bluuebunny/crossref_metadata_2025 huggingface dataset:
THE CYSTS OF OSTEOARTHRITIS OF THE HIP
Authors: Rhaney K. , Lamb D. W.
Published: February 2018

1. An attempt has been made to correlate the radiographic appearances and the morbid anatomy of the cystic changes that occur in the head of the femur in advanced osteoarthritis.

2. The suggestion is made that these lesions are foci of traumatic bone necrosis. Repair may be complicated by the subsequent entrance of synovial fluid through defects in the surface.
THE SIGNIFICANCE OF METALLIC TRANSFER IN ORTHOPAEDIC SURGERY
Authors: Bowden F. P. , Williamson J. B. P. , Laing P. G.
Published: February 2018

1. Experiments using radio-isotope techniques show that whenever an orthopaedic appliance is inserted into the body tiny fragments of the instruments used to handle it become detached and welded on to the surface of the buried metal.

2. There is evidence that these particles of non-passive tool-metal may cause a small but continuing dissolution of the stainless metal to which they are attached, and that this dissolution, although too small to be detected as visible corrosion, may produce an adverse tissue reaction.

3. In samples of human tissue taken from sites adjacent to buried metal the greatest level of tissue reaction and the highest concentration of iron were found near those parts of the appliances that had been handled with the tools and received the greatest amount of transferred metal.

4. Spectroscopic analyses of similar samples confirmed that the concentration of metal in the tissues surrounding a buried appliance correlates closely with the distribution on its surface of transferred tool metal. Particularly high concentrations of chromium, nickel, and cobalt were found near regions where the transfer had been heavy. The dissolution was not limited to the non-passive foreign metal; the stainless appliance was also dissolved in those regions.

5. The influence of the manner of handling the tools on the amount and distribution of transfer has been studied, and suggestions are made whereby the transfer might be reduced.
HEREDITARY FORMS OF RICKETS AND OSTEOMALACIA
Authors: Dent C. E. , Harris H.
Published: February 2018

1. We have described here various forms of rickets and osteomalacia that we have studied ourselves and have come to recognise as comprising definite syndromes. We have included only diseases in which hereditary factors have been proved or might be suspected to play a part.

2. There are more of these syndromes than previously defined.

3. All these hereditary diseases can be treated, usually very satisfactorily, using the same general principles and with only very few simple medicines such as vitamin D and sodium bicarbonate. Careful control and long follow-up, however, may be required to achieve best results and to avoid accidents.

4. A study of the genetics of the diseases is a help in diagnosis and treatment. Broadly speaking the group of diseases which mimic vitamin D deficiency more or less closely tend to be inherited in dominant fashion. The groups with more severe degree of renal-tubule abnormality are inherited as recessives.

5. When more than one member of a family is affected it has been found that in each family each syndrome runs true to type.
ANEURYSMAL BONE CYST
Authors: Barnes Roland
Published: February 2018

1. The clinical, radiographic and pathological features of aneurysmal bone cyst are described and illustrated by case reports.

2. Reasons are given for accepting the lesion as a clinical and pathological entity.

3. The cyst has a tendency to spontaneous regression and healing may occur after partial excision.
CHONDROMALACIA OF THE PATELLA
Authors: Wiles Philip , Andrews P. S. , Devas M. B.
Published: February 2018

1. Chondromalacia, sometimes a precursor of osteoarthritis, is present in the articular cartilage of the patella of most people by the age of thirty; it causes symptoms in only a few, and it gives rise to osteoarthritis in fewer still. It may progress slowly or quickly but there is no clinical method of assessing the prognosis at an early stage.

2. The earliest change is swelling of the cartilage associated with a decrease in the chondroitin sulphuric acid content of the matrix. Later the cartilage fissures and flakes off to expose the bone, and there are reactive changes in the cartilage, bone and synovial membrane. The process is described and the etiology discussed.

3. The symptoms, signs and treatment are discussed. Operation, which has been performed only when there are disabling symptoms, may consist in removing part or the whole of the articular cartilage, or in excision of the patella. The results in forty-six knees are given.
THE VALUE OF RIGID FIXATION IN THE TREATMENT OF FRACTURES OF THE ADULT TIBIAL SHAFT
Authors: Blockey N. J.
Published: February 2018

1. The thesis is advanced that in the treatment of fractures of the adult tibia rigid fixation is desirable.

2. The mechanical factors are discussed and a technique is described which provides a high degree of fixation without exposing more than one surface of the bone.

3. The process of healing of such fractures is described and the results in thirty-three unselected patients are given.
PARALYTIC SCOLIOSIS
Authors: Roaf Robert
Published: February 2018

The etiological factors concerned in paralytic scoliosis are complex. Four main types of paralytic scoliosis can be recognised.

1. The general C-curve due to the body's anatomical attempt to shift its centre of gravity towards the weaker side. Vertebral rotation is not usually marked. This type usually occurs when patients with relatively slight paralysis have been allowed up too early ; it does not usually progress to severe deformity but may occasionally do so, gradually changing into Type 2. This type usually responds well to a period of rest and muscle redevelopment in recumbency. It also responds favourably to correction and fusion because correction is easy and there is little tendency to deterioration. Many of the "successes" of correction and fusion are in this classâalmost equal success would often have been gained without "correction." The spine is slightly, but not very, unstable and a relatively localised fusion will give the little extra support that is needed.

2. The "general collapse" type of curve due to extensive spinal weakness. This is the type in which simple head suspension produces marked correction. Rotation is moderate. Provided the patient's general condition is satisfactory extensive spinal fusion is usually the best treatment and produces gratifying improvement.

3. The primary lumbar curve due to a combination of pelvic obliquity, extraspinal imbalance and imbalance of the deep rotator muscles. Rotation is usually marked. Treatment must include the correction of all these factors. In mild cases correction of the pelvic obliquity is enough, but in marked cases the spine must also be corrected. The disability from a lumbar paralytic scoliosis is much greater than that from a lumbar idiopathic scoliosis of the same degree; so correction is necessary in this type. Correction in a Risser-type jacket is often inadequate and recourse to operative correction is usually required.

4. The primary thoracic curveâoften associated with weakness of the scapular muscles. The indications for and methods of treatment are practically the same as in primary idiopathic thoracic curves. These curves tend to be progressive and uncompensated. Although the most popular treatment is correction and fusion, wedge osteotomy of the spine gives better correction in intractable cases.

The main need is for further investigation into the etiology of paralytic scoliosis so that adequate preventive measures may be undertaken at an early stage. It is essential that every child who contracts poliomyelitis should have his back muscles examined before he gets up. If there is any suggestion of scoliosis further investigations including radiography and electromyography are essential.
LOAD DISTRIBUTION IN A MODEL OF A HIP JOINT
Authors: Fessler H.
Published: February 2018

Photoelastic techniques were used to study the stresses in models which represented the central frontal plane of a normal hip joint. The pelvis and the femur were inclined and the direction of the resultant thrust on the joint was estimated. Inward tilting of the pelvis causes a force which tends to push the head of the femur out of joint.

The load distribution on the joint is not significantly changed if the line of action of the load is moved relative to the joint. The directions of the lines of principal stress in both bones are shown.
THE TREATMENT OF DISPLACED FRACTURES OF THE NECK OF THE FEMUR BY COMPRESSION
Authors: Charnley J. , Blockey N. J. , Purser D. W.
Published: February 2018

We adduce the following conclusions from our experience of using this spring-loaded compression screw on completely displaced medial fractures of the femoral neck:

1. That this method probably eliminates non-union when the head is fully viable.

2. That primary "first-intention" osseous union occurs in approximately 33Â·3 per cent of cases.

3. That a vascular complication, of varying severity, undetectable by orthodox radiological tests, is revealed by extrusion of the screw in 66Â·6 per cent of cases.

4. That these observations disprove the idea that the main obstacle to revascularisation of an ischaemic head is the existence of forces so inclined to the axis of the femoral neck as to cause "shear."

5. That, compared with the Smith-Petersen nail used for completely displaced fractures, continuous spring compression can materially reduce the incidence of utter mechanical failure within the first year after operation. This is the result of "mushroom" impaction which itself can resist shearing strain and so can permit function as a fibrous union.

6. That early and rapid extrusion is a sensitive indication of a vascular complication in the head. Forewarned by this, activity can be restricted, or possibly other measures adopted, to anticipate or permanently postpone serious trouble.
PARTIAL SYNOVECTOMY AND CURETTAGE IN THE TREATMENT OF TUBERCULOSIS OF THE HIP
Authors: Wilkinson M. C.
Published: February 2018

The records of these patients show that restitution of joint function is quite possible even after severe disease. These results have been obtained by a combination of three methods, constitutional, antibiotic and operative. The duration of treatment averaged ten months and the patients were discharged to full activities in a short time without splints. There was one immediate failure in a child who received full, early and adequate treatment. There were two late relapses in patients treated early in the series whose operation was inadequate. The results were more variable in adults. If it is conceded that the triple treatment is valuable for patients with bone necrosis or severe synovial disease with pus in the joint, eight patients in this series remain who might have got better without operation. Two of these had had a synovial biopsy before admission. Whether the remaining six would have done as well without operation is a matter for speculation. It is difficult to assess the condition inside the joint solely by radiographic examination. Cauchoix (1955) allows me to say that, at the Institut Calot, Berck Plage, he has used similar methods to those reported in this paper, and that he endorses my belief that good results can be obtained by them. He does not, however, open the joint when operating upon an iliac focus, and for patients with purely synovial disease he prefers repeated intra-articular injections of streptomycin to operation. For my part, I consider that a simple arthrotomy at the beginning of treatment is less disturbing, and that, even if it is only done for diagnosis, it may be of therapeutic benefit. To me it seems unjustifiable to delay intra-articular operation for a patient whose hip disease is not manifestly resolving: operation is especially indicated for patients who have necrotic bone lesions.
POSTERIOR DISLOCATION OF THE SHOULDER
Authors: Scougall Stuart
Published: February 2018

1. At an operation for recurrent posterior dislocation of the shoulder observations were made on the mechanism, head defect, method of reduction, and the position of greatest stability.

2. Experimentally, avulsion of the glenoid labrum in a monkey was shown to be capable of sound repair without operation.

3. In the treatment of primary posterior dislocation it is suggested that the position of abduction, lateral rotation and extension is favourable for the approximation of the stripped labrum and capsule to the glenoid rim, and for an effective buttress after cicatrisation.

4. If the risk of recurrence is to be reduced to a minimum the shoulder should be retained in the position of greatest stability for at least four weeks, to allow firm union of the avulsed soft tissues.

5. This position for an optimum buttress would also apply after surgical repair for recurrent posterior dislocation.
THE EFFECT OF INTERMITTENT CORTISONE ADMINISTRATION IN THE RABBIT
Authors: Storey Elsdon
Published: February 2018

The intermittent administration of cortisone in both the young and the mature rabbit is associated with appositional bone growth on the periosteal surfaces of the cranium, premaxilla and middle of the shaft of the femur; each new layer of bone is separated from the next by a darkly haematoxylin-staining "reversal" line. The internal architecture of the bone also changes in consequence of the repeated waves of resorption and deposition of bone round vascular spaces.

Cartilaginous growth at the epiphysis in the young rabbit is also affected. The long columns of metaphysial cartilage are replaced by a layer of new bone which partly seals the epiphysial cartilage from the marrow spaces.
PROGNOSIS OF EPIPHYSIAL SEPARATION
Authors: Dale G. G. , Harris W. Robert
Published: February 2018

1. The methods by which epiphyses receive their blood supply was studied by means of India ink injections in monkeys. Two types were identified depending upon whether the epiphysis was entirely or partly covered by articular cartilage. In the former, nutrient vessels enter the epiphysis by traversing the perichondrium at the periphery of the plate. In the latter they enter the epiphysis by penetrating the cortex at the side of the epiphysis at a point remote from the epiphysial plate.

2. The histological changes after separation of the second type of epiphysis were also studied. After temporary interference with endochondral ossification marked by increased thickness of the epiphysial plate, healing occurred so rapidly that within three weeks it was difficult to determine that the epiphysis had been separated at all.

3. It is concluded that when nutrient vessels enter an epiphysis at a point remote from the epiphysial plate, that epiphysis can be separated without serious disturbance to its blood supply and accordingly without interference with its capacity for growth. As it has been established that an epiphysis which is entirely covered by articular cartilage cannot be separated without destruction of its blood supply and subsequent avascular necrosis (Harris and Hobson 1956), it is concluded that the prognosis of an epiphysial separation is dependent upon the degree of damage to its blood supply rather than the mechanical disturbance of the epiphysial plate.
CONGENITAL VERTICAL TALUS
Authors: Lloyd-Roberts G. C. , Spence A. J.
Published: February 2018

1. The clinical and radiological features of thirty-two feet with congenital vertical talus are described and subdivided into groups determined by the presence or absence of associated abnormalities.

2. The differential diagnosis of congenital vertical talus from flat foot, talipes calcaneus and uncorrected club foot is discussed.

3. No benefit came from either non-operative treatment or tenotomy of the tibialis anterior.
HYPERKALAEMIA IN TRAUMATIC RENAL FAILURE
Authors: Morton Kenneth S. , Patterson Frank P.
Published: February 2018

1. Two cases are reported in which hyperkalaemia was a prominent feature in acute renal failure and in which obvious sources of excess potassium were apparent.

2. The literature pertaining to potassium in acute renal failure is briefly reviewed.

3. A return to the surgical elimination of large and expendable tissue sources of potassium in the management of acute renal failure with hyperkalaemia is suggested.
LEGG-CALVEÌ-PERTHES' DISEASE
Authors: Evans David L.
Published: February 2018

1. Fifty-two patients with Perthes' disease (affecting both hips in six instances) have been reviewed ten or more years after the beginning of treatment.

2. Judged radiographically, approximately one-third developed good, one-third fair and one-third poor femoral heads.

3. The clinical results paralleled the radiographic. Except with the worst shaped heads, function was excellent.

4. Certain constant early and late radiographic features are recorded.

5. Of the factors influencing prognosis, the age at onset of the disease and the sex of the patient appear to be important.
TREATMENT IN LEGG-CALVEÌ-PERTHES' DISEASE
Authors: Evans David L. , Lloyd-Roberts G. C.
Published: February 2018

I. There is no significant difference in the final radiographic appearance of the femoral head between patients treated in hospital or as out-patients.

2. In view of this, from both a social and economic standpoint, out-patient treatment appears to be the method of choice.
INTERTROCHANTERIC OSTEOTOMY FOR OSTEOARTHRITIS OF THE HIP
Authors: Adam A. , Spence A. J.
Published: February 2018

1 . Intertrochanteric osteotomy is valuable in the treatment of patients with osteoarthritis of the hip, giving a high percentage of satisfactory results. It often relieves the pain immediately, is long-lasting in its effects, and may even increase the range of movement.

2. There is no evidence from our figures that the extent of medial displacement of the lower fragment influences the result as judged from relief of pain, performance, and the patient's assessment. Movement, however, is less improved if displacement exceeds half the diameter of the divided bone.

3. Our observations did not support the view that improvement is caused by a changed relationship between the upper fragment and the acetabulum. When measurements were possible the position of the upper fragment usually remained virtually unaltered.

4. Our figures confirm that in most patients relief of pain is immediate; that is to say, the patient is aware on regaining consciousness that his pain has gone, even though he formerly had pain at rest. Whatever may be the mechanism that relieves the pain, it acts immediately.
STRESS FRACTURES OF THE TIBIA IN ATHLETES OR "SHIN SORENESS"
Authors: Devas M. B.
Published: February 2018

1. A type of stress fracture of the tibia in runners is described.

2. This type of fracture, associated with "shin soreness," has not been recognised before.

3. The signs, symptoms and radiological appearances are discussed, and treatment is outlined.
FUNNEL CHEST
Authors: Sutherland Ian D.
Published: February 2018

1 . Funnel chest deformity is a common cause of progressive postural defects in children.

2. The underlying pathology of the funnel chest is a congenital deficiency of the muscle fibres of the anterior part of the diaphragm which allows the stronger posterior element to pull backwards the xiphoid and sternum. The postural changes are secondary to the chest deformity.

3. Operative correction of the chest deformity is described.

4. Post-operative physiotherapy is essential to correct the postural deformities. Patients must remain under orthopaedic supervision to maintain the correction obtained.

5. A series of twelve children treated by operation is reported, with excellent results in all.
DISAPPEARING BONES
Authors: Milner S. M. , Baker S. L.
Published: February 2018

A case is reported of a woman in whom the bones of one upper limb have been progressively disappearing during at least eleven years. Investigations have thrown no light on etiology or treatment.
THE FLEXOR-EXTENSOR TRANSPLANT OPERATION FOR CLAW TOES
Authors: Pyper J. B.
Published: February 2018

1. Patients subjected to the flexor-extensor transplant have been reviewed. The results in forty feet were assessed by direct questioning and examination, and the results of a further five operations were assessed from the records.

2. Worthwhile improvement was gained in a little over half the cases. The chances of success are greatest when the symptoms are mildest.

3. The operation appears to be inadequate in certain respects and it seems doubtful whether it has any advantage over the multiple arthrodesis (Lambrinudi) operation.
FURTHER OBSERVATIONS ON THE ELASTIC MECHANISM OF THE INTERVERTEBRAL DISC
Authors: Horton W. G.
Published: February 2018

By polarising microscope and x-ray crystallographic techniques the annulus fibrosus has been shown to consist of regularly oriented sheets of collagen fibres. These results have been interpreted in terms of an elastic mechanism whereby thrust from the nucleus causes increased girth in the annulus. It is suggested that this is accomplished by a change in the angle between the axis of the fibres in adjacent uniaxial layers of the annulus. Furthermore, the loss of elasticity of the intervertebral disc associated with age would seem to be mainly due to changes occurring in the nucleus pulposus.
THE VALUE OF INTRA-ARTICULAR INJECTIONS IN OSTEOARTHRITIS OF THE KNEE
Authors: Miller James H. , White John , Norton Thomas H.
Published: February 2018

1 . Criticisms are expressed of previous reports on the use of intra-articular injections in the treatment of osteoarthritis of the knee.

2. A series of 181 patients with primary osteoarthritis of the knee treated by certain intra-articular injections is reported. Three solutions in common use were studied; normal saline and mock injections served as controls.

3. Irrespective of the injection used, including the controls, no significant difference in the effects was demonstrated in the results.

4. The place of intra-articular injection therapy in osteoarthritis is discussed. Attention is drawn to the psychological implications.
TROCHANTERIC FRACTURES OF THE FEMUR TREATED BY THE VITALLIUM McLAUGHLIN NAIL AND PLATE
Authors: Foster J. C.
Published: February 2018

1. A series of 142 fractures of the trochanteric region treated by fixation with Vitallium nail-plates of the original McLaughlin pattern is described. The hospital mortality was 9 per cent. Disruption of the nail-plate junction occurred in 8 per cent of cases. This confirms McLaughlin and Garcia's (1955) view that this pattern of nail-plate should no longer be used.

2. Despite this, satisfactory functional results were achieved in 78 per cent of the survivors.

3. The new Model V McLaughlin nail-plate is described, and the stresses in nail-plates are considered. On theoretical grounds and laboratory tests the weakness at the nail-plate junction has been eliminated in the new model, and the strength of the appliance as a whole compares favourably with other types of nail-plate. Full clinical trial is therefore justified, and seventy-one patients have so far been operated on, with satisfactory early results.

4. Marked stiffness of the hip joint greatly increases angulatory and rotational stresses on the nail-plate, and a high incidence of disruption is to be expected in these cases.
RESOLVING SCOLIOSIS
Authors: Scott J. C.
Published: February 2018

Four cases are reported in which infantile idiopathic structural scoliosis gradually decreased during the period of active growth.
A FOLLOW-UP STUDY OF ILIOPSOAS TRANSFER FOR HIP INSTABILITY
Authors: Mustard W. T.
Published: February 2018

Fifty cases of iliopsoas transfer have been reviewed. The indications for operation, operative technique and post-operative care have been described. It seems that the iliopsoas muscle transferred laterally through the ilium acts as a better hip stabiliser than it does in its original position. The operation should not be undertaken by a casual operator and should be performed first in the post-mortem room.
THE TREATMENT OF UNREDUCED CONGENITAL DISLOCATION OF THE HIP IN ADULTS
Authors: Ring P. A.
Published: February 2018

1. The results of fifty-three operations in forty adults with a persistent congenital dislocation of the hip have been reviewed.

2. Arthrodesis as a primary operation was successful in five of six patients, giving a pain-free hip and good function. After an arthroplasty or an osteotomy that had failed to relieve symptoms it was successful in only one patient.

3. Cup arthroplasty on one hip relieved pain in five of nine patients, giving an increase in functional activity, although the range of hip movement was often disappointing. Bilateral cup arthroplasty, performed in four patients, gave partial relief in three, but did not permit an increase in activity.

4. High osteotomy of the femur was undertaken in eleven patients with a unilateral dislocation; pain was rarely relieved, and a stiff hip resulted in seven.

5. Low osteotomy in nine patients gave some relief from pain with a good range of hip movement.

6. In unilateral dislocation arthrodesis appeared to be the operation of choice, although cup arthroplasty was capable of giving a good functional result.

7. In bilateral dislocation, when only one hip was painful, the results of both these operations were on the whole good. When both hips were painful the operations that had been performed seldom gave clinical improvement.

8. High osteotomy of the femur appeared to have little place in the treatment of the painful dislocated hip. Low osteotomy, either of the Schanz or Batchelor type, appeared to be of value mainly as a salvage procedure when other measures had failed to give relief.
MECHANISM OF DERANGEMENTS OF THE MEDIAL SEMILUNAR CARTILAGE AND THEIR MANAGEMENT
Authors: Helfet Arthur J.
Published: February 2018

1. The semilunar cartilages are part of the rotator mechanism of the knee joint.

2. Movement of the weight-bearing knee comprises synchronous lateral rotation of the tibia with extension and medial rotation of the tibia with flexion.

3. When this synchrony is disturbed, injuries to the semilunar cartilages result.

4. Damage to the anterior two-thirds of the medial cartilage blocks lateral rotation of the tibia, with consequent physical signs that are pathognomonic of the retracted and the bowstring cartilage, which are the most common types of injury.

5. Each type of cartilage injury produces its own pattern of erosion of articular cartilage and its own sequence of symptoms as so-called arthritis develops.

6. The sequence of symptoms may be halted and often reversed by removal of the torn cartilage. Operation is warranted in most cases however long the history and whatever the age of the patient.

7. The development of medial retropatellar arthritis is explained. The symptoms are often relieved by removal of the medial semilunar cartilage and adequate post-operative rehabilitation.
PRIMARY INTERNAL FIXATION IN OPEN FRACTURES OF THE TIBIAL SHAFT
Authors: Veliskakis Konstantin P.
Published: February 2018

1. Eighty consecutive open fractures of the tibial shaft were treated by primary internal fixation and wound closure. Wound healing was complicated by deep infection in eight patients (10 per cent) and by skin loss of varying degree in ten (l2·5 per cent).

2. Careful selection of patients on the basis of associated soft-tissue injuries is urged. A simple method of grading open fractures by the appearance of the wound and adjacent skin and the effectiveness of wound closure is suggested. If internal fixation is indicated on mechanical grounds, the nature of the soft-tissue injury should be the deciding factor in the choice of the method of treatment. In the less severe (Grade 1) fractures internal fixation and wound closure may be safely employed. In the severe (Grade 3) injuries, primary wound closure with or without internal fixation should be avoided. Moderately severe (Grade 2) fractures should be carefully assessed and treated by internal fixation and wound closure only if primary wound healing is confidently expected.

3. Wound healing by first intention requires, in addition to adequate debridement of the deep layers of the wound, careful approximation of healthy wound edges without excessive tension. An adequate knowledge of skin-plastic procedures is essential to achieve this.

4. A combination of systemic penicillin and streptomycin in adequate doses is a safe and effective prophylactic antibiotic for use in the treatment of open fractures.
A CASE OF CONGENITAL ARTERIOVENOUS ANEURYSM INVOLVING THE FEMUR
Authors: Howard R. C.
Published: February 2018

1. A case of congenital arteriovenous aneurysm involving the left femur, with dangerous cystic changes in the shaft of the bone, is described.

2. After ligation of the anastomosing fistulae the radiological appearance of the femur became normal.
THE RESULTS OF TREATMENT OF MALLET FINGER
Authors: Robb W. A. T.
Published: February 2018

1. The method of treatment of a mallet finger deformity by immobilisation in a plaster in the position of hyperextension of the distal interphalangeal joint and flexion of the proximal interphalangeal joint is, on the whole, unsatisfactory because the splint is difficult to apply, it may need to be changed frequently, and it is sometimes complicated by pressure sores.

2. In many cases the deformity is still present after six weeks of adequate immobilisation, but gradual improvement from the contraction of fibrous tissue occurs for up to six months.

Therefore an assessment of the results of any method of treatment should be made only after an interval of at least six months.

3. The subjective end results at the end of six months are satisfactory whether or not there has been efficient immobilisation in hyperextension. Few patients have any disability and only rarely is this sufficient to cause interference with normal activities. A high proportion of patients show slight persistent deformity and limitation of movement, and this is seemingly uninfluenced appreciably by the type or duration of treatment.

4. The only treatment necessary for most cases of mallet finger is the application of elastic adhesive strapping or a straight spatula splint in order to relieve the initial discomfort from the injury.
THE BONE CHANGES IN SICKLE CELL ANAEMIA AND ITS GENETIC VARIANTS
Authors: Golding J. S. R. , MacIver J. E. , Went L. N.
Published: February 2018

1. The bone changes are described in fifty-one cases of sickle cell anaemia. nineteen cases of sickle cell haemoglobin C disease and two cases of sickle cell thalassaemia.

2. Avascular necrosis of the head of the femur has been found in all three types of sickle cell disease. These responded to treatment.

3. The changes found in six cases of Perthes' disease in the negro are compared with the changes in avascular necrosis of the head of the femur in sickle cell disease.

4. Hyperplastic bone changes are seen only in true sickle cell anaemia and not in the variants.

5. Secondary osteomyelitis appears to be fairly common in sickle cell anaemia. Organisms of the salmonella group have often been found in these cases.
TRIPHALANGEAL THUMB IN A BANTU FAMILY
Authors: Abramowitz I.
Published: February 2018

1 . Three cases of triphalangeal thumb are described in three generations of a Bantu family. In the youngest member both thumbs were affected; in his mother and grandfather only one thumb was abnormal.

2. The literature is reviewed and the etiology of the anomaly is discussed.

3. Attention is drawn to the hereditary tendency of this condition.
THE VASCULAR REACTION OF TUBULAR BONE TO ISCHAEMIA IN PERIPHERAL OCCLUSIVE VASCULAR DISEASE
Authors: Brookes M.
Published: February 2018

1. Twenty-five lower limbs, amputated above the knee for senile atherosclerosis with peripheral gangrene, have been investigated radiologically and histologically to determine the vascular patterns in ischaemic bone with particular reference to the tibia. These have been contrasted with the patterns found in non-atherosclerotic tubular bone.

2. The principal changes are the development of a diffuse vascularisation of compact and spongy bone; a widening of Haversian spaces which come to contain a variable number of sinusoidal blood vessels; and an increasing periosteal participation in cortical nutrition which is related to the severity and chronicity of the ischaemic process.

3. Views on the normal blood supply of long bones are discussed, and evidence is presented for regarding this as discrete and end-arterial in nature; in particular it is suggested that the normal cortex has a wholly medullary, centrifugal, arterial supply.
AMPUTATION OF ALL TOES
Authors: Flint Michael , Sweetnam Rodney
Published: February 2018

1. The indications for amputation of all the toes for severe toe deformity in rheumatoid arthritis, hallux valgus and pes cavus are discussed.

2. The results of forty-seven amputations in twenty-eight patients are analysed: 93 per cent were found to be very satisfied with the operation.

3. The technique of the operation and the subsequent management are described. The importance of retaining full-length shoes fitted with metatarsal insoles and toe blocks to preserve a good gait and balance is emphasised.
ALBERS-SCHÖNBERG'S DISEASE
Authors: Montgomery R. D. , Standard K. L.
Published: February 2018

1. A type of bony sclerosis is described, occurring in nine members of a Jamaican family and resembling the more benign form of Albers-Schönberg's disease. The parents were consanguineous. Three of the patients developed facial palsy at the same age, and one had bilateral optic atrophy and proptosis.

2. Although radiological changes occurred of all grades of severity, certain features often described in this condition were lacking. In one child the onset of radiological changes was observed at the age of eleven years.

3. Serum studies showed increased alkaline phosphatase activity.

4. These features are discussed in the light of present-day knowledge and theory of the pathology of Albers-Schönberg's disease.
DYSCHONDROPLASIA
Authors: Murray A. M. , Cruickshank Bruce
Published: February 2018

1. A patient with Ollier's disease, who has been observed for fifty-four years, is described.

2. Repeated operations have been performed and the radiological appearances have been interpreted on several occasions as sarcomatous, but no evidence of malignant change has occurred.
ANATOMICAL VARIATIONS AFFECTING THE SURGERY OF DE QUERVAIN'S DISEASE
Authors: Giles K. W.
Published: February 2018

Attention has been drawn to the variations found in the anatomy of the tendons of the abductor pollicis longus and extensor pollicis brevis muscles as they lie in the first extensor compartment of the wrist. Such variations involve reduplication of the abductor pollicis longus tendon and more rarely the extensor pollicis brevis tendon. An accessory tendon may occasionally lie in a separate osseo-fibrous canal. It is not unusual to find the abductor pollicis longus and extensor pollicis brevis tendons lying in separate compartments, because an accessory fibrous septum is subdividing the first extensor compartment into two parts. Furthermore, the extensor pollicis brevis tendon may also lie in its own separate fibrous canal in the depths and the more distal part of this common compartment.

Such variation could lead to two possible misinterpretations during the course of surgical decompression for de Quervain's disease and these misinterpretations could reasonably be linked with the failure rate for this particular operation.

1. The finding of the abductor pollicis longus and its accessory tendon in a single compartment (12 per cent of wrists in the series) after a limited surgical incision could be mistaken for the abductor pollicis longus and extensor pollicis brevis tendons. Such a mistake would lead to failure to decompress the extensor pollicis brevis.

2. A failure to identify the deeper-lying separate canal for the extensor pollicis brevis in the distal part of the compartment would again be responsible for failure to decompress the extensor pollicis brevis (14 per cent of wrists in this series).
THE VASCULAR CONTRIBUTION TO OSTEOGENESIS
Authors: Trueta J. , Little K.
Published: February 2018

Throughout this work data have been gathered favouring the concept that the metaphysial vascular arrangement is primarily related to the process of enchondral ossification, and has very limited, if any, responsibility for the nourishment of the growth cartilage.

The present evidence favours the suggestion that when the chondrocytes of the column have become too far separated from their source of nourishment (the epiphysial vessels) they and their surrounding matrix suffer changes which prepare them for the process of calcification. At least calcium and phosphate ions will be required for this to take place. The proximity of the vessel and also the fact that it is not isolated by a membrane at its very end suggests a profuse interchange of fluids with the surrounding area.
EXCISION OF THE TRAPEZIUM IN OSTEOARTHRITIS OF THE FIRST CARPO-METACARPAL JOINT
Authors: Murley A. H. G.
Published: February 2018

1. The results of excision of the trapezium for degenerative changes in the first carpometacarpal joint are given.

2. The grip is usually permanently reduced by an appreciable amount, but functional power is improved by the absence of pain.

3. The patients most commonly affected, middle-aged women, usually derive appreciable benefit.

4. Recovery after operation often takes several months.

5. Interference with the radial nerve should be preventable by modification of the incision.
UPPER LUMBAR CHORDOMA
Authors: McCormack M. P.
Published: February 2018

A case of chordoma affecting the first lumbar vertebra is reported, with comments on its situation, diagnosis and treatment.
THE RADIOGRAPHIC DENSITY OF AVASCULAR BONE
Authors: Bobechko W. P. , Harris W. Robert
Published: February 2018

1. Experimental avascular necrosis of the femoral head was produced in rabbits and the histological and radiographic changes were compared.

2. Avascular bone which was not re-ossified or altered in any way showed no change in density to x-rays.

3. Areas of avascular bone which were being repaired by the formation of appositional new bone showed an absolute increase in density in the radiographs. This is apparently due to simple increase in bulk of bone to be penetrated by the x-ray beam. On this basis, increasing density in radiographs of bone suspected of being dead is a sign of increasing re-ossification rather than of increasing necrosis.

4. Re-ossification of dead bone occurred rapidly in the absence of simultaneous resorption of necrotic trabeculae. It is thus suggested that the term "creeping substitution" is misleading and does not reflect accurately the histological findings, at least as they occur in rabbits.
FLEXION CONTRACTURES OF THE KNEE
Authors: Somerville E. W.
Published: February 2018

1. The nature of flexion contractures of the knee joint is discussed.

2. It is suggested that division of the anterior cruciate ligament will help in the correction of the deformity when conservative methods have failed.

3. The results of the treatment of twelve such knees are mentioned and illustrative cases are described.

4. It must be emphasised that this method of treatment should be undertaken only when conservative methods have failed.
THE INFLUENCE OF THE NERVOUS SYSTEM UPON THE GROWTH OF BONES
Authors: Ring P. A.
Published: February 2018

1. An experimental study of the effects of nerve and muscle lesions upon the growth of bone has been made. In each case animals were subjected to unilateral lesions in the hind limb, the other limb serving as a control. The growth of the tibia was measured by calculating the difference between the length of the bone on a radiograph at the beginning of the experiment and the length of the dried bone after necropsy. The weights of the dried bones were compared.

2. In the young rabbit simple exposure of the common peroneal nerve, or division of the sural nerve, produced no change in the growth rate of the tibia. Division of both peroneal nerves, producing paralysis of the muscles below the knee, led to lengthening of the affected tibia, and this lengthening persisted until maturity several months later. A similar lengthening was seen after division of the tendons around the ankle. In spite of this lengthening the tibia on the side of the operation was almost always lighter than its fellow.

3. In the puppy division of the anterior nerve roots supplying the hind limb produced a significant lengthening of the tibia of the affected limb three months after operation. No significant changes in limb length occurred after lumbar sympathectomy in the puppy.

4. The significance of these experimental nerve lesions has been considered together with recent observations upon the growth of bone in the presence of lower motor neurone lesions in the child. From this analysis it is suggested that the initial effect of paralysis is to produce lengthening of the affected bone. This lengthening is probably due to the hyperaemia of disuse. In the presence of persistent paralysis the growth of the limb is ultimately depressed. This depression is rarely seen in the experimental animal because the growing period is relatively short. The possible causes of this secondary depression of bone growth have been considered.
TRAUMATIC DISLOCATION OF THE HIP IN CHILDREN
Authors: Glass Alan , Powell H. D. W.
Published: February 2018

1. A collected series of forty-seven traumatic dislocations of the hip in children is reported and reviewed in detail.

2. All were simple hip dislocations, and no child was included in whom there was any other injury to the affected joint.

3. All were posterior dislocations.

4. No anatomical predisposition was observed.

5. Significant complications occurred in fourteen children: avascular necrosis of the head of the femur in four, degenerative joint changes in three, premature epiphysial fusion in one and overgrowth of the femoral head in six. Study of the children with these complications revealed no common cause except the dislocation itself.

6. The injury responsible was often trivial.

7. The results suggest that it is harmless to bear weight four weeks after reduction.
RADIOTHERAPY FOR OSTEOGENIC SARCOMA
Authors: Tudway Robert C.
Published: February 2018

1. Nine patients treated for osteogenic sarcoma by elective radical irradiation are reviewed. Five of the nine patients have survived for from three to fourteen years, but one patient has metastases.

2. These results are compared with those from primary amputation.

3. The importance of histological grading in prognosis is emphasised.

4. It is concluded that radical irradiation should be considered in place of primary amputation for osteogenic sarcoma in the upper limb.
PROGRESSIVE FIBROSIS OF THE VASTUS INTERMEDIUS MUSCLE IN CHILDREN
Authors: Hnêvkovský O.
Published: February 2018

1. Twelve children are described in whom gradual limitation of knee flexion developed, without previous injury or inflammation.

2. Clinical and histological investigation showed progressive fibrous degeneration of the vastus intermedius and rectus femoris.

3. As the patella showed signs of retarded development a particular form of myodysplasia, probably congenital, may be supposed.

4. Conservative treatment always failed to stop the progress of this disease.

5. Surgical treatment (Bennett's method or an elongation of the ligamental apparatus of the intermedius muscle) was carried out in ten cases and gave good permanent results. Flexion remained possible only to the extent obtained at operation; rehabilitation gave no further improvement.

6. In the opinion of the author, these cases occur more often than is generally believed, but they are recorded under a different diagnosis and consequently are not submitted to rational treatment.
THE ASSESSMENT OF HAND FUNCTION AFTER PERIPHERAL NERVE INJURIES
Authors: Bowden Ruth E. M. , Napier J. R.
Published: February 2018

1 . Power and precision grip (Napier 1956) were tested in 154 patients with nerve injuries.

2. The results are described, illustrated and discussed and it is suggested that these tests provide a simple, repeatable and objective method of assessing prehensile function of the hand as a whole.
INNOMINATE OSTEOTOMY IN THE TREATMENT OF CONGENITAL DISLOCATION AND SUBLUXATION OF THE HIP
Authors: Salter Robert B.
Published: February 2018

1. The problem of instability of reduction in congenital dislocation and congenital subluxation of the hip has been studied and it has been concluded that the basic cause of this instability is the abnormal direction in which the entire acetabulum faces.

2. An operation, innominate osteotomy, has been designed to correct the abnormal direction of the entire acetabulum in children over the age of eighteen months. The principle of innominate osteotomy is redirection of the acetabulum so that the reduced dislocation or subluxation, which previously was stable only in a position of abduction and flexion, is rendered stable in the functional position of weight bearing.

3. The operative technique, and the pre-operative and post-operative management are described.

4. The indications for innominate osteotomy are outlined and the advantages of the operation are enumerated.

5. The early results of innominate osteotomy are very encouraging.
SUBCORTICAL ILIAC BONE GRAFTS IN FRACTURE OF THE TIBIA
Authors: Forbes D. B.
Published: February 2018

The use of a subcortical graft of autogenous iliac bone in patients with delayed union or non-union of fractured tibiae is described together with the results in twenty-nine patients. This procedure when performed early even in the presence of mild sepsis makes it possible to shorten the time of healing without any undue risk.
BONE GROWTH IN DIAPHYSIAL ACLASIS
Authors: Solomon L.
Published: February 2018

1. The widespread deformities commonly associated with diaphysial aclasis have been studied in seventy-six patients. Apart from the adaptations of growth due to pressure by neighbouring exostoses, all the deformities of the tubular bones can be explained in terms of the same underlying factor–diminished length of the bones affected by the disease.

2. When the condition first manifests itself the future pattern of bone growth is completely unpredictable except in so far as it is known that the more actively growing ends of the long bones are the more severely affected in each case. It has also been shown in this series that, in general, the bones with the smallest cross-sectional area at the epiphysial plates (such as the ulna and the fibula) are the most severely shortened of all.

3. The cause of this disturbance of growth is still unknown, but there is an undoubted relationship between the presence of exostoses or thickening of the metaphysial region and shortening of the bone involved.

4. The phenomena of migrating exostoses and disappearing exostoses are also described and are shown to be examples of the normal process of bone modelling applied in special circumstances.

5. Although the importance of the cartilage-capped exostoses is not underestimated, it is hoped that this study will stimulate further work on what is probably the basic defect in this disease–namely, the disturbance of bone growth.
LONG SURVIVAL IN SOLITARY PLASMOCYTOMA OF BONE
Authors: Wright C. J. E.
Published: February 2018

1. A case of solitary plasmocytoma of bone with survival for twenty-two years after amputation is described.

2. Recent follow-up of a previous tumour reported from this department by Stewart and Taylor in 1932 has shown survival for thirty-five years after amputation.

3. These two instances of long survival, together with three culled from the literature, substantiate the hitherto doubted concept of a true solitary plasmocytoma of bone.
INTRANEURAL GANGLION OF THE LATERAL POPLITEAL NERVE
Authors: Parkes Athol
Published: February 2018

1. Eight cases of intraneural ganglion of the lateral popliteal nerve seen at operation within a period of six years are described.

2. In seven of these a pedicle was found arising from the superior tibio-fibular joint–it was probably present in the remaining case.

3. The essential step at operation is to find and extirpate the pedicle.

4. The implications of these findings are discussed.