bluuebunny/crossref_metadata_2025 huggingface dataset:
OSTEOPOROSIS OF UNKNOWN CAUSE IN YOUNGER PEOPLE
Authors: Jackson W. P. U.
Published: February 2018

1. The syndrome of osteoporosis is reviewed and its various causes are mentioned. Osteoporosis in youngish patients without any demonstrable cause is referred to as "idiopathic." The scant literature on this condition is reviewed. Its clinical, radiological, biochemical and histological features are considered.

2. A series of thirty-eight cases is analysed, and illustrative case histories are described. The peculiarities of the disease as it is seen in women are discussed, particularly the relationship to pregnancy and lactation, which appear to act as precipitating factors, rather than being primarily causative.

3. The differential diagnosis is discussed. Osteogenesis imperfecta may not always be easy to distinguish; since it is really a "congenital osteoporosis" this is hardly surprising.

4. The following possible etiological factors are propounded (apart from pregnancy): nutritional, occupational, lack of sex hormone, liver dysfunction, loss of protein, diabetes, premature ageing, hypophosphatasia, "alarm reaction," and inheritance. None of them can be incriminated except in the odd case. The relationship between osteoporosis and idiopathic hypercalcuria is mentioned. The only conclusion regarding etiology is that some people are simply more prone to bone loss than are others, and in these a variety of accentuating factors may render the disorder clinically apparent.

5. The treatment of the condition is unsatisfactory, although occasionally a positive calcium balance may be obtained with sex hormones or intravenous infusion of plasma albumin or whole plasma. The general tendency seems to be towards clinical improvement (biologically "stabilisation" rather than improvement), but some patients become permanently crippled.
HALLUX RIGIDUS IN THE ADOLESCENT
Authors: Kessel Lipmann , Bonney George
Published: February 2018

1. The etiology of hallux rigidus has been studied by an examination of ten adolescent and four adult patients.

2. Although osteochondritis dissecans of the metatarsal head has been seen in two cases, our evidence generally suggests that metatarsus primus elevatus is the important etiological factor in established hallux rigidus.

3. The common factor for the production of symptoms is the limitation of dorsiflexion of the first metatarso-phalangeal joint, just as the key to treatment is the existence of a good range of plantar-flexion of the joint.

4. The technique and results of the operation of phalangeal extension osteotomy for hallux rigidus are given.
LAMBRINUDI'S ARTHRODESIS
Authors: MacKenzie I. G.
Published: February 2018

One hundred cases of Lambrinudi's arthrodesis are reviewed. The shortest follow-up was one year. and the longest twenty-seven years. Thirty-seven per cent were successful. Nineteen per cent were failures; many of these were associated with faulty technique, and one method of operation which gives good results is described.

Success is likely if there is a balance of power between the dorsiflexors and plantarflexors of the ankle, especially if there is some fixed equinus before operation.

Success is less likely when the operation is done for a flail foot. In such circumstances arthrodesis of the ankle may have to be considered subsequently for instability of the lateral ligament, recurrence of dropfoot, or arthritis which may develop in the more active patients.

Age in itself is no bar to success, but pseudarthrosis is more likely to occur in patients over the age of twenty.
A FURTHER REVIEW OF THE RESULTS OF OPERATIONS ON THE HIP JOINT
Authors: Shepherd Margaret M.
Published: February 2018

General remarks–Comparison of the two reviews shows that patients with good results return more readily for a review than those with poor results. In middle-aged patients with some disability for walking an attendance of 80 per cent at least is necessary in order to obtain a representative follow-up five to ten years after operation.

An outstanding feature of all the operations reviewed is the degree of lasting relief of pain. It is rare to find that a patient with severe hip pain before operation has pain of the same severity after any of these operations at least up to ten years afterwards, and probably for much longer. Generally speaking, although in advancing years stiffness of the hip is undoubtedly a handicap, it is preferable to instability, particularly if this is progressive. A patient can adapt himself to and accept a disability that is permanent and unaltering, but instability increasing in later years can be distressing mentally and incapacitating physically.

Cup arthroplasty–There is an element of unpredictability in the results, especially the late results, of cup arthroplasty. Movement decreases and there is a tendency for pain and instability to increase after four or five years. There is little to indicate which case will be successful although the results vary according to the condition for which operation is performed. The operation gives good results, on the whole, for osteoarthritis, particularly when the operation is done on one hip only. Stability is much more important when both hips are involved, and, unless this is good in at least one hip, the results of bilateral operations are poor. "Excellent" results are not obtained in rheumatoid arthritis but few results are "poor." Operations for congenital dislocation of the hip give the most disappointing results. In operations for ankylosing spondylitis there is a high incidence of stiffening of the hip, but many patients are greatly improved in comparison to their state before operation.

Displacement osteotomy–The hazard in displacement osteotomy is ankylosis, particularly when internal fixation is not used. Relief of pain and stability are well maintained. The results in general, and for pain in particular, are less good when internal fixation is used. Adduction of the upper fragment of the femur appears to be of value in the production of a good result. In the series examined it was less often achieved when internal fixation was the method of immobilisation. The best results were obtained in cases of congenital dislocation of the hip and there were few "poor" results in cases of congenital subluxation.

Excision of the head and neck of the femur and Batchelor's operation–Rehabilitation may take a long time, but the late results are more predictable than in the other operations reviewed. A "fair" result is more likely than an "excellent" one, but late "poor" results are few. Relief of pain is better after excision of the head and neck than after any other operation reviewed.
CONGENITAL DISLOCATION OF THE HIP
Authors: MacKenzie I. G. , Seddon H. J. , Trevor D.
Published: February 2018

1. The results of treatment of 134 patients with congenital dislocation of 167 hips are reviewed.

2. Late diagnosis is still a major problem.

3. Subluxations rarely give rise to poor results, but in dislocations first treated over the age of five years there is a one-in-three risk of failure.

4. Manipulative reduction is successful less often than reduction on a frame and carries a higher risk of avascular necrosis.

5. Closed reduction on a frame was satisfactory in 58 per cent of patients under the age of three years, and can succeed up to the age of five.

6. Open reduction was required in 20 per cent of cases under the age of three, and can be used successfully up to the age of six.

7. Seven anatomical barriers to closed reduction have been recognised and two or more are commonly found in one hip when open reduction is performed.

8. The acetabular roof may fail to develop after reduction, especially if this is delayed. A C.E. angle of under 20 degrees does not necessarily forebode this, unless measured on an arthrograph. Sclerosis of a sloping acetabular roof is an indication for operation. Acetabuloplasty is the proper operation for a sloping acetabulum and can be done successfully up to the age of twelve. Over this age, a shelf operation should be performed; this is appropriate also in younger patients in whom the curvature of the acetabulum is normal but does not extend far enough laterally. These operations were required in 38 per cent of hips treated in patients under the age of three, and in 64 per cent over this age. There is a one-in-three risk of avascular necrosis when acetabular reconstruction is done in patients under three.

9. Anteversion, if excessive, should be corrected by subtrochanteric osteotomy, and any valgus of the femoral neck should be corrected simultaneously.

10. Unilateral dislocations in patients over the age of six are best treated by Colonna's operation. In our few bilateral cases over this age our results have been disappointing.

11. Avascular necrosis is less common but more serious when it occurs over the age of three. Manipulative reduction and the use of frog-leg plasters are two avoidable factors which appear to increase its incidence. The more serious degrees are accompanied by stiffness of the hip, and when this sign is present weight bearing should be avoided.

12. Prolonged, though rarely permanent, limitation of movement occurs in some 10 per cent of cases. In a few, operative correction was required.
RHEUMATOID CYSTS OF THE CALF AND THEIR RELATION TO BAKER'S CYSTS OF THE KNEE
Authors: Maudsley Roy H. , Arden George P.
Published: February 2018

1. Three cases are described of a calf swelling occurring in rheumatoid arthritis.

2. This condition has been described by Baker, though many of his patients had tuberculous infection of the knee.

3. The diagnosis may present difficulty because of the distance of the swelling from its origin in the knee joint.

4. Excision of the cyst is advised when it causes pain, but recurrence is likely if disease of the joint remains active.
THE HEREDITARY FACTOR IN OSTEOCHONDRITIS DISSECANS
Authors: Stougaard J.
Published: February 2018

Nine cases of osteochondritis dissecans of the elbow and knee in three generations of the same family are described. There was clear evidence of a dominant inherited factor.
PRIMARY OSTEOSARCOMA OF THE PATELLA
Authors: Goodwin Martin A.
Published: February 2018

1. A case of primary osteosarcoma of the patella is reported.

2. A brief review of the literature has been made.

3. In the author's opinion only nine genuine cases have been reported, including the present case.
DISLOCATION OF THE PERONEAL TENDONS WITH MARGINAL FRACFURE OF THE LATERAL MALLEOLUS
Authors: Murr Sepp
Published: February 2018

1. Three patients are described in whom forward dislocation of the peroneal tendons was associated with a chip fracture of the lateral malleolus and forward dislocation of the tendons through the fracture.

2. This injury differs from the more usual simple anterior dislocation of the peroneal tendons in which rupture of the superior peroneal retinaculum allows the dislocation to occur.

3. A simple operation is described which succeeded in holding reduced the dislocated tendons by suturing the fractured small chip of bone back to the lateral malleolus.
A RADIOLOGICAL APPROACH TO THE SUBTALAR JOINT
Authors: Isherwood Ian
Published: February 2018

The subtalar joint is not easy to visualise by standard radiographic methods. Several projections are described including medial and lateral oblique axial views to demonstrate the three compartments of the joint. It is suggested that when visualisation of the subtalar joint is required these views should be routine.

Various conditions affecting the subtalar joint and their demonstration by these oblique axial views are discussed.
A PROLONGED FOLLOW-UP OF PERONEAL SPASTIC FLAT FOOT
Authors: Braddock G. T. F.
Published: February 2018

1. The radiographic appearances are no guide to prognosis or treatment of peroneal spastic flat foot.

2. Only 10 per cent of peroneal spastic flat feet are likely to cause severe persistent disability.

3. Severe symptomatic tarsal arthritis is exceptional in this condition.
STUDIES ON BONE MATRIX IN NORMAL AND OSTEOPOROTIC BONE
Authors: Little K. , Kelly M. , Courts A.
Published: February 2018

1. The appearance of decalcified bone matrix in the electron microscope is described.

2. In the matrix two types of collagen fibril have been distinguished. Differences observed are in solubility, x-ray diffraction pattern and appearance. In infant bone the form which appears as fine fibrils predominates. In adult bone the form which appears as tubular fibrils of larger diameter predominates.

3. In bones from elderly subjects the chemical reaction employed to convert collagen into eucollagen sometimes hydrolyses fatty acid esters, and lines due to the free fatty acid are found on the x-ray diffraction patterns of the insoluble residue after citrate extraction.

4. In ancient bones and fossils the stable tubular form of collagen survives, but not the fine fibrils.

5. When decalcified, the matrix in osteoporotic bones loses its architecture and fibrillar form. Under conditions in which only a small fraction is dissolved from normal bone most of the collagen in osteoporotic bone disperses in citric acid. The insoluble residue then gives a modified x-ray diffraction pattern.

6. Evidence has been produced to suggest that the immediate cause of many forms of osteoporosis is some local factor affecting the osteocytes, rather than a general chemical effect.
CONGENITAL HYPOPLASIA OF THE CARPAL SCAPHOID BONE
Authors: Davison E. P.
Published: February 2018

Thirteen patients with congenital hypoplasia of the carpal scaphoid and associated abnormalities have been described and the significance of the condition discussed.
THE HEALING MECHANISM IN ARTIFICIALLY CREATED CIRCUMSCRIBED DEFECTS IN THE FEMORA OF ALBINO RATS
Authors: Melcher A. H. , Irving J. T.
Published: February 2018

1. An experimental study of the healing mechanism in circumscribed defects in femora of albino rats of the Wistar strain is described.

2. Only the outer one-fifth of the defect is repaired by subperiosteal bony callus, the rest of the defect being repaired by endosteal callus.

3. Subperiosteal callus does not bridge the defect until endosteal callus is developed fully.

4. As peripheral callus matures the greater part of the endosteal callus is resorbed, with the exception of trabeculae attached to the margin of the defect.

5. The resorbed area in the medullary part of the defect is gradually obliterated by deposition of inner circumferential lamellae.

6. There appear to be differences between the mechanism responsible for repair of fractures of a long bone and that which heals circumscribed bone defects.
PRIME FACTORS IN THE ETIOLOGY OF CONGENITAL DISLOCATION OF THE HIP
Authors: Wilkinson John A.
Published: February 2018

1. Breech malposition and hormonal joint laxity produce atraumatic posterior dislocations in the hip joints of young rabbits.

2. Experimental studies were shown to cause the development of a limbus and other softtissue changes similar to those found in human congenital dislocations.

3. The development of femoral retroversion and anteversion in the presence of joint laxity is described.

4. The co-existence of breech malposition and hormonal joint laxity in utero, and their importance as prime factors in the etiology of congenital dislocation of the hip, are discussed.
GROWTH AND STRUCTURE OF BONE DISTAL TO AN ARTERIOVENOUS FISTULA: QUANTITATIVE ANALYSIS OF TETRACYCLINE-INDUCED TRANSVERSE GROWTH PATTERNS
Authors: Vanderhoeft Patrick J. , Kelly Patrick J. , Janes Joseph M. , Peterson Lowell F. A.
Published: February 2018

Puppies in the second half of their growing period have been observed for one and a half to four and a half months after creation of a superficial femoral arteriovenous fistula on the right side. From measurements of the whole bone and from microradiographic and tetracycline-fluorophore studies of the diaphysial bone, it is believed that the following statistically significant phenomena may be attributed to the influence of the arteriovenous fistula.

1. All bones distal to the fistula are influenced in their growth. The tibia and metatarsals become heavier and larger, but retain normal shape. Although stimulation of longitudinal growth is small, it is significant for the tibiae and nearly significant for the femora in these short-term experiments.

2. The histological structure of the bones remains normal but quantitative changes are induced. The compact bone is more porous because of an increased number of osteones. Haversian turnover itself is affected in that the individual formation time of osteones tends to become longer, especially in the metatarsals.

3. Periosteal new bone formation is immediately stimulated, producing a flare of new bone. This accounts for the increase in diaphysial weight in the tibia but not in the metatarsals, where the same effect results from decreased resorption of old bone.

4. Endosteal new bone formation is depressed, especially in the metatarsals, resulting in an enlarged medullary cavity.
PREMATURE EPIPHYSIAL FUSION AFTER INJURY OF THE CAPITULUM
Authors: Wadsworth Thomas G.
Published: February 2018

Premature epiphysial fusion is a common complication of injury of the capitulum in childhood and sometimes results in valgus deformity. Premature fusion can either follow the normal pattern of fusion, perhaps being accelerated on the capitular side, or it can be confined to the capitulum and metaphysis. An optimistic prognosis with regard to valgus deformity and the possible onset of ulnar neuritis cannot be made in view of this complication, even in the undisplaced or perfectly reduced and immobilised cases.
FURTHER STUDIES ON THE ETIOLOGY OF CHONDROMALACIA PATELLAE
Authors: Outerbridge R. E.
Published: February 2018

1 . Current theories of the etiology of chondromalacia patellae do not explain satisfactorily either its great frequency or its common site of origin on the medial patellar facet.

2. The etiology can be more logically explained by the presence of a ridge on the upper anterior border of the cartilage of the medial femoral condyle, in most knees. This ridge, consisting of cartilage, or cartilage and bone, varies considerably in height and, in normal knee joint movement, causes considerable friction on the medial patellar facet.

3. The degenerative changes were found to be greater in the presence of the larger ridges, and–because of longer wear and tear–in the older patients.

4. This study indicates that chondromalacia was more severe in women than in men, and in patients overweight. Although the activity of the individual and the power of the quadriceps mechanism must play an extremely important part in this condition, it was not possible to assess this.

5. Two factors previously considered to be important in the etiology of this condition, namely, the length of the patellar tendon and Wiberg's Type III patellar shape, have not been confirmed in this study.

6. Resulting from the present investigation certain precautions are suggested in rehabilitation after operations on the knee, and a surgical method for discouraging the progress of this common, and sometimes disabling, condition has been devised.
THE MENISCO-FEMORAL LIGAMENTS OF THE HUMAN KNEE
Authors: Heller Leon , Langman Jan
Published: February 2018

1. The menisco-femoral ligaments, extending from the posterior horn of the lateral meniscus to the lateral aspect of the medial femoral condyle, were found in ninety-nine (71 per cent) of the 140 knees examined. Fifty per cent of the ligaments were identified as the anterior menisco-femoral ligament while the remaining 50 per cent were of the posterior type.

2. During flexion of the knee with the foot fixed the menisco-femoral ligaments pull the posterior horn medially and slightly anteriorly, increasing the congruity between the meniscotibial socket and the lateral femoral condyle.

3. During lateral rotation of the femur with the knee flexed the menisco-femoral ligament pulls the posterior horn medially and slightly anteriorly, in this way increasing the risk of the posterior horn being crushed by the lateral femoral condyle. It is suggested that this is prevented by the contraction of the tibio-meniscal portion of the popliteus muscle which pulls the posterior horn of the lateral meniscus posteriorly.

4. When removing the lateral meniscus it may be advisable to make another incision in order to free the posterior horn from its attachment to the popliteus muscle and then to cut the menisco-femoral ligaments under direct vision.
CONGENITAL FIBROSIS OF THE VASTUS INTERMEDIUS MUSCLE
Authors: Karlen A.
Published: February 2018

1. The cases of six Chinese children affected by so-called congenital fibrosis of the vastus intermedius muscle are described. The reasons for the choice of name are discussed.

2. Reasons for early operation are put forward: in young children simple division of the tendon of the vastus intermedius is adequate.

3. With increasing age severe changes in all the joint tissues occur, notably in the articular cartilage of the patella. These changes are likely to vitiate the result after operation.

4. The importance of getting as much flexion as possible in children of Asiatic race is stressed.
TIBIALIS SPASTIC VARUS FOOT WITH TARSAL COALITION
Authors: Simmons Edward H.
Published: February 2018

1. Tarsal coalition often presents with the clinical picture of a peroneal spastic flat foot, but may present with a painful varus foot and spasm of the tibial muscles.

2. Three cases of tibialis spastic varus foot are described with a calcaneo-navicular bar as the associated anomaly.

3. Complete excision of the bar with interposition of the origin of the extensor digitorum brevis muscle appears to be a satisfactory method of treatment when carried out at a sufficiently early age.
COMPARATIVE RADIOLOGICAL STUDY OF THE SPINES OF A PRIMITIVE POPULATION WITH NORTH AMERICANS AND NORTHERN EUROPEANS
Authors: Fahrni W. Harry , Trueman Gordon E.
Published: February 2018

1. On the basis of radiographic studies the incidence of degenerative change in the intervertebral disc in primitive squatting populations is considerably less than that found in civilised peoples.

2. The suggestion is made that lordosis is implicated in the pathogenesis of degeneration, but further studies are required.
RIGID VALGUS FOOT FROM FIBROUS CONTRACTURE OF THE PERONEI
Authors: Harrold A. J.
Published: February 2018

1. A child with a rigid valgus foot caused by fibrous contracture of the peronei muscles is described.

2. The probable cause of the contracture is discussed.
THE ETIOLOGY OF FEMORAL EPIPHYSIAL SLIPPING
Authors: Alexander Colin
Published: February 2018

1. The hypothesis is advanced that the fundamental lesion of epiphysiolysis is a slow posterior growth migration of the head on the neck.

2. It is suggested that this is unrelated to the erect posture or to any abnormality of the growth cartilage.

3. Sitting stresses are measured and are postulated as the likely cause of the growth deviation.

4. The result of the deviation is an increase in the shear stress component; in the erect posture clinical epiphysiolysis is regarded as a simple fracture occurring in a proportion of deviated cases when the increased shear component exceeds the critical level appropriate to the individual.

5. It is suggested that this hypothesis explains the age and sex incidence, the left predominance, the reduced epiphysial angle found on the uninvolved hip and the clinical and radiological evolution of the disorder.
RECURRENT DISLOCATION OF THE ELBOW
Authors: Osborne Geoffrey , Cotterill Paul
Published: February 2018

1. Recurrent dislocation of the elbow is caused primarily by collateral ligament laxity with secondary damage to the capitulum and head of radius.

2. The pathological changes resemble those of recurrent dislocation of the shoulder.

3. Subluxation or instability of the radial head is often associated with capsular ossification and deserves wider recognition because it may be confused with osteochondritis dissecans.

4. A simple method of soft-tissue repair has successfully prevented redislocation of eight elbows.
TREATMENT OF CONGENITAL DISLOCATION OR SUBLUXATION OF THE HIP IN CHILDREN OVER THE AGE OF THREE YEARS
Authors: Eyre-Brook A. L.
Published: February 2018

1. A small personal consecutive series of children with congenital dislocation or subluxation of the hip who came for treatment at the age of over three years has been reviewed. The children have been kept under review up to the age of ten years or more.

2. A number of late results are illustrated. They lead to the conclusion that open operation is indicated in all these cases and that acetabuloplasty will effectively provide stability in most, particularly when combined with osteotomy of the femur with adduction angulation and lateral rotation.

3. It is still too early to assess the value of pelvic osteotomy of the Salter (1961) or Chiari (1955) type.

4. Capsular arthroplasty appears from Trevor's (1960) considerable experience to have a valuable place in patients over six years old.
BONE FORMATION IN PAGET'S DISEASE
Authors: Lee W. R.
Published: February 2018

1 . Normal and diseased bone was obtained by biopsy from five patients suffering from Paget's disease. The tissue was studied by histology, microradiography and quantitative fluorescence microscopy using tetracycline markers. Study of the morphological changes showed that two of the biopsies could be regarded as normal, while one was osteoporotic; two biopsy specimens were in the porotic phase of Paget's disease and the remaining five were in the sclerotic phase.

2. The tetracycline markers were used to measure the linear rate at which bone was deposited on individual surfaces (appositional growth rate) in µ per day and the percentage volume of new bone added to the total volume of bone per day (bone formation rate). The values obtained for appositional growth rate in all the biopsies were of the order of 1 µ per day, but slightly higher values were obtained in the diseased tissue of each individual. The bone formation rate in normal bone from the proximal femur was about 0·04 per cent per day, about 0·13 per cent per day in the porotic phase, and about 0·4 per cent per day in the sclerotic phase of Paget's disease.

3. Although these values must be accepted with some reservation, there seems to be no doubt that there is an upper limit of about 1 µ per day to the rate of deposition of bone on an individual bone surface; this suggests that in Paget's disease the osteoblast behaves as a normal cell.
THE PATTERN OF AGEING OF THE ARTICULAR CARTILAGE OF THE ELBOW JOINT
Authors: Goodfellow John W. , Bullough Peter G.
Published: February 2018

1. The age changes in the articular cartilage of the elbow joint are presented from a study of twenty-eight necropsy subjects aged eighteen to eighty-eight years. During early adult life those areas of cartilage which do not usually articulate with opposed cartilage always show some degree of chondromalacia.

2. Evidence is presented that the almost inevitable degeneration of the radio-humeral joint in old age is related to the combination of rotation and hinge movements that occur at that joint. This is in marked contrast with the relative immunity of the humero-ulnar articulation which has hinge movement only.
COMPLICATED CRUSHING INJURIES OF THE PELVIS
Authors: Froman Colin , Stein Archie
Published: February 2018

1. Seventy-five patients sustained fractures of the pelvis with associated soft-tissue complications. Twenty died, and of these, thirteen died within forty-eight hours of admission to hospital.

2. The initial resuscitation and clinical assessment of these patients are discussed, and attention is drawn to the significance of the concomitant retroperitoneal haematoma as a cause of oligaemic shock, and as a dissembler of internal visceral injury.

3. The morphological fracture patterns are classified into six categories, but the fracture patterns are not correlated with specific visceral injuries.

4. Forty-six patients sustained urinary tract injuries. Of these, nineteen had suffered rupture of the urethra; fourteen had rupture of the bladder; two had both urethral and vesical disruption, and one patient had a torn ureter. The diagnosis and management of these injuries is discussed.

5. Twelve patients had a traumatic laceration or perforation of the ano-rectum. Nine of these patients had associated urethral or vesical injuries.

6. Four patients were involved in accidents and sustained pelvic fractures while in the last three months of pregnancy. The tragic outcome of this combination of circumstances is noted.

7. Attention is drawn to peripheral nerve injuries in association with pelvic fractures, and the difficulty of localising these lesions is stressed.

8. Eight instances of damage to the abdominal parietes are recorded. Four patients suffered skin and soft-tissue loss, two patients had diaphragmatic disruptions and two patients had abdominal wall dehiscences.

9. Major accident victims frequently have multiple injuries. This series of patients has been analysed to draw attention to the association of pelvic fractures with bizarre visceral injuries.
UNILATERAL FACET INTERLOCKING IN THE LOWER CERVICAL SPINE
Authors: Braakman R. , Vinken P. J.
Published: February 2018

Bilateral interlocking of the articular facets of the cervical spinal column results from excessive flexion. Unilateral interlocking (hemiluxation) results from simultaneous excessive flexion and rotation. Patients with hemiluxation of the cervical spine often have only mild complaints and the clinical signs may be slight. The diagnosis is made radiologically, but it is often overlooked.

Various forms of treatment may give good results. In recent hemiluxation, reduction is advisable to promote recovery of radicular symptoms. The effect of reduction on spinal cord symptoms is uncertain. Manual reduction under general anaesthesia is usually successful, with the possible exception of some cases of interlocking at C.6-C.7, or C.7-T.1. Skull traction with weights of 5 to 10 kilograms even when prolonged is hardly ever successful; with weights of 10 kilograms or more there is a chance of success. Surgical reduction is not always necessary. A hemiluxation of more than two weeks' standing may still be reduced but non-operative methods offer little chance of success. In this series there has been no aggravation of the neurological deficit after reduction. Although hemiluxation shows a tendency to spontaneous stabilisation it is wise in our opinion to apply some form of fixation. The selection of the method of fixation depends on the neurological picture and on the estimated degree of instability. The latter depends on the presence or absence of additional damage to the interlocked and adjacent vertebrae. Manual reduction by means of traction in the longitudinal axis of the cervical spine under general anaesthesia with muscle relaxation, followed by immobilisation in a plaster jacket (Minerva type) for three months is successful in many cases. If surgical stabilisation is considered necessary an attempt at manual reduction should be made before operation so that when the patient is placed on the table the cervical spinal canal has regained its normal shape. In general, sufficient stability will have been achieved after approximately three months, so that for hemiluxations of more than three months duration surgical treatment will only rarely be necessary. Figure 11 shows the methods of treatment that we advise.
EPIPHYSIAL STAPLING AND LEG EQUALISATION
Authors: Poirier H.
Published: February 2018

1. Thirty-three patients who had had stapling of the lower femoral and upper tibial epiphysis to correct inequality of the leg lengths were reviewed after maturity. The staples were inserted so that correction of the disparity would coincide with termination of growth.

2. The predicted corrections were found to be inaccurate. The error was 47 per cent in girls operated on between ten and twelve and 51 per cent in boys between ten and thirteen. In older children the prediction was more accurate.

3. Despite the inaccuracy of prediction only four patients were left with shortening of more than 3·5 centimetres.

4. Complications of the operation were deformity, ligamentous laxity, subjective symptoms and necessity for further operation.

5. Only one girl had a serious deformity–genu recurvatum of 25 degrees. Half the patients had minor degrees of hyperextension.

6. The causes of the complications are discussed and suggestions made how their incidence might be reduced.

7. It is concluded that the operation of stapling the epiphyses around the knee of the long leg has a small but useful part to play in the correction of inequality of leg lengths. It should be confined to tall boys over thirteen and girls over twelve.
THE PROGNOSIS IN ZOSTER PARALYSIS
Authors: Gupta S. K. , Helal B. H. , Kiely P.
Published: February 2018

1. Forty-five cases of zoster paralysis, not involving the cranial nerves, are detailed. These include eighteen cases not previously published. Of these eighteen patients, one-third were referred for an orthopaedic opinion.

2. Complete or almost full recovery occurred within a year in two-thirds of the patients. Permanent paralysis occurred in one-sixth of the patients studied.

3. Muscles that failed to recover were mainly or wholly supplied from single segments of the spinal cord; so the prognosis must be guarded in those cases in which such muscles are completely paralysed.

4. Various phenomena occurring in zoster paralysis are discussed.
TWO-LEVEL FRACTURES OF THE TIBIA
Authors: Zucman J. , Maurer P.
Published: February 2018

1. Intramedullary nailing in two-level tibial fractures provides the following advantages: it allows walking with full weight-bearing in an average time ofthree to four months; it decreases the rate of non-union ; it decreases the rate of malunion ; it should decrease the rate of infection in closed fractures when compared with other types of internal fixation, due to the technique of blind nailing without exposure of the fracture site.

2. Compound tibia! fractures treated by nailing are still often complicated by infection. Nevertheless, we have not been able to find studies in the literature based on series large enough to permit the conclusion that other methods could lower significantly the infection rate.
HALO TRACTION
Authors: Pieron A. P. , Welply W. R.
Published: February 2018

1. The usefulness of the halo method of traction in orthopaedic surgery, neurosurgery and plastic surgery is not widely appreciated.

2. Modifications of the apparatus are described and the technique of application is detailed.

3. Some advantages of the method are discussed.
NIEVERGELT-PEARLMAN SYNDROME
Authors: Dubois H. J.
Published: February 2018

1. A case of massive tarsal synostosis with supination of the forefeet, synostosis in the carpus with brachydactylia, clinicocamptodactylia, symphalangism and dysplasia of the elbows is presented.

2. This conforms to the description by Nievergelt (1944) and Pearlman et al. (1964).
ARTHROGRYPOSIS MULTIPLEX CONGENITA
Authors: Lloyd-Roberts G. C. , Lettin A. W. F.
Published: February 2018

1. We have reported our experience in fifty-two patients with arthrogryposis multiplex congenita.

2. The nature of the disorder, its possible cause, the clinical features and differential diagnosis are discussed.

3. Early management is described with special reference to the infant, his parents, and general principles of selection and timing. The treatment of the individual deformities which commonly occur is outlined.

4. We have emphasised that lower limb deformities should be treated vigorously in the first year, whereas in the upper limb treatment is better delayed until an accurate assessment can be made.

5. Correction in the young child should be by soft-tissue release rather than by osteotomy.

6. Prolonged splinting after operation is necessary.

7. Severe weakness may dominate the problem and make operation unrewarding.

8. The intelligence, determination and adaptability of these children flatters even modest surgical success.
GEOGRAPHICAL VARIATIONS IN SENILE OSTEOPOROSIS
Authors: Chalmers J. , Ho K. C.
Published: February 2018

1. Using the incidence of hip fracture as an indication of senile osteoporosis, the occurrence of this disease is found to vary greatly in different racial groups. The highest reported incidence is in Sweden, followed by Britain, Hong Kong Chinese, Singapore Chinese and South African Bantu, in that order. Likewise, the sex incidence varies, women outnumbering men in Sweden and Britain, men exceeding women in Singapore; an equal sex incidence is found in Hong Kong.

2. In all races and in both sexes the incidence is more closely related to age than any other factor, a progressive increase being noted after forty-five. Ageing is clearly the dominant etiological factor, but this does not explain the different racial incidence. These differences cannot be attributed to hormonal state or to the dietary intake of calcium, but do accord in general with the living standards of the different countries and the degree of physical activity undertaken by the different populations and sexes.

3. Hereditary factors may play a part, but further geographical study of the incidence of senile osteoporosis is necessary before the relative importance of inheritance and environment can be assessed.
DISTURBED EPIPHYSIAL GROWTH AT THE KNEE AFTER OSTEOMYELITIS IN INFANCY
Authors: Roberts P. H.
Published: February 2018

1. Fifteen patients who had had osteomyelitis of the lower femur or upper tibia during infancy have been studied. The cases of four patients showing particular features of the disease are presented in detail and the remainder are summarised.

2. It is suggested that damage to the epiphysis may be due to an abscess, or to ischaemia following occlusion of the blood supply. In the latter instance the prognosis may be better.

3. In the early stages the radiographic appearances may be deceptive, suggesting that damage to the epiphysis is irreparable.

4. Significant recovery of the epiphysis may occur in some patients after a delay of several years. This, together with the often good function which is preserved at the joint, should deter the surgeon from early destructive operation on the limb.

5. Deformity, which was present to some extent in all cases, appeared early and was not well controlled by conservative treatment. Operations were performed in twelve patients.

6. Shortening of the limb occurred in all patients and in some it was severe.
ACETABULAR DYSPLASIA AND FAMILIAL JOINT LAXITY: TWO ETIOLOGICAL FACTORS IN CONGENITAL DISLOCATION OF THE HIP
Authors: Wynne-Davies Ruth
Published: February 2018

1. A survey of genetic and other etiological factors has been carried out in 589 index patients with congenital dislocation of the hip and their families, with special investigation of acetabular dysplasia, familial joint laxity and a comparison of neonatal and late-diagnosis cases.

2. It is believed that there are two etiological groups with congenital dislocation of the hip, i) a group with acetabular dysplasia which is inherited as a multiple gene system and is responsible for a high proportion of cases diagnosed late, and ii) a group with joint laxity which is responsible for a high proportion of neonatal cases.

3. Evidence is presented to show that acetabular dysplasia is a separate heritable system in some families.

4. Other findings relating to the genetic aspects of the survey are summarised.
PRIMARY PROTRUSION OF THE ACETABULUM
Authors: Hooper Jonathan C. , Jones E. Wyn
Published: February 2018

1. A study of fifty-nine patients with protrusion of the acetabulum showed that they fell into three age groups: those in their teens, those aged thirty-five to fifty years, and those presenting from fifty-one years onwards.

2. The juvenile age group was investigated clinically and biochemically but no causative metabolic factor was found.

3. The familial incidence was confirmed by radiological and biochemical surveys of several families.

4. The results of treatment show that when conservative treatment is insufficient a total hip replacement gives the best result from operation.
PLATE FIXATION OF TIBIAL SHAFT FRACTURES
Authors: Burwell H. Nevile
Published: February 2018

1. One hundred and eighty-one fractures of the tibial shaft were treated by rigid fixation using conventional plates.

2. Comparison is made with series of fractures treated by the closed method.

3. The incidence of non-union, or delayed union requiring a long period of plaster immobilisation, was found to be less with the open method of treatment.

4. Plating was also found to give better functional results with a shorter period of disability except in severe open fractures.

5. Plating is a valuable method of treatment for tibial fractures in the elderly.
CONGENITAL DEFECTS OF THE TIBIA IN SIBLINGS WITH NEUROFIBROMATOSIS
Authors: Wellwood J. M. , Bulmer J. H. , Graff D. J. C.
Published: February 2018

The case histories of two brothers with congenital defects of the tibia and neurofibromatosis are presented. This report of congenital pseudarthrosis of the tibia in siblings is believed to be the first in the English literature.
DISPLACED FRACTURES OF THE NECK OF THE RADIUS IN CHILDREN
Authors: Jones E. R. L. , Esah M.
Published: February 2018

1. Thirty-four cases of displaced fracture of the neck of the radius in children are reviewed with special reference to elbow and forearm function.

2. There were eight poor functional results-four after eighteen closed reductions and four after sixteen open reductions.

3. The causes of the poor functional results are recorded and the complications discussed. Union in a displaced position was the main cause of restricted movement. Deformity of the radial head due to avascular necrosis, and fibrous adhesions between the neck of the radius and the ulna, were other factors.

4. Fractures that were held reduced by Kirschner wires had better results than comparable fractures treated by closed reduction or op en reduction without fixation.

5. It is concluded that all fractures, whatever the age of the child, with angular displacement exceeding 15 degrees need accurate reduction. Closed reduction is not easy, and repeated check radiographs are needed to ensure maintenance of reduction. Certain of these fractures are unstable and require internal fixation with Kirschner wires.
POSTERIOR RIB RESECTION IN SCOLIOSIS
Authors: Piggott Harry
Published: February 2018

1. The production of scoliosis in young animals by resection of the posterior ends of the ribs is described and the etiological mechanisms discussed. It is suggested that retardation of posterior rib growth, removal of mechanical support from one side of the spine, and disturbance of proprioceptive impulses are the factors which initiate the deformity.

2. Some or all of these mechanisms may contribute to the production of certain human curves, for instance impaired rib growth and support in post-poliomyelitic deformities, proprioceptive and reflex disturbances in syringomyelia.

3. Therapeutically resection of the heads and necks of the ribs on the concave side of thoracic idiopathic curves is followed by improvement in some cases. Exactly how much improvement, in what proportion of curves, and for how long it will be maintained cannot be defined at present, but therapeutically worthwhile effects have been obtained, especially in children under five years old; even if this improvement is followed by later progression, several years of freedom from bracing may have been achieved, and the operation has not in any way interfered with subsequent correction and posterior fusion if this has seemed necessary. It is thought that this operation may have a small but useful role in the early management of idiopathic scoliosis, especially in a young child who is not responding well to bracing.
FRACTURES OF THE TIBIA
Authors: Hamza K. N. , Dunkerley G. E. , Murray C. M. M.
Published: February 2018

1. Fifty tibial fractures treated by intramedullary nailing during seven years have been presented. There were twenty-eight closed and twenty-two open fractures.

2. The use of the method for treating open (compound) fractures is discussed.

3. The indications for intramedullary nailing are outlined.
DiFFICULTIES OF EARLY DIAGNOSIS AND TREATMENT OF CONGENITAL DISLOCATION OF THE HIP IN NORTHERN IRELAND
Authors: Williamson Jean
Published: February 2018

1. In Northern Ireland a campaign to eradicate congenital dislocation of the hip by neonatal demonstration of abnormal laxity and early splintage has been reviewed. The number of live births in the area covered is approximately 30,000 per annum.

2. The results to date suggest that the problem has been greatly over-simplified. The number of established dislocations has not fallen appreciably.

3. Failures have occurred both in early diagnosis and in early treatment.

4. To help close the diagnostic net all children should be screened again during the first year. Infants born by breech presentation and infants with a family history of dislocation should have radiographs taken in the early months, even if clinical tests are negative.

5. With regard to neonatal treatment, early splintage has failed to prevent established dislocation in about 2·4 per cent of the hips so treated. How to detect such resistant cases is an important problem.
LOW-FRICTION ARTHROPLASTY OF THE HIP FOR THE FAILURES OF PREVIOUS OPERATIONS
Authors: Dupont Joseph A. , Charnley John
Published: February 2018

1. Two hundred and seventeen low-friction arthroplasties performed between November 1962 and April 1969 in 203 patients with failed previous operations have been analysed.

2. The technical details of operation in relation to these conversion problems have been outlined.

3. The quality of the results in relation to pain, mobility and ability to walk has been assessed before operation and one year afterwards, with small numbers at three and five years.

4. Pain was completely relieved or was minimal in 96·3 per cent of the patients, and in no case was the pain worse.

5. The total range of movement was 100 degrees or more in 98·5 per cent. No hip lost movement after conversion.

6. The failures were principally due to infection and to technical difficulties. There were no mechanical failures without a technical or radiological explanation.

7. Low-friction arthroplasty is an excellent salvage procedure, especially for failed cup arthroplasty.
SPINAL OSTEOTOMY FOR SEVERE KYPHOSIS IN CHILDREN WITH MYELOMENINGOCELE
Authors: Eckstein H. B. , Vora R. M.
Published: February 2018

1. Kyphosis and kyphoscoliosis associated with myelomeningocele are discussed.

2. It is suggested that the condition be treated by osteotomy of the spine, with removal of one or more vertebral bodies.

3. Sixteen patients treated by this method of spinal osteotomy are presented.

4. Although almost a third of the patients died, a high operative and post-operative mortality in this condition is considered acceptable.
CONGENITAL ELEVATION OF THE SCAPULA
Authors: Cavendish M. E.
Published: February 2018

1. One hundred cases of congenital elevation of the scapula are reviewed; thirty-four were treated by operation.

2. A method of grading of appearance is suggested to assist in selecting cases for operation.

3. In very mild cases operation does not confer worthwhile benefit.

4. Very severely affected patients cannot be made to look normal.

5. The appearance often deteriorates during a period of rapid growth of the neck, making continued observation and reassessment essential.

6. The primary aim of treatment is to improve appearance; improvement in function is uncertain.

7. Excision of the supero-medial part of the scapula, and of the omo-vertebral bone when present, is recommended in most cases requiring operation. It is safe and simple, with little risk of loss of function and with simple after-treatment.