. The incidence in Singapore seems to be higher than elsewhere and the patients are all Chinese males.

2. In Singapore the disease is sporadic but seems to appear about once every three years.
TEARS OF THE HUMERAL ROTATOR CUFF
Authors: Cotton R. E , Rideout D. F.
Published: February 2018

1. Radiographs of both shoulders were performed on 106 unselected necropsy subjects and those found to be abnormal were examined pathologically.

2. Radiological abnormalities were found in sixty-eight shoulders of thirty-eight subjects. Pathological examination showed rotator cuff tears and associated abnormalities in thirty-five of these, rheumatoid arthritis in one, a previous fracture in one, and one was not examined.

3. The criteria for radiological diagnosis of rotator cuff tears are examined and discussed.

4. The radiological changes give little indication of the severity of the tears or associated abnormalities except in the case of complete rupture of the cuff when acromio-humeral articulation occurs.

5. The lesions are all explicable on a traumatic basis. There is no correlation with the presence or absence of osteoarthritic disease of the joint.

6. The biceps tendon may become damaged or even ruptured in this condition.

7. Villous synovial proliferation was found in fourteen cases, in five of which it was pigmented with histological appearances resembling pigmented villonodular synovitis. The significance of this finding is briefly discussed.
THE REPAIR OF EXPERIMENTAL DEFECTS IN RABBIT SKULLS
Authors: Young M. H.
Published: February 2018

1. Experimental defects in the cranial vaults of young adult rabbits were implanted with decalcified, deproteinised and deep frozen homogenous whole bone. The experiments were similar to those of Ray and Holloway (1957) except that these workers used rats as the experimental animals. In addition, six control defects were made and not implanted.

2. All animals were killed six weeks after operation and thirty-four defects were studied by radiology and by histology.

3. All implants became surrounded by connective tissue and in all cases some new bone formed in apposition to implanted fragments. The degree of incorporation of the implants in new bone varied widely, not only between the three implanted groups, but also within each group. In general, new bone formation was greatest in defects implanted with deproteinised and whole bone, least in defects implanted with decalcified bone.

4. The fate of bone implants and the extent to which they can be said to induce osteogenesis are discussed.
EXPERIENCES WITH BOILED CADAVERIC CANCELLOUS BONE FOR FRACTURES OF LONG BONES
Authors: Williams Grant
Published: February 2018

1. Fifteen cases of bone transplantation for fibrous union of fractures of long bones are described, using boiled minced cancellous bone from cadavers. One transplant became infected but the infection responded to treatment.

2. In one patient with non-union of the shaft of the humerus, bony union was not obtained, but a good functional result obviated further treatment.

3. It is suggested that this relatively simple method of bone transplantation could be used more widely if its potentialities were appreciated more fully.
ANTERIOR MARGINAL SEPARATION OF THE MENISCUS OF THE KNEE
Authors: Boucher H. H.
Published: February 2018

1. Strain or rupture of the anterior marginal attachments of the meniscus was observed in approximately 10 per cent of a group of patients operated upon for internal derangement.

2. In about half of these a tear of the body of the meniscus was found and it is probable that this tear may have been the cause of the symptoms. In the remainder no injury to the body of the meniscus was found.

3. Recognition may be difficult and delay in diagnosis may be the cause of degenerative joint changes.

4. The condition should be looked for at operation when the meniscus appears to be intact or when the only lesion appears to be an area of chondromalacia on the weight-bearing surface of the femoral condyle.
OBSERVATIONS ON THE WATER CONTENT OF BONE
Authors: Smith J. W.
Published: February 2018

1. A method is described by which the relative water contents of adjacent microscopic regions of bone can be assessed.

2. The water content is correlated with the inorganic and organic contents in regions of different age.

3. The results suggest that the age increase in the mineralisation of bone occurs at the expense of both the organic and water fractions.
POST-TRAUMATIC OSTEOLYSIS OF THE OUTER END OF THE CLAVICLE
Authors: Jacobs Philip
Published: February 2018

1. Two cases of post-traumatic osteolysis of the outer end of the clavicle are reported.

2. The essential features of the lesion are summarised.

3. The possible medico-legal importance of the condition is mentioned.
MEDIAN NERVE LIPOMA IN THE HAND
Authors: Mikhail I. K.
Published: February 2018

1. Two cases are reported in which there was diffuse fibro-fatty overgrowth or tumour formation involving the adipose tissue of the median nerve. In each the diagnosis was confirmed by operation and histological examination.

2. The first case is an example of the developmental abnormality usually referred to as "macrodystrophia lipomatosa." The second case should be termed fibrolipoma.

3. The literature is reviewed; no case of fibrolipoma has been recorded.
A PLASTIC SOCKET AND STUMP CASTING TECHNIQUE FOR ABOVE-KNEE PROSTHESES
Authors: Gleave J. A. E.
Published: February 2018

1. This is a report on the production of sockets for above-knee prostheses utilising a composite laminate of synthetic and natural materials and using a principle of total stump contact with the socket, which before fitting is shaped to suit individual stump contours.

2. A new method of taking casts is described, as is the production of the socket, and observations on the use of the prosthesis over the last two and a half years are made.
EXPERIMENTAL COMPARISON OF LIVING AND DEAD BONE IN RATS
Authors: Stevens Jack , Ray Robert D.
Published: February 2018

1. The radiographs of paired living and dead rat tibiae, obtained in an experiment previously reported, have been examined by densitometry.

2. The dead bone became progressively less dense than the living bone as the duration of the implantation increased.

3. The change in density was related to the quantity, but not to the quality, of the bone tissue examined.
THE TREATMENT OF CHRONIC ACROMIO-CLAVICULAR DISLOCATION
Authors: Dewar F. P. , Barrington T. W.
Published: February 2018

1. A method of treating chronic acromio-clavicular dislocation by transfer of the coracoid process to the clavicle is described.

2. This has been successful when other procedures have failed.

3. Three patients have been reviewed a long time after this operation and two others after a short time. All obtained a good result.
INFRACLAVICULAR BRACHIAL PLEXUS INJURIES
Authors: Leffert R. D. , Seddon Herbert
Published: February 2018

Over a period of twenty years a small number of patients, thirty-one, have been seen who suffered injuries of the infraclavicular brachial plexus as a direct result of skeletal injury in the region of the shoulder joint.

Except for isolated circumflex nerve injuries the prognosis is generally good whatever part of the plexus is damaged. The treatment is conservative and its two most important features are prevention of stiffness of joints and the control, by regular galvanic stimulation, of denervation atrophy of muscle during the often prolonged period before recovery becomes apparent.
BILATERAL FRACTURE OF THE FIRST RIB
Authors: Joshi S. G. , Panday S. R. , Parulkar G. B. , Sen P. K.
Published: February 2018

1. Two cases of bilateral fracture of the first rib are reported. The fractures were situated near the neck of the first rib.

2. A possible mechanism responsible for the bilateral fracture of the first rib at this particular site has been suggested.
SYNTHETICALLY POWERED ORTHOTIC SYSTEMS
Authors: Nickel V. L. , Savill D. L. , Karchak A. , Allen J. R.
Published: February 2018

1. The various methods of powering orthoses are described.

2. The details of control systems are given.

3. The applications of these systems are described.
STRUCTURAL IDIOPATHIC SCOLIOSIS IN INFANCY
Authors: Lloyd-Roberts G. C. , Pilcher M. F.
Published: February 2018

1. One hundred babies under the age of one year with untreated structural idiopathic scoliosis have been studied and the outcome assessed.

2. Ninety-two recovered spontaneously. Five developed progressive curves of bad prognosis and three developed secondary structural (double primary) scoliosis.

3. It is suggested that intrauterine moulding may cause the deformity.
AN EVALUATION OF AN EXTERNAL SPLINT FOR IDIOPATHIC STRUCTURAL SCOLIOSIS IN INFANCY
Authors: Walker Geoffrey F.
Published: February 2018

1. The records of forty-nine patients with idiopathic structural scoliosis in infancy treated by a combination of splinting and physiotherapy have been reviewed.

2. Nine curves (18·3 per cent) failed to respond to treatment and five of these progressed.

3. The percentage of good results (81·7 per cent) shows no improvement on the natural course of the condition.
AUTO-IMMUNE RESPONSE TO NUCLEUS PULPOSUS IN THE RABBIT
Authors: Bobechko W. P. , Hirsch Carl
Published: February 2018

1. A hypothesis outlining an auto-immune mechanism for antibody production against autogenous nucleus pulposus is presented.

2. Auto-antibodies to autogenous nucleus pulposus have been experimentally produced in rabbits.

3. These antibodies are cell-bound within lymphoid cells and are greatest in primary lymph nodes. This antibody is demonstrated by a positive pyronin reaction.

4. Lymphoid cells fixed in Carnoy's fluid and stained for pyronins also show a distinct natural yellow fluorescence. This fluorescence occurs only in the cytoplasm of those cells which are pyronin-positive and presumably producing antibody.

5. The lymph node phase of the reaction is greatest at four days and is sustained for three weeks. A secondary generalised lymph node response occurs in all lymph nodes at six weeks.
TREATMENT OF RUPTURES OF THE LATERAL LIGAMENT OF THE ANKLE
Authors: Freeman M. A. R.
Published: February 2018

1. The results of three forms of treatment (mobilisation, immobilisation for six weeks, and suture with immobilisation for six weeks) for ruptures of the lateral ligament of the ankle have been compared in previously uninjured asymptomatic patients.

2. Only suture and immobilisation ensured final mechanical stability of the ankle as assessed by stress radiography. Unstable ankles were found after both mobilisation and immobilisation, but in these groups no ankle finally displayed more than 8 degrees of relative talar tilt.

3. The mean duration of disability in patients who finally became symptom-free was: after mobilisation, twelve weeks; after immobilisation, twenty-two weeks; and after suture and immobilisation, twenty-six weeks.

4. One year after injury 58 per cent of patients treated by mobilisation, 53 per cent of patients treated by immobilisation, but only 25 per cent of patients treated by suture and immobilisation, had become perfectly symptom-free.

5. For these reasons, and because simple sprains are satisfactorily treated by mobilisation, it is suggested that mobilisation may be the treatment of choice for most, perhaps all, ruptures of the lateral ligament of the ankle.
INSTABILITY OF THE FOOT AFFER INJURIES TO THE LATERAL LIGAMENT OF THE ANKLE
Authors: Freeman M. A. R.
Published: February 2018

1. Forty-two previously asymptomatic patients presenting with a recent rupture of the lateral ligament of the ankle, and twenty similar patients with a simple sprain of this ligament, have been followed for one year. The physical and radiological findings upon the completion of treatment have been related to functional instability of the foot one year later.

2. Persistent mechanical varus instability of the talus in the ankle mortise was a possible cause of functional instability one year after injury in four (or perhaps six) patients.

3. Adhesion formation was a possible cause of functional instability in one patient.

4. Seventeen patients finally displayed no clinical or radiological abnormality after injury, but noted functional instability of the foot one year later.

5. It is concluded that the pathological process which is usually responsible for functional instability of the foot after a lateral ligament injury is at present unknown.
ARTHRODESIS OF THE HIP BY CENTRAL DISLOCATION AND ILIO-FEMORAL NAILING
Authors: Altchek Martin
Published: February 2018

1. Central dislocation of the hip combined with ilio-femoral intramedullary nailing is a technically difficult operation, but one which, if well done, provides a high percentage of hip fusion without external fixation.

2. Fifteen hips have been operated upon. Twelve have fused; two cannot yet be assessed as the time since operation is too short; and one failed, presumably due to osteoporosis resulting from rheumatoid arthritis.
OSTEOCHONDRITIS DISSECANS OF THE KNEE
Authors: Green J. P.
Published: February 2018

1. This is a small series and patients have been treated in a variety of ways. Some impressions emerge, however, concerning the importance of initial trauma, the importance of the factor of heredity and the results of treatment.

2. More than 40 per cent of the patients in the series had an injury to the knee before symptoms began, which tends to support the traumatic theory. Twenty of the twenty-three patients who gave a past history of trauma had a lesion on the medial condyle, next to the intercondylar notch, and one patient of the three who had lesions on the lateral femoral condyle suffered from recurrent dislocation of the patella.

3. Although numerous examples have been reported in the literature of osteochondritis dissecans occurring in several members of a family, the family history of only one patient in this series suggested a familial tendency, and this was doubtful. It seems that patients showing a familial tendency are not commonly seen compared with the number of patients presenting with osteochondritis dissecans.

4. It is often stated that osteoarthritic changes will follow if part of the articular surface is lost, as in osteochondritis dissecans, and this belief has led to the school of thought which advocates restoration of the articular surface by reposition of the fragment. While there is no doubt that this method should be used if a large proportion of the weight-bearing surface of a femoral condyle is affected, the argument has less force if a small area is affected. It is interesting to find that of the five patients treated by replacement of a separated fragment four developed osteoarthritis, whereas in the first series only six patients out of the twenty-two developed such changes. Although these former had what appeared to be an accurate reposition of the fragment it is possible that a "step up" on the joint surface was produced, which gave rise to a more rapid deterioration of the articular cartilage. Accurate conclusions cannot be drawn from five patients, but it may be that attempts to reconstruct the articular surface of a femoral condyle can, over a long period of time, give worse results than simple removal of the lesion.

5. The group of patients treated conservatively gave encouraging results, and improved radiographic appearances were seen in most cases. There was also a notable absence of osteoarthritic changes and these results support the view that conservative treatment is indicated in adolescents and children.
CHARNLEY COMPRESSION ARTHRODESIS OF THE HIP
Authors: Morris John B.
Published: February 2018

1 . The results of compression arthrodesis of the hip have been studied in fifty-six patients. There was one post-operative death from pulmonary embolism on the tenth day.

2. Bony union for the whole series (fifty-five patients) was achieved in 76·4 per cent. Sound fibrous ankylosis, indistinguishable from bony union clinically and functionally, was achieved in 10·9 per cent. Residual movement occurred in 12·7 per cent.

3. Thirty-five patients were treated by the standard technique of eight weeks in plaster, followed by full weight bearing, irrespective of whether any movement was detected on clinical testing. 82·8 per cent achieved sound bony union; 5·7 per cent achieved sound fibrous ankylosis, and residual movement occurred in 11·4 per cent.

4. Ten patients were treated without plaster protection; six achieved bony union; three had sound fibrous ankylosis and one had residual movement. Healing was delayed in this group and there was more residual deformity.

5. 67·5 per cent of all patients recovered full knee range. Only one patient with reduced range had knee flexion of less than 90 degrees. Twenty-four of the thirty-five patients treated by the standard technique of eight weeks in plaster were examined. Fifteen had full knee movement; in only four was knee flexion less than 120 degrees and in no case was it less than 90 degrees.

6. Return to full activity was rapid. Sixty per cent of patients returned to work within six months and 80 per cent within nine months of surgery. Five of the six patients examined with residual movement in the hip joint were back at work within six months of surgery.

7. This study lends support to the view that arthrodesis of the hip, in the presence of normal function in the opposite hip, is compatible with vigorous and full activity.
OSTEOCHONDRAL FRACTURES OF THE FEMORAL CONDYLES
Authors: Kennedy John C. , Grainger R. Wayne , McGraw Robert W.
Published: February 2018

1. The importance of recognising osteochondral fractures of the femoral condyle in the adolescent knee joint is emphasised.

2. The mechanism of the formation of the fractures is discussed. Essentially, a powerful rotary and compressive force shears off cartilage and subchondral bone. The absence of lateral condylar lesions in the experimental group lends support to the theory that the patella may cause the fracture by impingement.

3. On the basis of the mechanism a clinical classification of osteochondral fractures of the femoral condyles is presented.

4. Early surgery is recommended. The arguments for removal or replacement of the fragment are discussed.
BLACKTHORN INFLAMMATION
Authors: Kelly J. J.
Published: February 2018

1. Cases are presented to show that blackthorn inflammation is not uncommon in the West Midlands.

2. The pathology is that of a chronic non-suppurative inflammation.

3. Cases are divisible into three groups on the basis of their history. In the third group, with no history of blackthorn trauma, diagnosis may be very difficult.

4. Removal of the blackthorn fragments causes prompt resolution of the inflammation.
OSTEOGENIC SARCOMA IN FOUR SIBLINGS
Authors: Harmon T. P. , Morton K. S.
Published: February 2018

1. The case histories of four siblings affected by osteogenic sarcoma are described.

2. The lesions appeared over a period of twelve years. The ages of the patients at the onset of symptoms were fifteen, twenty, eleven and twenty-two years.

3. The diagnosis of osteogenic sarcoma was in each case established by radiological and histological methods.

4. Two patients survived for eight and sixteen years after treatment and both are still alive and well.
THE EFFECTS OF HORMONES ON BONE IN GROWING RATS
Authors: Tapp E.
Published: February 2018

1. In growing rats oestrogen, cortisone and thyroxine in high doses suppress bone formation, and this effect is probably part of a general suppression of body growth.

2. Growth hormone and thyroxine in small doses stimulate both body growth and bone formation.

3. Testosterone has no effect on bone formation.

4. Oestrogen and cortisone suppress bone resorption. The effect of cortisone may be modified in conditions of calcium depletion.

5. Thyroxine appears on the other hand to increase bone resorption.

6. Testosterone has no effect on bone resorption.
CHONDROSARCOMA OF BONE
Authors: Barnes R. , Catto Mary
Published: February 2018

1. Chondrosarcoma is a malignant tumour of bone with clinical and morphological features which distinguish it from osteosarcoma.

2. Cartilage tumours present an unbroken spectrum in their clinical behaviour and histological appearances from the entirely benign to the frankly malignant.

3. A few chondrosarcomata, particularly those in children and young adults, run a rapidly fatal course but in general they metastasise late and some kill by local extension of the tumour.

4. "Secondary" chondrosarcomata arising from a pre-existing osteocartilaginous exostosis or enchondroma are mostly low grade tumours.

5. The first appearance of an osteocartilaginous exostosis after skeletal maturity, renewed growth, or pain unassociated with a fracture, should arouse suspicion of malignancy in any cartilage tumour.

6. Cartilage tumours of the trunk and upper end of femur and humerus are especially liable to sarcomatous change.

7. Although most benign cartilage tumours occur in the hand and foot they rarely become malignant with the exception of those in the calcaneus.

8. If biopsy is necessary it should be of the incisional type, a generous amount of material being removed from the edge of the tumour. Calcified, degenerate areas must be avoided.

9. In low grade tumours microscopic fields judged to be malignant by Lichtenstein and Jaffe's well established criteria may be scanty and many paraffin sections should be examined. Absence of mitotic figures, heavy calcification and poor vascularity are no guarantee of benignity.

10. Information as to the site of the tumour and age of the patient must be available to the pathologist if a useful report is to be given.

11 . In "borderline" tumours or where any difficulty in diagnosis arises the clinical, radiographic and histological features must all be taken into account and treatment based on the most unfavourable features.

12. Chondrosarcoma is a radio-resistant tumour and treatment is by radical excision or amputation.

13. Malignant cartilage cells implanted in the tissues at operation will often continue to grow and in all instances the biopsy wound and surrounding tissues must be removed en bloc with the tumour.

14. Small, low grade, readily accessible, peripheral tumours may be successfully treated by excision with a wide margin of healthy tissue.

15. In the limbs or pelvis large tumours and those of high grade malignancy should be treated by amputation. Since marrow permeation is often greater than the radiograph suggests amputation should, as a rule, not be performed through the bone in which the chondrosarcoma is situated.

16. Recurrence carries the danger that an initially accessible tumour becomes inaccessible and inoperable and, less frequently, a low grade tumour recurs in a metastasising form.

17. Recurrence is frequent after inadequate surgery; it indicates that the tumour is at least locally malignant and a cure can usually only then be achieved by more radical surgery.