bluuebunny/crossref_metadata_2025 huggingface dataset:
OSTEOCHONDRITIS DISSECANS IN THREE MEMBERS OF ONE FAMILY
Authors: Gardiner T. B.
Published: February 2018

Three cases of osteochondritis dissecans of the knee in two brothers and a sister are described. In the brothers both knees were involved. None of the other joints of the skeleton was affected in any of the patients.
SPONDYLOLISTHESIS
Authors: Adkins E. W. O.
Published: February 2018

1. A detailed analysis of the anatomy of spondylolisthesis reveals many causes of serious interference with the nerve roots.

2. These anatomical findings can be correlated with the symptoms.

3. In association with spondylolisthesis, cases of disc prolapse, tuberculosis, and a cauda equina lesion are described.

4. Adequate decompression of the affected nerve root is essential in all cases with sciatica. The operative procedure is described.

5. The problem of arthrodesis will be discussed fully in a separate paper.
OSTEOTOMY AS AN AID TO ARTHRODESIS OF THE HIP
Authors: Apley A. G. , Denham R. A.
Published: February 2018

1. Arthrodesis of the hip is satisfactory provided a good range of knee flexion is preserved.

2. The hip is best arthrodesed in its deformed position, and the deformity corrected by a high femoral osteotomy. Knee range can readily be retained by treating the patient on traction for the first six weeks instead of using plaster.

3. Thirty-three arthrodeses were attempted without osteotomy. Only thirteen were satisfactory. Even our best method without osteotomy gave sound fusion in only seven out of ten cases.

4. In a series of twenty-three unselected cases in which osteotomy was performed in addition to other methods, fusion occurred in twenty-two.
THE RESULTS OF A REALIGNMENT OPERATION FOR RECURRENT DISLOCATION OF THE PATELLA
Authors: Harrison M. H. M.
Published: February 2018

1. A realignment operation is described for the treatment of recurrent dislocation of the patella.

2. In twenty-three patients (twenty-seven knees) operation prevented further dislocation. The physical and functional condition of the knees two to twenty years after operation is described.

3. Patello-femoral osteoarthritis was not a clinical complication in any of these patients. This finding is discussed.

4. Genu recurvatum developed in four patients operated upon between the ages of ten and thirteen years. The cause of this deformity is discussed. It is concluded that the realignment operation should not be performed under the age of fourteen years.

5. In three patients operation failed to control the recurrent dislocation.
PRIMARY RETICULO-SARCOMA OF BONE
Authors: Magnus H. A. , Wood H. L.-C.
Published: February 2018

1. Seven new cases of primary reticulo-sarcoma of bone are recorded, including one in which a full necropsy was carried out.

2. The literature of Ewing's tumour and reticulo-sarcoma of bone has been examined and the conclusion reached that the separation of these two tumours is an artificial one.

3. The investigation of our cases confirms this observation.
POLYARTERITIS NODOSA WITH NEW BONE FORMATION
Authors: Saville Paul D.
Published: February 2018

1. A case of polyarteritis nodosa is reported, the presenting manifestation of which was subperiosteal new bone formation in both legs.

2. The effect of cortisone on the symptoms is recorded.

3. The histology is reported after biopsy of bone and adjacent tissue.

4. Skeletal involvement in polyarteritis nodosa is believed to be hitherto unrecorded.
CONGENITAL VERTICAL TALUS
Authors: Osmond-Clarke H.
Published: February 2018

1. Attention is drawn to that type of rigid congenital flat foot in which the talus lies vertically instead of horizontally.

2. This deformity is rare, but if not treated successfully leads to an ugly, painful foot in adolescence.

3. The experience of five patients forms the basis of the present preliminary account. One adolescent and two young children under the age of five were treated unsuccessfully by both conservative and operative measures. More recently in two children with bilateral deformity open operation has been successful in restoring the shape of the foot.

4. The operation is essentially a reduction of a subluxation at the talo-navicular and subtalar joints. It entails freeing the head of the talus sufficiently to allow it to be lifted dorsally and laterally. The talus is then anchored in position by transplanting the distal end of the peroneus brevis tendon through the neck of the bone.
FEMORAL OSTEOTOMY IN EXTRA-ARTICULAR ARTHRODESIS OF THE TUBERCULOUS HIP
Authors: Cholmeley J. A.
Published: February 2018

1. One hundred and forty-two cases of extra-articular arthrodesis of quiescent tuberculous hips with fibrous ankylosis have been reviewed.

2. The methods used were the ilio-femoral graft with and without osteotomy, and the ischio-femoral graft by the Brittain or Foley technique.

3. Success occurs more frequently when the grafting operation is combined with or followed by a femoral osteotomy.

4. It is suggested that this success is due largely to the increased immobilisation afforded by the osteotomy.

5. It appears that equally good results can be obtained with either an ilio-femoral or an ischio-femoral graft in these cases provided that an upper femoral osteotomy is also carried out, preferably at or soon after the grafting operation.

6. An upper femoral osteotomy will frequently convert an unsuccessful extra-articular hip graft into a successful one without further grafting.
THE RESULTS OF LUMBO-SACRAL FUSION FOR LOW BACK PAIN
Authors: Shaw E. G. , Taylor J. G.
Published: February 2018

1. In this series of posterior onlay grafting with fresh autogenous bone and without internal fixation, in the treatment of non-infective structural lesions in the lumbo-sacral area, 71 per cent of the patients were relieved of their symptoms, but bony fusion was obtained in only 60 per cent.

2. It is probable that with this technique twelve weeks' immobilisation in a plaster bed is required.

3. Some failures are ascribed to the use of an insufficient quantity of bone or to poor apposition of the graft to its bed.

4. It is evident that the more vertebrae one attempts to fuse the more difficult it is to succeed. When the diseased area is successfully fused but an unnecessarily long graft has been used, a pseudarthrosis above the level of the pre-operative pathology may be the cause of persisting backache. For these reasons we believe that one should not attempt to graft more vertebrae than is necessary to stabilise the local lesion.

5. The complication rate, particularly from deep vein thrombosis, was high. This major complication could perhaps be overcome by using banked bone.

6. The indications for the operation are assessed as follows. It should be done for low back pain only when there is a definite diagnosis and a limited extent of structural pathology; one can then expect excellent results when successful fusion is achieved and also an appreciably high proportion of satisfied patients even when bony fusion has not been obtained, presumably because there is a fibrous union strong enough to stabilise the affected spine.

It is inadvisable to undertake lumbar-lumbo-sacral fusion for intervertebral disc degeneration when there are more than three adjacent vertebrae involved, and in any case operation should be confined to the indicated extent.
PARALYTIC SCOLIOSIS
Authors: James J. I.P.
Published: February 2018

1. The prognosis of paralytic scoliosis has been studied by defining curve patterns and establishing the natural development as seen in fully grown patients who have not had surgical correction.

2. The prognosis, unlike that in idiopathic scoliosis, is related to the age of onset of the curvature and the degree of muscle imbalance rather than the site of the primary curve.

3. Paralysis of limb muscles is shown to be unrelated to the development of scoliosis. The intercostal muscles and the lateral abdominal flexors produce scoliosis when weaker on the convex side of the curve. Gravity and the other trunk muscles certainly play a part in the development of lumbar curves but their importance is difficult to assess.
FRACTURES OF THE LATERAL TIBIAL CONDYLE TREATED BY SKELETAL TRACTION AND EARLY MOBILISATION
Authors: Apley A. Graham
Published: February 2018

1. The term "bumper fracture" is colourful but usually inaccurate. The injury is a valgus split or crush.

2. A series of sixty bumper fractures is reported: forty-eight were treated without operation or plaster.

3. Twenty-seven of the forty-eight patients treated without splintage have been followed up for more than five years, and seventeen of these for more than ten years.

4. The results are satisfactory and there is no evidence that there is any late deterioration of the joint.

5. It is suggested that bumper fractures should be treated without operation and without fixation in plaster.
ANKLE AND SUBTALAR FUSION BY A TRANSARTICULAR GRAFT
Authors: Bingold A. C.
Published: February 2018

1. Three pantalar, one ankle and subtalar, and three ankle arthrodeses have been performed by a technique, the essential step of which is the insertion of a transarticular graft from below. Union has occurred in four to five months.

2. A method is described of determining the degree of equinus before the operation and securing it during the operation.

3. Pantalar fusion by this technique compares favourably with the methods described so far.
RHEUMATOID ARTHRITIS PRESENTING AS TENOSYNOVITIS
Authors: Jacobs J. H. , Hess E. V. , Beswick Isobel P.
Published: February 2018

1. Three cases of tenosynovitis presenting as the first manifestation of rheumatoid arthritis are described.

2. An account is given of the histology of the affected tendon sheaths.
DYSTROPHIA MYOTONICA ASSOCIATED WITH FAMILIAL PAGET'S DISEASE (OSTEITIS DEFORMANS) WITH SARCOMATA
Authors: Caughey J. E. , Gwynne J. F. , Jefferson N. R.
Published: February 2018

1. A report is given of a family suffering from dystrophia myotonica and familial Pagetâs disease of bone.

2. Radiological changes in the skull occur in both disorders, which are quite dissimilar. Thickening of the calvarium, however, may be common to both.

3. The serum alkaline phosphatase is high in Paget's disease and normal in dystrophia myotonica.

4. In one patient the Paget's disease was complicated by the development of multiple sarcomata. Sarcomatous involvement of the vertebral column, observed in one of the cases, has not been recorded before.
THE NORMAL VASCULAR ANATOMY OF THE HUMAN FEMORAL HEAD DURING GROWTH
Authors: Trueta Joseph
Published: February 2018

1. The results of a study of the characteristics of the vessels found in forty-six human femoral heads during the growth period are described.

2. Of the three different sources of blood entering the human adult femoral head it was found that from birth to about three to four years the vessels of the ligamentum teres do not contribute to the nourishment of the head.

3. After the fourth year the metaphysial vessels decrease in importance until they finally disappear, leaving the head with only one source of blood through the lateral epiphysial vessels; the ligamentum teres is not yet contributing to the circulation of the head.

4. After about eight or nine years it was found that the vessels of the ligamentum teres contribute to the blood supply of the head while the metaphysial blood flow is still arrested.

5. Finally, at puberty, after a period of activity of the metaphysial vessels, epiphysial fusion takes place, bringing together the three sources of blood characteristic of the adult.
UNREDUCED ANTERIOR DISLOCATION OF THE HIP
Authors: Hamada Gawad
Published: February 2018

1. Un reduced anterior dislocation of the hip is very uncommon. Four cases are reported.

2. The aim of treatment is to correct the deformity, to improve the gait and to produce pelvic stability.

3. Osteotomy of the femur at the trochanteric level is the simplest corrective operation and will greatly improve the function of the limb.
FLEXION-COMPRESSION INJURY OF THE STERNUM
Authors: Fowler A. W.
Published: February 2018

1. Injuries of the sternum from flexion-compression violence are described and contrasted with injuries from direct violence. The characteristic feature of flexion-compression injuries is a dislocation or fracture at or near the manubrio-sternal joint with backward displacement of the manubrium.

2. Treatment is outlined, with special reference to the indications for open reduction and wire fixation.

3. The mechanism of flexion-compression injuries of the sternum is discussed. The opinion is expressed that most of the force is transmitted to the sternum by the ribsâespecially the upper ribs.
ERRORS OF DIAGNOSIS REVEALED AT MENISCECTOMY
Authors: Murdoch G.
Published: February 2018

1. In the course of 2,668 operations for suspected cartilage lesions 119 errors of diagnosis were revealed.

2. These errors are analysed and certain conclusions are drawn.
THE HYDRATION OF THE NUCLEUS PULPOSUS AND ITS RELATION TO INTERVERTEBRAL DISC DERANGEMENT
Authors: Hendry Neil G. C.
Published: February 2018

1. Eighteen normal discs from cadavers and seventy-five specimens of abnormal disc material obtained at laminectomy have been compared.

2. Imbibition pressure, and not osmotic pressure, is the important factor in maintaining hydration of the nucleus, and the comparison has been based on this finding. The terms "free imbibition index" and "effective imbibition index" are suggested as being readily determinable means of expressing the functional efficiency of a nucleus.

3. A reduction in imbibition pressure was a constant feature of the specimens obtained at operation. No evidence was found to support the theory that hyper-hydration or engorgement of the nucleus plays a part in disc protrusion. A reduction in imbibition pressure can, however, be expected in itself, by a combination of mechanical and hydrostatic effects, to cause disc derangements.

4. The reduced imbibition pressure of abnormal discs is related to abnormal loss of, or deterioration in, the protein/polysaccharide of the nucleus. The premature onset of, or some disturbance in, the normal ageing process is a prime cause of mechanical derangement of the disc.
TUBERCULOSIS OF THE PUBIS
Authors: Nicholson O. R.
Published: February 2018

1. Eleven cases of tuberculosis of the pubis are described.

2. The disease is often of insidious onset, and symptoms vary from vague discomfort to incapacitating pain in the region of the symphysis and the groin.

3. Abscess formation is common and was present in nine of the eleven patients when they first attended.

4. The lesion has a good prognosis and responds well to simple curettage.

5. In this series operation, without bone grafting, has not been followed by pelvic instability or back pain.
FAMILIAL METAPHYSIAL DYSPLASIA
Authors: David J. E.A. , Palmer P. E.S.
Published: February 2018

1. Familial metaphysial dysplasia occurring in two families is recorded.

2. One case with unusual skull changes and webbing of the digits is described in detail.

3. The similarity between the shape of the bones in familial metaphysial dysplasia and other bone disease is discussed.
CORACOID TRANSPLANTATION FOR RECURRING DISLOCATION OF THE SHOULDER
Authors: Helfet Arthur J.
Published: February 2018

1. Coracoid transplantation for recurring dislocation of the shoulder is described.

2. In my experience of over thirty cases only once has true dislocation recurred after this operation. Recurrence was due to avulsion of the bone block.

3. Failure to repair the original detachment of the glenoid labrum is a frequent cause of recurrence of dislocation of the shoulder. An explanation is offered for this failure; namely that the injured labrum adheres to the deep surface of the subscapularis muscle instead of reattaching itself to bone. This reinforces Watson-Jones's advice that the original dislocation should be treated by complete immobilisation in full medial rotation for three weeks.
RECURRENT POSTERIOR DISLOCATION OF THE SHOULDER
Authors: Jones Victor
Published: February 2018

1. A case of recurrent posterior subluxation of the shoulder is described. After failure of a soft-tissue repair, a posterior bone block operation was performed.

2. The distinction between traumatic dislocations with tearing of the capsule or of the glenoid labrum, and habitual luxations from laxity of the capsule, is emphasised. Although the anterior rim of the glenoid was detached in this case, it is considered to fall into the latter category.

3. A posterior bone block provides a simple and efficient form of repair in this type of case. It is free from the disadvantage of causing limitation of rotation at the shoulder joint; it employs a principle which might well merit more application than at present in the repair of anterior dislocations.
EXPERIMENTAL PRODUCTION OF CARTILAGE DURING THE REPAIR OF FRACFURES OF THE SKULL VAULT IN RATS
Authors: Girgis F. G. , Pritchard J. J.
Published: February 2018

Cartilage formation was provoked in the skull vault of the young rat by making multiple incisions, and scraping the periosteum to reduce the blood supply to the injured area. The hypothesis that ischaemia induces osteogenic cells to produce cartilage in the course of fracture repair thus receives experimental support.
THE OCCURRENCE OF PYROPHOSPHATE IN BONE
Authors: Perkins H. R. , Walker P. G.
Published: February 2018

A small proportion of the total phosphate in normal bone salt occurs in the form of pyrophosphate. The deposit formed in vitro on incubation of rachitic cartilage with a calcifying medium does not contain pyrophosphate unless ATP is added to the medium, in which case the proportion of pyrophosphate is of the same order as that found in normal bone.
THE ILIAC APOPHYSIS AND THE EVOLUTION OF CURVES IN SCOLIOSIS
Authors: Zaoussis Alexander L. , James J. I. P.
Published: February 2018

1. The belief that the cessation of spinal growth and curve progression coincides with the completion of growth in the iliac apophyses has been confirmed in a review of material from 224 cases. This applies also to paralytic curves.

2. In a high number of cases this ossification centre showed an asymmetrical development on the two sides of the pelvis. The appearance of a separate posterior centre of ossification is also common, and probably represents an advanced stage in the growth of the iliac apophysis.

3. Menarche and the growth of the apophyses of the vertebral bodies almost always occurred in advance of the iliac apophyses. They should be regarded as early signs of maturation, not reliable in the prognosis of curve progression.

4. The growth of the iliac apophysis appeared to be unaffected by poliomyelitis.
MASSIVE OSTEOLYSISâDISAPPEARING BONES
Authors: Jones G. Blundell , Midgley R. L. , Smith G. Stewart
Published: February 2018

1. The clinical and pathological features are given of an example of the rare syndrome of progressive and massive osteolysis associated with haemangiomatous changes in the bones affected.

2. Twenty-six cases have been previously reported, but this is only the second from Britain. Only one other patient is considered to have died as a direct result of the disease.
PROGNOSIS IN TRACTION LESIONS OF THE BRACHIAL PLEXUS
Authors: Bonney George
Published: February 2018

1. Twenty-nine patients with traction lesions of the brachial plexus have been studied.

2. The methods of study have been by clinical examination, by operative exploration and biopsy and by examination of axon reflexes.

3. Results in each of these sections have been related to the progress of the lesions.

4. The results suggest: a) that the reason for the generally poor prognosis in traction lesions of the brachial plexus is the frequency of intradural preganglionic damage and of tearing apart of the plexus; b) that the former occurrence can with some accuracy be diagnosed by examination of axon reflexes and that the latter can be detected at operation.

5. Indications for operative exploration are given and a plan is outlined for the management of these cases.
THE SHORT LEG IN POLIOMYELITIS
Authors: Ratliff A. H. C.
Published: February 2018

A study of limb shortening after poliomyelitis in 225 children in whom paralysis was confined to one leg shows:

1. The paralysed leg became shorter than its fellow in 219 patients (97 per cent).

2. The discrepancy in leg length only once exceeded three and a half inches.

3. Both the tibia and the femur were shorter than their fellows in 171 out of 184 studied (93 per cent). In only one patient was the femur alone shortened.

4. Three patterns of progress of shortening are described. No evidence was found that reduction of shortening ever occurs.

5. It is impossible accurately to predict shortening. In general, the more severe the paralysis the greater the shortening, but there are notable exceptions.

6. No relationship could be found between the amount of shortening and the incidence of paralysis of any individual muscle-group.

7. There was no significant difference in leg shortening in adult life between those who had developed the disease in the first two years of life and those who had developed it later.

8. A cold blue limb is not more likely to undergo severe shortening.

9. When the paralysis was confined below the knee the greatest shortening seen was one and three-quarter inches. When muscles both above and below the knee were involved severe paralysis may produce shortening up to three and a half inches.

10. Lengthening of a paralysed leg can occur during the first two years after the onset of the disease, but this is always a temporary phase.

11. The cause of leg shortening is unknown. In only two patients in this series was there evidence of premature epiphysial fusion.
A METHOD OF SPINAL FUSION
Authors: Boucher H. H.
Published: February 2018

1. A relatively simple method of spinal fusion with internal splinting by screw fixation has been described. Complications have been few.

2. Emphasis is placed upon thorough removal of soft tissue, correct placement of screws of good length, the exposure of bleeding bone wherever possible in the fusion area, and the use of well packed cancellous bone.

3. There is enough spongy bone in one posterior superior iliac spine for an ordinary spinal fusion, and, if more is needed, the other is readily available through the same skin incision. Not only is cancellous bone more desirable than a massive cortical graft, but the leg is spared, allowing early walking and freedom from complications in the limb.

4. The lateral articulations are left intact.

5. Screw fixation has eliminated the use of external support except in spondylolisthesis, or when so much bone has been removed during laminectomy that good fixation cannot be obtained.

6. Early, sometimes immediate, relief of symptoms is usual after operation, and early walking with moderate activity is desirable.

7. When the operation was done for degenerative changes with no apparent defect in the laminae there was no radiological evidence of failure of fusion after operations at one level, but two failures were found after attempted fusions at multiple levels.

8. Root irritation from screw contact in two patients was due to faulty technique. A method of screw placement to avoid this complication is described and illustrated by radiographs and photographs of a cadaver specimen.

9. There has been no known instance of an adverse psychological effect from the use of screws. Rather, there has commonly been a lively and healthy interest shown in the factor which has allowed early activity.
PARALYTIC DISLOCATION OF THE HIP
Authors: Somerville E. W.
Published: February 2018

1. Two types of paralytic dislocation of the hips are discussed.

2. The mechanics of dislocation and the methods of reduction are described, with emphasis on the importance of maintaining or increasing stability where possible.
CONGENITAL DISLOCATION OF THE HIP IN IDENTICAL TWINS
Authors: Geiser M. , Buri P.
Published: February 2018

1. Congenital dislocation of the hip in identical twins is reported.

2. The heredity of congenital dislocation of hip is discussed. Studies in twins show that congenital dislocation of hip is probably a hereditary dysplasia of the acetabulum and upper end of the femur, and that external factors play a less important role.
THE ANKLE JOINT IN RELATION TO ARTHRODESIS OF THE FOOT IN POLIOMYELITIS
Authors: Robins Robert H. C.
Published: February 2018

1. Sixty feet operated upon either by triple or pantalar tarsal fusion for instability after poliomyelitis were re-examined ten to twenty-four years later.

2. After triple fusion with preservation of the ankle joint there was a striking absence of late osteoarthritis of the ankle, and only a low incidence of troublesome lateral instability of the ankle. The results were generally good provided the patient had reasonable power of extension of the knee.

3. Triple arthrodesis for completely flail foot in patients without active muscle control of the knee was often disappointing, so far as the limb as a whole was concerned, because of a persistent flexion deformity of the knee which usually necessitated the wearing of an appliance.

4. The results of pantalar arthrodesis for the flail foot were satisfactory. When this operation was performed (with the foot in slight equinus) in patients who lacked active extension of the knee it helped to stabilise the knee in walking by encouraging hyperextension.
CONGENITAL POPLITEAL WEBBING IN SIBLINGS
Authors: Champion Randell , Cregan J. C. F.
Published: February 2018

The early management of bilateral congenital popliteal webbing in a brother and sister is described. There was no familial history of webbing, but the maternal grandfather had a hare-lip. Although the sciatic nerve is so unfavourably placed in the web, correction of the flexion deformity can apparently be carried out safely after plastic repair of the skin by Z-plasty and excision of the fibrous web cord alone, without causing a traction paralysis. These cases appear to be unique in that the patients are siblings of different sex with identical congenital abnormalities of bilateral webbing, cleft palate and fistulae of the mucous membrane of the lower lip.
MULTIPLE OSSIFICATION CENTRES IN THE EPIPHYSES OF THE LONG BONES OF THE HUMAN HAND AND FOOT
Authors: Roche A. F. , Sunderland S.
Published: February 2018

1. The occurrence of multiple centres of ossification in the epiphyses of the long bones of the hand and foot is shown to be frequent, and in the first metatarsal and first proximal phalanx of both hand and foot in both sexes the normal pattern of epiphysial ossification must be regarded as taking place in this way.

2. Multiple centres of ossification are shown to occur simultaneously in several epiphyses of the same hand or foot.

3. There seems to be a relationship between the shape of an epiphysial area and the pattern of ossification occurring within it.

4. Care should be taken to avoid confusing these normal patterns of ossification with radiological appearances caused by pathological changes.
ON THE VISCOSITY AND pH OF SYNOVIAL FLUID AND THE pH OF BLOOD
Authors: Jebens E. Henrietta , Monk-Jones M. Eileen
Published: February 2018

1. The results of viscosity measurements on a number of normal, traumatic and osteoarthritic synovial fluids from human knee joints are described and discussed.

2. A decrease of the viscosity of normal synovial fluid with age has been found.

3. The decrease of the viscosity with age and in the pathological groups is analysed and its relation to the viscous anomaly is considered (Fig. 6).

4. The question whether dilution or depolymerisation is the important factor in decrease of viscosity in these groups, and the value of viscosity measurements as a whole, are discussed.

5. Measurements of pH have been made on the same groups of synovial fluids and on the blood of patients in these groups.

6. The mean values for blood and synovial fluid differ significantly, and the pH of the synovial fluid of adolescents is significantly higher than at other ages.

7. There is no significant difference between the traumatic and osteoarthritic groups, but both are significantly less than the normal.

8. In both fluids the peak frequency in all three groups is the same, that for blood being 7·3 to 7·5 and that for synovial fluid being 7·5 to 7·7 (Fig. 7).
SPINA BIFIDA OCCULTA WITH ENGAGEMENT OF THE FIFTH LUMBAR SPINOUS PROCESS
Authors: de Anquin Carlos E.
Published: February 2018

1. Fifteen patients with spina bifida occulta are described in whom the fifth lumbar spinous process was pressing on the fibrous membrane that closes the spina bifida, or on the bony stumps of the defective lamina.

2. That this is a cause of low back pain, with or without pain referred to the lower limbs, is supported by the findings at operation and the results of treatment.

3. Eleven patients were treated by operation; in each the spinous process of the fifth lumbar vertebra pressed against the spina bifida, either directly or through the vestigial remnant of the first sacral spinous process.

4. In eight cases the fibrous membrane was adherent to the dura mater; in one case the nerve roots were adherent.

5. Excision of the fifth lumbar spinous process and the membrane across the breach of the spina bifida was an effective method of treatment.
HYDATID DISEASE OF THE SPINE
Authors: Murray R. O. , Haddad Fuad
Published: February 2018

1. The radiological features of skeletal hydatid disease are discussed. Osseous lesions occur in about 1 to 2 per cent of cases, bone being involved only after the embryos have passed the filters provided firstly by the liver and secondly by the lungs. At first, ill defined areas of translucency appear which are not diagnostic. In developed lesions, clear-cut destructive areas, with a surrounding sclerotic reaction, become visible. The cysts thin and expand the cortex and tend to spread throughout an affected bone. In advanced stages the cortex is ruptured, and exuberant hydatid cyst growth takes place in the adjacent soft tissue. Around this an ectocyst forms, which may later calcify, indicating death of the parasite. The progress of the disease is very slow.

2. Three cases of affection of the thoracic spine are described, and the differential diagnosis is considered, particularly from plasmacytoma and neurofibroma. Each case presented with cord pressure symptoms. Operative decompression relieved these totally in one case, incompletely in another, and not at all in the third and most advanced case.

3. With rapid and easy travel in the modern world hydatid disease is liable to be seen in areas where it is not endemic.
MYOSITIS OSSIFICANS AS A COMPLICATION OF TETANUS
Authors: Gunn D. R. , Young W. B.
Published: February 2018

1. Myositis ossificans as a complication of tetanus is described.

2. Ossification in mesodermal tissue is briefly discussed.
HIP MECHANICS
Authors: Denham R. A.
Published: February 2018

1. The hip joint usually acts as the fulcrum of a lever system.

2. The centre of gravity of supported parts, which is usually medial to the hip joint, exerts a rotational effect upon the pelvis. If pelvic position is to be maintained this force must be counterbalanced by hip muscles.

3. The force transmitted by the hip joint is the sum of the supported body weight and the tension in the balancing muscles. This force often exceeds the total weight of the body.

4. In some circumstances the loss of one pound of body weight relieves the hip joint of three pounds pressure.

5. A long femoral neck is an advantage to hip function, but in arthroplasty this must not lead to mechanical failure such as breaking or loosening of the prosthesis, or fracture of the bone.

6. Medial displacement of the femoral head upon the pelvis may cause a great decrease in joint pressure, but medial displacement alone of the shaft upon the head and neck does not influence the mechanics of the joint.

7. The position of the centre of gravity of supported parts is easily altered by slight variations in spinal position. Great changes in hip joint pressure are caused by small coronal spinal movements, but the advantage to man of being able to walk with the eyes steady outweighs the mechanical disadvantage to which his hip is subjected.

8. A femoral abduction osteotomy improves the mechanics of a hip joint deformed in adduction.

9. A walking stick or a crutch is most helpful in relieving joint pressure and reducing the work done by hip muscles.
SKELETAL LESIONS PRODUCED BY SEMICARBAZIDE AND EXPERIMENTAL ANALYSIS OF THE ACTION OF LATHYROGENIC COMPOUNDS
Authors: Ramamurti P. , Taylor H. E.
Published: February 2018

1 . Young Wistar rats fed on a diet containing 0·3 per cent semicarbazide hydrochloride developed the characteristic lesions of osteolathyrism. This consisted of kyphoscoliosis, displacement of epiphyses and dislocations of joints. A pathological study of the skeletal lesions showed widening, disorganisation and tears of the epiphysial plate with the zone of maturing cartilage showing the greatest increase in width. The severe kyphoscoliosis was due to a derangement and displacement at and through the epiphysial plates of the twelfth thoracic or first lumbar vertebra.

2. Some of the compounds that are known to produce osteolathyrism in laboratory animals are beta aminopropionitrile, amino acetonitrile, mercaptoethylamine and semicarbazide. The mode of action of the lathyrogenic compounds was analysed in the light of a number of experiments done in this laboratory.

3. lt is possible that they interfere with the metabolism of the epiphysial plate. There appears to be a decreased polymerisation of the ground substance of the epiphysial cartilage, but the exact metabolic reaction involved is not known. Other chemicals of similar structure, with the same reactive groups, did not show lathyrogenic properties. It is concluded that it is not a particular chemical structure, configuration or specific reactive group that is responsible for the production of osteolathyrism. The chemistry of the lesions still remains to be solved.
CORROSION OF ORTHOPAEDIC IMPLANTS
Authors: Scales John T. , Winter G. D. , Shirley H. T.
Published: February 2018

1. A total of 564 metal components from 109 patients have been examined.

2. Corrosion was detected on 228 components.

3. Most implants were removed for reasons other than corrosion.

4. In at least twelve cases corrosion was the reason for removal of the implant.

5. No corrosion of cobalt-chromium-molybdenum implants has been detected by the methods described in this paper.

6. Corrosion of ferrous alloy implants occurs in the human body.

7. The most common site for corrosion is the junction between components of implants.

8. The most corrosion-resistant type of ferrous alloy for implant uses is 18/8/Mo steel, which falls within specification En58.J of the British Standards Institute, and specification 316/317 of the American Iron and Steel Institute.

9. About 13 per cent of components removed (and by no means only when something was amiss) showed "face" corrosion when all the components of the implant were made of 18/8/Mo steel.

10. Four per cent of 18/8/Mo components of implants showed corrosion at sites other than the interface between components.

11. On the basis of corrosion resistance it is preferable to use cobalt-chromium-molybdenum alloys for implants that are to be left in the body for an indefinite period.

12. The corrosion resistance of the high alloy steels examined (18/8, 18/8/Ti, 18/8/Mo) does not appear to be related to hardness.

13. The marking of components, either by punching or by electrolytic methods, has not predisposed to corrosion.

14. All hollow 18/8/Mo implants should have a clean and metallurgically satisfactory internal surface.

15. The figures in this report do not permit a full statistical survey of corrosion in surgical implants because it has not been possible to examine a satisfactorily random sample. Many patients cannot be followed up and others die with the implant still in the body.
SEPTIC ARTHRITIS OF THE HIP AND OSTEOMYELITIS OF THE UPPER END OF THE FEMUR IN INFANTS
Authors: Eyre-Brook Arthur L.
Published: February 2018

A series of ten infants is reported, seven of whom showed evidence of osteomyelitis of the upper end of the femur; the remaining three did not, but presented with an acute subluxation of the hip in a febrile illness. Four sequelae among the seven more severe cases were: 1) destruction of the capital epiphysis with dislocation at the hip; 2) destruction of the capital epiphysis, the femoral neck remaining in the acetabulum; 3) destruction of the epiphysial plate with the femoral head, remaining in the acetabulum, connected to the femoral neck by a fibrous union; 4) recovery with coxa magna but no other deformity.

The streptococcus plays a greater part in this osteomyelitis of infancy than in osteomyelitis of older children, but various other organisms were identified. The organism should be sought by blood culture as well as from the local lesion.

Aspiration of the hip, treatment of the hip in abduction and the use of the appropriate antibiotic are recommended. If there is marked swelling and induration, freer release of the pus is strongly advised.

Controlled abduction osteotomy plays a useful part in stabilising the femoral neck in the acetabulum or in stabilising the femoral neck beneath the capital epiphysis, but may usefully be preceded by an arthrograph because late ossification of a detached head sometimes occurs.
CHONDROMALACIA OF THE PATELLA
Authors: Wiles Philip , Andrews P. S. , Bremner R. A.
Published: February 2018

Removal of a small, moderate or major part of the articular cartilage of the patella for chondromalacia has been successful in twenty-two knees out of twenty-eight. These knees are functionally at least as good as after a successful patellectomy, and their appearance is better.

Only one knee that was initially improved by operation deteriorated during a follow-up period of five to seven years.

Of the six unsuccessful results, four were in patients whose symptoms began during adolescence. Excision of articular cartilage therefore seems to be contra-indicated during adolescence and when there is reason to believe that the chondromalacia will be rapidly progressive.

Failure of excision of articular cartilage to relieve the symptoms within a few months is an indication for patellectomy.
CONGENITAL DISLOCATION OF THE HIP
Authors: Esteve Rafael
Published: February 2018

1. The "frame" or traction method of reduction of congenital dislocation of the hip is, from the evidence collected in this hospital, both more effective and safer than the manipulative method of reduction. The traction method caused less frequent and less severe lesions of the femoral head than the manipulative method.

2. In cases in which closed reduction failed, open reduction was attempted; the quality of the results depended mainly on the time of operation, the best being in patients operated upon a few weeks after the initiation of the frame treatment.

3. Even with its improved results, still about 40 per cent of cases treated by the frame method showed insufficient reduction or structural changes of the femoral head.

4. Arthrography may help in indicating those cases in which open reduction is desirable.
ANATOMY OF THE CALCANEAL TENDON OF THE RABBIT
Authors: Nisbet N. W.
Published: February 2018

1. Certain macroscopical and microscopical features of the tendo calcaneus of the rabbit are described and illustrated, and the vascularisation as revealed by Spalteholz clearing is presented.

2. The vessels of the epitenon are chiefly derived from proximal and distal sources.

3. The vessels of the paratenon are derived from the main arteries of the leg.

4. The two vascular systems are largely independent of each other except along one edge of the tendon by way of a mesotenon.

5. The paratenon, epitenon and mesotenon and the related vessels are comparable to those found in tendons with synovial sheaths. By inference and from evidence obtained by dissection on the living human subject it is suggested that the arrangements are similar in the human tendo calcaneus.

6. Considerable friction develops on movement between the surfaces of the paratenon and epitenon. This might be significant in pathological states of the human tendon.
SOME PROBLEMS IN THE DIAGNOSIS AND TREATMENT OF ACUTE OSTEOMYELITIS
Authors: Harris Nigel H.
Published: February 2018

1. Forty-five cases of acute osteomyelitis have been reviewed with the object of determining the causes of relapse. The importance of an early diagnosis and prompt treatment is stressed, and the question of when to stop antibiotic drugs is discussed.

2. The provisional diagnosis was anterior poliomyelitis in seventeen out of forty-five patients; acute osteomyelitis was diagnosed in twelve only. The criteria for making an early diagnosis are discussed, including the value and limitation of blood culture.

3. The place of operation is discussed and certain conclusions are set out.
CHORDOMA OF THE THORACIC SPINE
Authors: Husain F.
Published: February 2018

1. A case of chordoma of the thoracic spine is described.

2. Certain features of this case–notably the absence of vertebral destruction–are contrasted with those of cases previously described.
THE NATURAL HISTORY OF HALLUX VALGUS IN ADOLESCENCE AND EARLY ADULT LIFE
Authors: Piggott Harry
Published: February 2018

1. Pathological hallux valgus may be differentiated from an increase in the normal valgus alignment of the great toe by the relationship to each other of the articular surfaces of the first metatarso-phalangeal joint; these are congruous in the normal joint, but displaced on each other in the pathological.

2. The earliest change is lateral deviation of the proximal phalanx on the metatarsal head, which may progress rapidly to subluxation.

3. Subluxation is an early change in a high proportion of cases, and is frequently present when the patient is first seen in adolescence.

4. Once subluxation has occurred progression of the deformity is likely.

5. Metatarsus primus varus and hallux valgus increase pari passu. There is not enough evidence to be certain which of these is the primary change, but such as there is suggests that lateral deviation of the great toe occurs first, and increase in the intermetatarsal angle is secondary to this.

6. It is suggested that hallux valgus should be regarded primarily and fundamentally as a subluxation, or tendency to subluxation, of the first metatarso-phalangeal joint.
THE TREATMENT OF FRACTURES OF THE MEDIAL EPICONDYLE OF THE HUMERUS
Authors: Wilson J. N.
Published: February 2018

1. Fifty-nine patients with fractures of the medial epicondyle of the humerus have been reviewed, of whom more than one-third also had a dislocation of the elbow.

2. The final disability has been shown to be very slight. Non-union occurs very often with conservative treatment, but gives no disability. Union can be obtained by fixation with a Pidcock pin.

3. Operative treatment is advised only when the fragment is included in the joint. It is suggested that the best position of the elbow in patients treated conservatively is about 60 degrees below the right angle.
TENNIS ELBOW
Authors: Garden R. S.
Published: February 2018

1. Tennis elbow is largely an affliction of middle age, and it is believed that degenerative changes in the orbicular ligament may underlie its pathology.

2. It has been shown that most patients may be relieved by either extra-articular or intra-articular injection of hydrocortisone, and operative intervention is required only in a minority of cases.

3. Contraction of the extensor carpi radialis brevis is considered to be the principal pain-producing factor, and Z-lengthening of the tendon of this muscle has been found to relieve the symptoms when conservative measures have failed.

4. The late results in fifty patients have shown that this operation causes diminution neither of the power of wrist dorsiflexion nor in the efficiency of the grip. The operation may therefore be undertaken with every prospect of relieving the discomfort of tennis elbow without inviting alternative disability.
GIRAFFE-NECKED WOMEN
Authors: Roaf Robert
Published: February 2018

Radiographic examination of a giraffe-necked woman shows that there is no true elongation of the cervical spine. The apparent lengthening of the neck is due to incorporation of part of the thoracic spine and thorax in the neck.
CROSS-SPECIES GRAFTS OF DEPROTEINISED BONE
Authors: Hancox N. M. , Owen R. , Singleton A.
Published: February 2018

1. Cancellous bone cubes from calf and man were deproteinised with hydrogen peroxide and with ethylenediamine.

2. Long bones were removed aseptically from sheep, stored in the bone bank and used for cancellous homografts.

3. Holes were drilled in the upper part of the tibia or ulna or in the lower part of the femur of sheep. Some were left empty; others were filled with plugs of the deproteinised heterogenous bone, with autografts, or with homografts.

4. Histological appearances were studied after seventeen and thirty-six days.

5. At seventeen days repair was more advanced in the plugged holes; the biological result was better with the ethylenediamine-treated than with the peroxide-treated material. After thirty-six days repair was at an advanced stage. As much new bone had been deposited on the trabeculae of the deproteinised heterografts as on those of the homografts.

6. There was no evidence of metaplastic bone formation; new bone seemed to form from endosteal osteoblasts.

7. Certain clinical implications are briefly discussed.
FRACTURE OF THE NECK OF FEMUR IN CHILDHOOD
Authors: McDougall A.
Published: February 2018

1. Fracture of the neck of the femur in childhood and its complications are discussed.

2. The high incidence of these complications is not generally appreciated–in this series of twenty-four patients only eight achieved normal hip joints.

3. The complications are due to the arrangement of the blood supply to the head and neck. Avascular necrosis is unavoidable in a high proportion, and is not directly related to any particular method of treatment.

4. Extreme care and gentleness in handling the injured limb will help to reduce the incidence of deformities; internal fixation is not suitable for the very young as it may predispose to necrosis or may damage the epiphysis. In older children it can be used with care.

5. Where growth is still taking place in the limb the retention of the angle between neck and shaft is most important, as this will prevent coxa vara and progressive shortening with the consequent unsightly Trendelenburg limp.
PREVENTION OF THROMBO-EMBOLIC COMPLICATIONS IN ORTHOPAEDIC AND ACCIDENT SURGERY
Authors: Tubiana R. , Duparc J.
Published: February 2018

1. The gravity of thrombo-embolic complications in orthopaedic and accident surgery has stimulated us, since 1951, to devise a means of prevention which comprises: a) the use of anticoagulants, the mode of administration of which has been determined by an experience of over 5,000 cases; and b) a method of selecting those patients most threatened by thromboembolism.

2. Although there could be no absolute guarantee of protection, these measures offered a considerable reduction in the risk of thrombotic complications.
OSTEOGENIC SARCOMA
Authors: Price C. H. G.
Published: February 2018

1. The relationship between histological grading and survival has been studied in a consecutive series of eighty-eight patients with osteogenic sarcomata. The grading has been based entirely upon the mitotic activity of these tumours.

2. There is a positive correlation ("r"=+0·59) between the two variates mitotic ratio and survival in months.

3. The frequency distributions of the mitotic ratios and survivals are similar and, from the observed range, mean and mode of mitotic ratios a more precise definition is proposed for the terms "low," "medium" and "high" malignancy.

4. Comment is made on those patients (20 per cent) in whom actual survival was very different from that expected on the basis of histological grading.

5. The five-year survival rates were: Grade I–67 per cent, Grade II–15 per cent, Grade III–nil, all–17 per cent. For the whole series the average survival period from the time of the presenting symptom was thirty-six months.

6. The five-year survival rate for forty-five tumours of the femur was 20 per cent; no further analysis by sites is attempted.