bluuebunny/crossref_metadata_2025 huggingface dataset:
ACTIVATION OF OSTEOGENESIS BY THE "PETAL" TECHNIQUE
Authors: Jarry Léo , Uhthoff Hans K.
Published: February 2018

This paper describes a procedure of activating osteogenesis by the use of the "petal" technique. The osteogenetic effect of these "petals" has been established in experimentally produced fractures and pseudarthroses in rats by radiographical, biomechanical, mechanical and histological examinations.

The conventional concept of the osteogenetic activity of bone transplants is discussed.

The authors feel that this method will find its clinical application in the operative treatment of pseudarthroses and, in selected cases, of fractures that are known for their tendency to unite slowly.
LOCKED MIDDLE FINGER
Authors: Aston J. N.
Published: February 2018

1. Five cases of a sudden block to extension in the metacarpo-phalangeal joint of the middle finger, in middle-aged patients, are described.

2. A possible explanation is that the ulnar collateral ligament gets caught on an osteophyte on the metacarpal head.
THE RESULTS OF REPAIR OF THE SCIATIC NERVE
Authors: Clawson D. K. , Seddon H. J.
Published: February 2018

1. The results of repair of the sciatic nerve and of its main divisions have been analysed in a series of 118 cases, the patients having been under observation for three to eighteen years (average 11·7 years).

2. A result was satisfactory if there was some return of sensibility throughout the autonomous zone (the area of skin supplied exclusively by the damaged nerve) and if the more important muscles of the leg were capable of contraction against gravity and resistance.

3. When the whole of the sciatic nerve is damaged it is necessary to present the results separately for the lateral and medial popliteal divisions.

4. Of forty-seven cases of repair of the medial popliteal nerve 79 per cent showed useful motor and 62 per cent useful sensory recovery. In three out of four cases the correspondence between the degree of motor and of sensory recovery was fairly close.

5. Of seventy-two cases of repair of the lateral popliteal nerve 36 per cent showed useful motor and 74 per cent useful sensory recovery. The latter figure must be regarded with some reserve because sensory "recovery" in the lateral popliteal zone may be due to the ingrowth of nerve fibres from contiguous normally innervated skin. Thus it is not possible to correlate motor and sensory recovery.

6. In eighteen cases of repair of the posterior tibial nerve, there was useful sensory recovery in the sole in twelve. But although there was evidence of recovery in the plantar muscles in eleven cases it was functionally valueless.

7. In repair of the medial popliteal nerve the result was better if suture had been carried out early. In repair of the lateral popliteal nerve there was no evidence that delay was harmful; but the proportion of good results was so low (as judged by motor function alone, sensory recovery being often extraneous) that this exception to a general rule cannot be taken very seriously.

8. Gaps of up to twelve centimetres–estimated after resection of the damaged nerve ends–could be closed without difficulty by the usual technique, and the extent of the gap up to that limit had no influence on the prognosis. The closure of larger gaps, when the knee must be flexed beyond a right angle, is not compatible with good recovery because the post-operative stretching of the nerve causes serious intraneural damage.

9. Nerve grafting has given poor results in repair of the sciatic nerve.
THE LATE CONSEQUENCES OF SCIATIC NERVE INJURY
Authors: Clawson D. K. , Seddon H. J.
Published: February 2018

1. We have described what happens to patients a number of years after injury of the sciatic nerve or of its divisions; there were 329 who had been under observation for periods ranging from three to eighteen years. The neurological recovery was recorded in every case and, more important, the behaviour of the limb as appreciated by the patient.

2. Although it was generally true that good neurological recovery and good function went together there were remarkable discrepancies. Isolated paralysis of the medial popliteal or of the lateral popliteal nerve was often compatible with good function, though patients with lateral popliteal paralysis usually needed toe-raising apparatus. Even total sciatic paralysis sometimes gave little trouble.

3. Of the various types of injury, clean wounds and traction lesions led to rather better than average return of function.

4. Some degree of pain was present in about half the cases, and over-response–exaggerated and painful response to an ordinary stimulus–was present in one-third of the cases.

5. Repair of the posterior tibial nerve was rarely worth while; no less than eight out of twelve patients with this type of injury exhibited over-response.

6. One-third of the patients showed vasomotor and trophic disorders: coldness of the affected limb, erythema, thinness or pigmentation of the skin, changes in the nails or oedema.

7. Pressure sores were the most serious consequence of sciatic nerve injury and at some time or other were present in 14 per cent of our patients. The cause was deformity rather than insensibility of the sole.

8. Of the various palliative operations Lambrinudi's tarsal arthrodesis gave such disappointing results that we doubt whether the operation is worth doing. Tenodesis, revived as a time-saving expedient during the war, was a failure. For lateral popliteal paralysis anterior transplantation of tibialis posterior is excellent.

9. Amputation was done in only ten cases. When it was performed for fixed deformity with secondary ulceration the result was satisfactory. When it was done because of pain there was no relief. Amputation is, therefore, avoidable provided that vigorous steps are taken to prevent or correct deformity; it should not be done for the relief of pain.
FAILURE OF UNION IN FRACTURE OF THE NECK OF THE FEMUR
Authors: Harrold A. J.
Published: February 2018

The hypothesis provides a theoretical justification for, and re-emphasises the practical importance of, close reduction and strict immobilisation in the treatment of fractures of the neck of the femur. It does not support the view that failure of union is caused by vascular damage at the time of the original injury. Unexpected failure of union after nailing is more likely caused by unrecognised imperfection of reduction and the acknowledged deficiencies of internal fixation.

Attempts to improve results by passing the sartorius muscle around the fracture (Adams 1956), or by attaching muscle or joint capsule to the proximal fragment, have failed, because such soft tissues are swept off by the acetabular rim when the hip is flexed or medially rotated.

Further work is required, both on the more detailed biochemistry of haemarthroses and on the practical and wider implications of the hypothesis.
NORMAL AND ABNORMAL GROWTH AT THE UPPER END OF THE FEMUR
Authors: Morgan J. D. , Somerville E. W.
Published: February 2018

1. A brief description is given of normal epiphysial growth of the human femur.

2. Some ways in which abnormality of the growth plates may affect the shape and length of the human femur are described.

3. The influence of the blood supply on growth is discussed with particular reference to the etiology and treatment of congenital coxa vara.
TREATMENT OF SLIPPED UPPER FEMORAL EPIPHYSIS
Authors: Durbin F. C.
Published: February 2018

1. A series of eighty-one hips with slipped upper femoral epiphysis in sixty-three patients is reviewed.

2. The importance of early diagnosis is emphasised.

3. Conservative treatment is condemned.

4. In attempting reduction violent manipulation and strong traction must be avoided.

5. In cases of slight displacement pinning in the position of displacement gives the best results.

6. Three or four small pins are recommended for fixation.

7. When the amount of slip is 50 per cent or more of the diameter of the head gentle manipulation should be tried and, if successful, followed by fixation with three or four pins.

8. The hip with an irreducible slip of 50 per cent or more should be treated by pertrochanteric or subtrochanteric osteotomy.
SOME OBSERVATIONS ON THE REACTION OF BONE AND TENDON AFTER TUNNELLING OF BONE AND INSERTION OF TENDON
Authors: Whiston T. B. , Walmsley R.
Published: February 2018

1. A series of experiments on adult rabbits was carried out in which a tendon was transplanted and embedded in a bony tunnel and traversed a joint after the manner of a tenodesis.

2. Histological observations were made on the reaction of surrounding bone and tendon at intervals over a period of 307 days.

3. The findings suggest that the buried tendon undergoes a process of progressive degeneration, and that host cells issuing from the adjacent bone marrow infiltrate and ultimately replace it by new tendon tissue.

4. The invading cells are believed to be derived, as a result of the provocative stimuli provided by the experiment, from primitive reticular cells of the haemopoietic tissue.

5. The tunnelled bone undergoes considerable remodelling and associated with this is the presence of a considerable number of osteoblasts and osteoclasts.
MULTIPLE INJURIES: THE MANAGEMENT OF THE PATIENT WITH A FRACTURED FEMUR AND A HEAD INJURY
Authors: Gibson J. M. C.
Published: February 2018

1. Some of the problems of treatment of a patient with a head injury and a fractured femur are mentioned.

2. The methods of treatment and results obtained in fifty-nine such patients from the Oxford Accident Service are described.
INJURIES OF THE ARTICULAR DISC AT THE WRIST
Authors: Coleman H. M.
Published: February 2018

1 . A specific mechanism of injury can produce a tear of the articular disc of the wrist without any associated bony lesion.

2. Torn discs have been found associated with Colles's fractures and with dislocation of the inferior radio-ulnar joint.

3. The injury gives rise to clear-cut symptoms and definite physical signs.

4. Operation in fourteen cases has shown five types of tear of the disc.

5. Arthrographs of the wrist are helpful in establishing the diagnosis.

6. In isolated tears removal ofthe disc relieves the symptoms and does not prejudice function.

7. If there is other joint injury, removal of the disc cannot be expected to give as satisfactory a result.
THE ARRANGEMENT OF COLLAGEN FIBRES IN HUMAN SECONDARY OSTEONES
Authors: Smith J. W.
Published: February 2018

1. The arrangement of collagen fibres in the secondary osteones in human femora and tibiae has been examined. The fibres were observed in paraffin sections stained by Weidenreich's method.

2. Three fibre patterns have been observed. They differ from one another in the relative numbers of longitudinal and circumferential fibres which they contain, and in the degree of lamellation which they exhibit.

3. The incidence of the three fibre patterns has been correlated with the relative ages of the regions of bone in which they occur.

4. The possibility of a correlation between variations in fibre pattern and certain recent microradiographic observations is discussed.
RECURRENT DISLOCATION OF THE PATELLA AND OF THE SHOULDER
Authors: Carter Cedric , Sweetnam Rodney
Published: February 2018

An inquiry was made of ninety-seven patients with recurrent dislocation of the patella and forty patients with recurrent dislocation of the shoulder to see how often they had a relative similarly affected, and also how often such dislocation is associated with, and perhaps caused by, familial joint laxity.

Ten of those with recurrent dislocation of the patella and two of those with recurrent dislocation of the shoulder were found to have a near relative with a similar dislocation. Familial joint laxity was found in two of the ten families with more than one member affected by recurrent patellar dislocation, and in both those with more than one member with recurrent dislocation of the shoulder. Familial joint laxity was also found in two out of twenty patients with recurrent dislocation of the patella who had no family history of similar dislocation; but in none out of twenty patients with recurrent dislocation of the shoulder and who had no family history of similar dislocation.

Familial joint laxity may be the only cause of recurrent dislocation of the shoulder occurring in more than one member of the family. But there are other, as yet undefined, causes of familial recurrent dislocation of the patella.
HALLUX VALGUS IN ADOLESCENTS
Authors: Simmonds F. A. , Menelaus M. B.
Published: February 2018

1. An operation suitable for the correction of hallux valgus in adolescents is described.

2. The results of thirty-three operations performed in children between the ages of nine and eighteen years are analysed.

3. Twenty-six operations are considered to have produced a good result, four a moderate result, and three a poor result.

4. It is suggested that the operation is best performed between the ages of eleven and fifteen years.
LATERAL DISLOCATION OF THE RADIO-HUMERAL JOINT WITH GREENSTICK FRACTURE OF THE UPPER END OF THE ULNA
Authors: Beddow F. Howard , Corkery P. H.
Published: February 2018

1. Two cases of lateral dislocation of the radio-humeral joint with greenstick fracture of the upper end of the ulna are described.

2. One case was complicated by a radial nerve lesion.

3. Treatment was by reduction under general anaesthesia and resting the elbow in a collar and cuff sling. Full recovery was present in six weeks.
JAVELIN THROWER'S ELBOW
Authors: Miller J. E.
Published: February 2018

1. Pain in the elbow in javelin throwers is a common complaint.

2. The commonest type is caused by recurrent strain of the medial ligament. It develops in individuals who employ an incorrect throwing technique. The symptoms are cumulative, increasing with throwing and decreasing and resolving with rest. Treatment consists in improving the throwing technique. Local anaesthetic injected into the tender area produces complete but temporary relief. Hydrocortisone may produce partial or complete relief.

3. A second type of "javelin elbow" occurs in expert throwers and is the result of hyperextension of the elbow at the end of the throw, causing an injury to the tip of the olecranon. The symptoms are the result of a single throw or "mal-throw" and are completely disabling. They resolve with rest but tend to recur. If the tip of the olecranon is fractured excision of the fragment completely relieves the symptoms.
A STUDY OF THE MECHANICS OF SPINAL INJURIES
Authors: Roaf Robert
Published: February 2018

1. Compression forces are mainly absorbed by the vertebral body. The nucleus pulposus, being liquid, is incompressible. The tense annulus bulges very little. On compression the vertebral end-plate bulges and blood is forced out of the cancellous bone of the vertebral body into the perivertebral sinuses. This appears to be the normal energy-dissipating mechanism on compression.

2. The normal disc is very resistant to compression. The nucleus pulposus does not alter in shape or position on compression or flexion. It plays no active part in producing a disc prolapse. On compression the vertebral body always breaks before the normal disc gives way. The vertebral end-plate bulges and then breaks, leading to a vertical fracture. If the nucleus pulposus has lost its turgor there is abnormal mobility between the vertebral bodies. On very gentle compression or flexion movement the annulus protrudes on the concave aspect–not on the convex side as has been supposed.

3. Disc prolapse consists primarily of annulus; it occurs only if the nucleus pulposus has lost its turgor. It then occurs very easily as the annulus now bulges like a flat tyre.

4. I have never succeeded in producing rupture of normal spinal ligaments by hyperextension or hyperflexion. Before rupture occurs the bone sustains a compression fracture. On the other hand horizontal shear, and particularly rotation forces, can easily cause ligamentous rupture and dislocation.

5. A combination of rotation and compression can produce almost every variety of spinal injury. In the cervical region subluxation with spontaneous reduction can be easily produced by rotation. If disc turgor is impaired this may occur with an intact anterior longitudinal ligament and explains those cases of tetraplegia without radiological changes or a torn anterior longitudinal ligament. The anterior longitudinal ligament can easily be ruptured by a rotation force and in my experience the so-called hyperextension and hyperflexion injuries are really rotation injuries.

6. Hyperflexion of the cervical spine or upper thoracic spine is an anatomical impossibility. In all spinal dislocations a body fracture may or may not occur with the dislocation, depending upon the degree of associated compression. In general, rotation forces produce dislocations, whereas compression forces produce fractures.
AVASCULAR NECROSIS OF THE FEMORAL CAPITAL EPIPHYSIS AFTER TRAUMATIC DISLOCATION OF THE HIP IN CHILDREN
Authors: Haliburton Robert A. , Brockenshire Freeman A. , Barber John R.
Published: February 2018

1. The case history of a seven and a half-year-old boy who developed increased radiographic density of the femoral capital epiphysis after traumatic dislocation of the hip is presented.

2. The authors have been able to examine the case reports of thirteen similar cases presented in the literature.

3. The case presented is felt to be of interest because avascular necrosis was diagnosed early, and the radiographic appearance of the hip became normal five months after the injury.
RETROSTERNAL DISLOCATION OF THE CLAVICLE
Authors: Paterson Dennis C.
Published: February 2018

1. The symptoms, signs and treatment of three patients with a posterior dislocation of the clavicle are described.

2. The value of tomography in confirming the diagnosis is outlined.

3. Certain experimental work has been done in an attempt to determine the factors necessary to produce this dislocation.
ACUTE OSTEITIS OF UNDETERMINED ORIGIN WITH NEURO-INFECTION
Authors: Markowa Janina
Published: February 2018

1. A child is described in whom an acute osteitis was produced by some organism which could neither be identified nor cultured in vitro, and which provoked a violent general reaction but which also showed a distinct affinity for the central nervous system.

2. This organism survived in a cavity in the femur for four months; it preserved its pathogenic properties, and could only be cultured in living tissue.

3. A twice repeated passage through animals increased the toxicity of this organism and proved its affinity for the central nervous system.

4. This organism may have been a virus similar to those producing encephalitis. A final answer may be obtained by further attempts to provoke experimental osteitis with live cultures of viruses in animals.
THE BROKEN SCAPHOID BONE
Authors: London P. S.
Published: February 2018

1. The bad reputation of fractures of the scaphoid bone is based on a) past disasters caused by inadequate splintage and premature resort to operation; and b) selection of disabling cases for publication.

2. The results obtained in five series comprising over 1,000 fractures suggest that 95 per cent of adequately studied fractures less than a month old unite if properly treated.

3. Sixty cases of established non-union have provided evidence that disability is almost always the result of further injury and that the disability is usually relieved by a short time in plaster.

4. There is no evidence to support the widely held beliefs that a) union by bone can occur only if the fracture is immobilised throughout the process; and b) union after prolonged immobilisation is due to the immobilisation.

5. A policy of treating the wrist and not merely its radiological appearances is advocated.
EFFECT OF PERSISTENT PRESSURE ON THE ARTICULAR CARTILAGE
Authors: Trias Antoni
Published: February 2018

The effects on articular cartilage of continuous and intermittent excessive pressures have been studied in the knees of rabbits. Severe degenerative changes in the cartilage were observed; these resembled the typical lesions seen in osteoarthritis in man. They included fibrillation of cartilage, death of chondrocytes, eburnation of joint surfaces, sclerosis of bone and the production of "bone cysts." Regeneration of cartilage was common and it was brought about either by the deeply situated chondrocytes which had escaped death or by metaplasia of young connective tissue cells of the bone marrow.
GENETICALLY CONTROLLED DEGENERATION OF THE NUCLEUS PULPOSUS IN THE MOUSE
Authors: Berry R. J.
Published: February 2018

A description is given of a mutation in the mouse which reduces the size of the nucleus pulposus in the intervertebral disc of the adults. The discs of these mice show greatly accelerated age changes. The consequences of a similar mutation in man are discussed.
COMPRESSION STRESS FRACTURES IN MAN AND THE GREYHOUND
Authors: Devas M. B.
Published: February 2018

1. Compression stress fractures are described.

2. These fractures have all been previously described in various bones but have not been associated as a clinical or radiological entity.

3. The greyhound suffers a compression stress fracture of the navicular bone. This is described with certain deductions therefrom.
REDUCTION OF CERVICAL DISLOCATIONS
Authors: Evans David K.
Published: February 2018

1. The trends in treatment of cervical dislocation are reviewed.

2. Seventeen patients treated by manual reduction under general anaesthesia are reported.

3. The evidence is that reduction in this way is not dangerous and has advantages over other methods.
THE STRUCTURE AND FUNCTION OF THE PROXIMAL END OF THE FEMUR
Authors: Garden R. S.
Published: February 2018

Many analyses of the geometric arrangement of trabeculae in the proximal end of the femur have accepted and perpetuated the theories of Ward (1838), Culmann (1866) and Meyer (1867), and have contributed to the belief that the structure of the femoral neck embodies mechanical principles which are foreign to bony formations elsewhere. This isolated departure from the normal pattern of skeletal behaviour is considered to be most unlikely, and an attempt has been made to show that the structure of the femoral head and neck departs but little from the normal anatomy of the long bone.

From a developmental point of view, the proximal end of the human femur is believed, in its simplest interpretation, to represent an upward continuation of the original shaft which has undergone rotation and expansion. The cancellous arrangements of the internal weight-bearing system are likewise believed to represent the expanded and rotated lamellae of the neck as they are presented radiologically or on coronal section.

The forces acting upon the proximal end of the femur are considered to be mainly compressive in nature, and both crane and street-lamp bracket theories have therefore been rejected. The spiral conformity of the proximal end of the femur has been related to the spiral disposition of the soft-tissue structures that surround the hip, and in the interpretation of hip joint mechanics the principle of the screw has been preferred to the principle ofthe lever.
LOW-ANGLE FIXATION IN FRACTURES OF THE FEMORAL NECK
Authors: Garden R. S.
Published: February 2018

The successful management of femoral neck fractures is obviously based upon many factors. The forces acting upon the proximal end of the femur are believed to be mainly compressive in nature, and the low-angle nail by stabilising the fully reduced fracture in the line of these forces is held to allow weight bearing to take place. Low-angle nailing is believed to offer many advantages over conventional methods of treatment but only in the presence of stability. Stable reduction is the essential preliminary to any form of treatment, and low-angle fixation with early weight bearing in the absence of stability is regarded as futile.

It is suggested that those subcapital separations which follow trivial injury may originate as stress fractures accompanying the process of bone remodelling in the aged, and that many of these fractures may remain unrecognised and heal spontaneously. With rare exceptions, subcapital fractures are regarded as being of the same essential pattern, and their varying radiological appearance is considered to be due to the different degrees of displacement to which they have been subjected. A new classification based on this premise has been suggested.

In a series of eighty subcapital fractures the incidence of avascular necrosis was not adversely affected by early weight bearing, but reduction in the extreme valgus position was invariably followed by this disaster. This is probably also true of any malposition in extreme rotation which must stretch and obliterate the vessels in the ligamentum teres.

A rough alignment index of reduction was found to provide an almost infallible guide to the prognosis both in regard to union and to avascular change. It may therefore be possible to base prognosis on the quality of reduction before the fixation appliance has been inserted. The unsatisfactory results in those cases apparently destined to non-union or avascular necrosis may then be avoided by alternative means of treatment at an early stage. Whether this will prove to be true must depend upon a much longer experience of low-angle fixation, and, in common with almost every communication on this subject, premature publication must largely offset the value of the present findings.
TIBIALIS POSTERIOR TRANSFER IN CONGENITAL CLUB FOOT
Authors: Singer Martin
Published: February 2018

1. The tibialis posterior tendon was transferred in twenty-eight congenital club feet to maintain the correction obtained by serial wedge plasters.

2. There has been no relapse in twenty-seven of the twenty-eight feet in the period under review–namely, one to three years from operation.

3. The technique of the operation is described.

4. It appears that this operation should not be attempted when a soft-tissue correction has been done previously.
GANGLION OF THE LATERAL POPLITEAL NERVE
Authors: Clark Kenneth
Published: February 2018

1. Three cases of ganglion of the lateral popliteal nerve are reported, all of which were treated by resection of the nerve.

2. In none was a connection between the ganglion and the superior tibio-fibular joint seen.

3. A careful histological study suggests that the condition is one of simple ganglion arising in the supporting tissues of the nerve.

4. A search of the literature has revealed twelve reported cases. The clinical and operative findings, together with the results of treatment, have been reviewed.

5. The treatment of choice is dissection of the ganglion from the nerve. If this proves difficult because of the multiplicity of cysts, incision and evacuation of cyst contents should be performed, although recurrence is possible after this procedure.

6. The prognosis for recovery of function is good when paralysis has been present for less than one year. Recovery of motor function is unlikely to be complete if there has been a longer duration of paralysis, though sensory recovery is usually good.
A METHOD OF ESTIMATING QUALITATIVE CHANGES OF BLOOD-FLOW IN BONE
Authors: McPherson A. , Gordon L. H. , Scales John T.
Published: February 2018

1. A method of recording changes in bone blood-flow using a heated thermocouple is described.

2. Occlusion of the femoral artery or aorta decreases the blood-flow in the femoral metaphysis.

3. Occlusion of the femoral vein and intravenous injection of adrenaline, nor-adrenaline, acetylcholine, histamine or hexamethonium bromide increase the blood-flow in the femoral metaphysis.
THE VASCULAR CONTRIBUTION TO OSTEOGENESIS
Authors: Trueta Joseph , Trias Antoni
Published: February 2018

From this work it may be concluded that persistent compression affects the growth plate by interference with the blood flow on one or both sides of the growth cartilage.

Despite exertion of the same pressure upon both sides of the growth plate, only the metaphysial side was readily affected in the early stages, for, as long as no damage was caused to the epiphysial side of the growth cartilage, the lesions were fully reversible.

Interference with growth was directly proportionate to the damage caused by compression to the epiphysial side of the growth plate and, in general, to the duration of compression.

The first signs of interference with the metaphysial side of the plate were the lack of vascular progression and concomitant retardation of calcification.

When severe degeneration was not present the growth cartilage recovered within four days.

The matrix was ready for calcification all the time, as shown by the extremely rapid calcification occurring soon after the compression had ceased and the vessels were able to reach their proper place.

It seems justified to believe that the first hypertrophic cell not to be calcified after removal of the clamp is the one around which the matrix has not yet changed sufficiently to have an affinity for the apatite crystals. As in moderate compression, the division of the proliferative cells continues and it seems it must be the age, or even more likely the distance from the transudate coming from the epiphysial side of the growth cartilage that conditions the maturity of the cell, which prepares the field for calcification and thus initiates the osteogenic process.

Views similar to this have been advanced by Ham (1957) and his school.
STUDIES IN THE TRANSPLANTATION OF BONE
Authors: BURWELL R. Geoffrey , Gowland G.
Published: February 2018

1. An immunological examination of the sera of thirty rabbits which had received primary and secondary homografts of cancellous bone into a subcutaneous site did not reveal the presence of circulating precipitins, haemagglutinins or passive haemagglutinins. These findings are consistent with the observations of Bonfiglio and his colleagues (1955).

2. Electrophoretic examination of the serum of four rabbits receiving primary and secondary homografts of bone into an intramuscular site did not reveal any change in the serum protein fractions.

3. A search for auto-antibodies produced by primary and secondary autografts of cancellous bone was unsuccessful in fifteen rabbits.

4. The multiple injections of saline extracts of bone into four rabbits did not evoke the production of demonstrable circulating antibodies, results which are in accord with the findings of Bonfiglio and colleagues (1955) and Curtiss and colleagues (1959).

5. For the first time the production of classical antibodies in response to injections of extracts of heterologous bone has been recorded. The repeated injections of a saline extract of rabbit bone intraperitoneally into ten mice produced demonstrable precipitins and passive haemagglutinins both to protein and polysaccharide fractions present in the bone extracts.

6. Knowledge concerning the production of humoral antibodies to transplants and extracts of bone has been reviewed.
THREE CASES OF COMPOUND POSTERIOR DISLOCATION OF THE ELBOW WITH RUPTURE OF THE BRACHIAL ARTERY
Authors: Kilburn Peter , Sweeney John G. , Silk F. F.
Published: February 2018

1. Rupture of the brachial artery or of one of its divisions in association with elbow injuries is probably more common than a survey of the literature would imply. Three cases of rupture of the brachial artery complicating compound dislocation of the elbow are reported.

2. These cases appear to have a consistent pattern of soft-tissue damage, with avulsion of the common flexor origin, and a varying degree of damage to the biceps and brachialis. The median nerve escaped injury.

3. The method of dealing with the divided vessels does not appear to be of importance in determining the outcome, simple ligation being as satisfactory as attempts at grafting or suture.

4. In no case was there any evidence of Volkmann's contracture. Provided rapid reduction of the dislocation is effected, together with ligation of the vessels, a satisfactory return of the circulation may be expected.
A STUDY OF BONE GROWTH IN NORMAL CHILDREN AND ITS RELATIONSHIP TO SKELETAL MATURATION
Authors: Tupman G. S.
Published: February 2018

1. A study of the average rate of growth of the legs and trunk of 202 normal average maturing children is presented.

2. The annual growth of the limbs and trunk was related to the skeletal age of each child, and the increments of growth per skeletal year subjected to statistical analysis.

3. Methods of growth prediction of leg length and mature height have been derived and the practical application of the investigation to orthopaedic surgery is discussed.
OPEN REDUCTION OF CONGENITAL DISLOCATION OF THE HIP
Authors: Scaglietti O. , Calandriello B.
Published: February 2018

A few points in this report deserve to be stressed.

Indications–It is important that the orthopaedic surgeon should decide at a very early stage which of the two methods, closed or open, he must use. These do not exclude each other but are on the other hand complementary. Nowadays the dislocated hip can be reduced by open operation with a very good chance of lasting success. This should be carried out if a hip cannot easily be reduced otherwise, or if there is any doubt that closed reduction has been successful–and as early as possible, preferably before the age of three years.

Technique–Ample exposure of the joint and removal of all obstacles to reduction are important. Reduction must be complete and stable but without stress, and there must be no interference with the articular bone and cartilage.

After-care–Reduction, however perfect, is only the first step towards recovery. The hip must be observed carefully and the most suitable moments for mobilisation and for walking must be chosen; this calls for nice judgment. When it is clear that the roof of the acetabulum is not developing or that persistent valgus and anteversion may encourage subluxation, a secondary operation should be undertaken at once. Radiography is necessary about every three months for the first two years.

Assessment of results–With a strict system of assessment, like McFarland's, we have observed 68·3 per cent favourable results in 171 hips treated by open reduction.

It is obvious that the problem of congenital dislocation of the hip has not yet been completely solved. But if we review the progress of recent years we come to the encouraging conclusion that much has already been achieved, and that the efforts of the many orthopaedic surgeons who have dedicated themselves to the treatment of congenital dislocation of the hip have not gone unrewarded.
THE INCIDENCE OF OSTEOGENIC SARCOMA IN SOUTH-WEST ENGLAND AND ITS RELATIONSHIP TO PAGET'S DISEASE OF BONE
Authors: Price C. H. G.
Published: February 2018

1. The average number of cases of osteogenic sarcoma found in the years 1946-58 inclusive in the northern division of the South-west Hospital region of England was 6·7 for each year, varying from three to ten.

2. The annual incidence of this sarcoma in this area was one tumour per 230,000 population.

3. These figures were compared with similar figures from Norway which indicate a rather similar tumour incidence among juveniles, but a very much smaller number of tumours in elderly persons.

4. Among the eighty-seven sarcomata collected in the specified area in thirteen years twenty-Six were associated with Paget's disease.

5. It is estimated that among the population of the specified area there were probably 26,000 persons at any time with Paget's disease, of whom one in 650 (0·15 per cent) would eventually develop sarcoma.

6. This study suggests that Paget's disease increases the risk of sarcoma about thirty-fold in persons over forty years of age.

7. It is tentatively suggested that the incidence of Paget's disease is influenced more by heredity than environment.
FEMORAL ANTEVERSION IN THE RABBIT
Authors: Wilkinson John A.
Published: February 2018

1. Sustained medial rotation of the hind limb in the immature rabbit produces femoral anteversion and acetabular dysplasia.

2. Sustained lateral rotation produces retroversion.

3. Splinting the hind limbs in the Lorenz position corrects both anteversion and retroversion.

4. The mechanism of the Lorenz position is discussed.
AN EXPERIMENTAL COMPARISON OF LIVING AND DEAD BONE IN RATS, I. Physical Properties
Authors: Stevens Jack , Ray Robert D.
Published: February 2018

1. Some physical properties of living and dead bone have been studied in rats; most of these are interrelated and ultimately depend upon the composition of the tissue.

2. Dead bone, remaining within the body, does not take up measurable amounts of mineral from the tissue fluid but retains its original physical properties of radiographic density, specific gravity, strength and composition.

3. The altered radiographic density of avascular bone seen in clinical practice is almost certainly relative unless there has been concomitant appositional new bone formation.

4. Some other explanation must be sought for the finding that dead bone takes up significant amounts of bone-seeking isotopes in radioactive tracer studies.
FAMILIAL PERTHES' DISEASE RESEMBLING MULTIPLE EPIPHYSIAL DYSPLASIA
Authors: Monty Cyril P.
Published: February 2018

1. An account is given of a family in which five members in three generations were affected by osteochondritis involving the hips, in three cases bilaterally.

2. One patient showed aseptic osseous necrosis of the epiphyses of the ankles and fingers.

3. The differential diagnosis between Perthes' disease and multiple epiphysial dysplasia is discussed, but it is not certain into which category these patients fall.

4. The assistance of a family history and skeletal survey in diagnosis is illustrated.
DOUBLE PATELLAE IN MULTIPLE EPIPHYSIAL DYSPLASIA
Authors: Hodkinson H. M.
Published: February 2018

1. The occurrence of bilateral double-layer patellae in association with multiple epiphysial dysplasia is described in three siblings.

2. Twelve cases of bilateral double-layer patellae have been reported previously, and in all there was an accompanying skeletal dystrophy which, although not diagnosed as such, is likely to have been multiple epiphysial dysplasia.

3. It is suggested that although they occur only in a minority of cases, double-layer patellae when present are a feature of considerable diagnostic value in multiple epiphysial dysplasia. Lateral radiography of the knees may therefore be of assistance in the diagnosis of multiple epiphysial dysplasia.
TRAUMATIC ANEURYSM OF THE ANTERIOR TIBIAL ARTERY
Authors: Crellin R. Q. , Tsapogas M. J. C.
Published: February 2018

1. A case of traumatic aneurysm of the anterior tibial artery complicating fracture of the tibia and fibula is reported.

2. The diagnosis and management of such lesions are discussed.
ARTHROGRAPHY IN CONGENITAL DISPLACEMENT OF THE HIP
Authors: Mitchell George P.
Published: February 2018

1. The technique of arthrography in congenital displacement of the hip is described. No complications have been encountered in a series of over 200 examinations. The interpretation of the arthrographs is discussed.

2. It is suggested that the abnormal hips may be classified in three degrees: 1) Primary instability; 2) partial displacement without interposition of soft tissue; 3) complete displacement with interposition of soft tissue between head and socket.

3. Two types of complete displacement or dislocation are recognised: 1) the "tight" dislocation; 2) the "loose" dislocation. In the latter there is marked displacement of the femoral head, and arthrography done before reduction demonstrates interposition of a fold of capsule lying in front of the inverted limbus.

4. Arthrography is of special help in making the diagnosis between partial displacement with eversion of the labrum and "tight" dislocation with an interposed limbus. It is helpful too in establishing the cause of failure of reduction.
THE INHERITANCE AND DEVELOPMENT OF THE NAIL-PATELLA SYNDROME
Authors: Duthie Robert B. , Hecht Frederick
Published: February 2018

1. A genetic and orthopaedic analysis of a family of seventy members exhibiting the nail-patella syndrome is described.

2. The disorder is found to be determined by a simple dominant autosomal gene with complete penetrance, but displaying variable expressivity and great pleomorphism.

3. In the family reported all ten of the affected individuals whose blood was typed belonged to group O, demonstrating the adjacent chromosomal position of the nail-patella gene and the ABO blood group locus.

4. The pathogenesis is one of hypoplasia of the nail beds, but hyperplasia in mesodermal tissue as shown by the formation of iliac horns.

5. The skeletal changes are ascribed to a functional disturbance in the development of the traction epiphyses rather than to a primary teratogenic effect.
TREATMENT OF PERTHES' DISEASE OF THE HIP BY CANCELLOUS BONE GRAFFING
Authors: Cathro A. J. M. , Kirkaldy-Willis W. H.
Published: February 2018

1. Cancellous bone grafting of the head of the femur in Perthes' disease accelerates reossification and thus shortens the period of treatment.

2. There is no evidence from this series of cases that the final shape of the head is affected for better or for worse by the operation of cancellous chip grafting, by the rate of regeneration of the head after operation or by the stage in the disease process at which the operation is done.

3. No relationship has been found between the shape of the head at the time of operation and its final shape.

4. A larger series of cases is needed to determine the value of bone grafting in Perthes' disease of the hip.
VASCULAR INJURY TREATED WITH HIGH PRESSURE OXYGEN IN A MOBILE CHAMBER
Authors: Maudsley R. H. , Hopkinson W. I. , Williams K. G.
Published: February 2018

1. A small mobile oxygen chamber is described which overcomes some of the disadvantages of using high pressure oxygen therapy in cases of general or local anoxia.

2. A case of limb ischaemia following an open fracture of the tibia and fibula is described in which such a method of treatment was used.
NEURILEMMOMA OF BONE
Authors: Seth H. N. , Rao B. D. P. , Kathpalia P. M. L.
Published: February 2018

A case of intramedullary neurilemmoma of the terminal phalanx of the right index finger is reported, and the cases previously reported are briefly reviewed.
ISCHIO-FEMORAL ARTHRODESIS FOR TUBERCULOSIS OF THE HIP
Authors: Hahn Doojin
Published: February 2018

1. The results of ischio-femoral arthrodesis for tuberculous arthritis of the hip in thirty-five adults and in twenty-nine children are reported. The "blind" technique of Brittain was used in thirteen patients and the open technique in fifty-one.

2. Bony fusion was obtained by the first operation in thirty-three out of the thirty-five adults and in twenty-three out of twenty-nine children. In children strikingly better results were gained from the posterior open technique than from the original "blind"technique of Brittain.

3. There was no evidence that ischio-femoral arthrodesis in children interfered with the growth of the limb.
OSTEOTOMY OF THE PROXIMAL END OF THE RADIUS FOR PARALYTIC SUPINATION DEFORMITY IN CHILDREN
Authors: Zaoussis A. L.
Published: February 2018

1. Open osteotomy near the tuberosity of the radius to enable correction of fixed supination deformity of the forearm in children is an alternative to Blount's closed osteoclasis of both bones.

2. In five out of six cases with residual obstetrical palsy substantial correction of the deformity was maintained.

3. The cosmetic result was impressive, especially in girls, but an improved function was also observed. If the hand is paralysed, correction of supination facilitates reconstruction.

4. Complications such as angulation, displacement, delayed union and synostosis of the proximal radius and ulna did not affect the final results.

5. With the method described a more or less permanent "blocking" of rotatory movement in the forearm was observed but this did not seem to impair the functional result.
STRESS FRACTURES IN CHILDREN
Authors: Devas M. B.
Published: February 2018

1. Stress fractures are described in children. The fibula and tibia are most often affected.

2. Stress fractures of the humerus are described in two boys aged fifteen.

3. Stress fractures are described in the pelvis in children.
LISFRANC'S FRACTURE-DISLOCATION
Authors: Jeffreys T. E.
Published: February 2018

1. The mechanism of injury in tarso-metatarsal dislocation and fracture-dislocation has been investigated by experimental studies in the cadaver. Two distinct types of injury were observed.

2. Five cases of simple tarso-metatarsal dislocation and seventeen cases of fracture-dislocation are reviewed.

3. The treatment of the injury is discussed.
ANEURYSM OF THE POPLITEAL VESSELS AFTER MENISCECTOMY
Authors: Patrick James
Published: February 2018

1. Four cases of arterial injury complicating meniscectomy are described.

2. The danger of using chisel-type meniscectomy knives, especially when they are incorrectly sharpened, is emphasised.
THE VASCULAR CONTRIBUTION TO OSTEOGENESIS V. The Vasculature Supplying the Epiphysial Cartilage in Rachitic Rats
Authors: Trueta J. , Buhr A. J.
Published: February 2018

1. It has been shown that in experimental rickets the well known changes in the epiphysial cartilage which so seriously affect growth are accompanied by severe interference with the progress of the metaphysial vessels into the growth cartilage.

2. Further evidence has been found that, by the repeated increase in their number, the cartilage cells occupying the more distal part of the proliferative segment become more and more affected by their remoteness from the epiphysial vessels, which supply the transudates to these cells. At a given distance these cells are affected and change, becoming hypertrophic, with increasingly large vacuolae, and are rich in glycogen and alkaline phosphatase.

3. The hypertrophic cells alter the nature of the intercellular substance they deposit and this becomes calcifiable. Provided that the metaphysial vessels are situated at an appropriate distance–about three cell capsules away–and that the blood has its necessary components, calcification occurs.

4. Calcification produces the advancing, rigid multitubular structure within which the progressing metaphysial vessels are protected.

5. The interruption of calcification by the withdrawal of fat-soluble vitamins breaks down the whole mechanism of growth and stops the vessels growing into their proper position. The administration of the required vitamins re-establishes the normal sequence of events and allows the vessels to play their decisive role in osteogenesis.

6. Any mechanism which causes the interruption of the vascular progression, whether from metaphysial ischaemia (Trueta and Amato 1960), from severe pressure (Trueta and Trias 1961) or from lack of calcification by withdrawing the fat-soluble vitamins, equally interrupts growth.
THE TREATMENT OF PROGRESSIVE SCOLIOSIS BY UNILATERAL GROWTH-ARREST
Authors: Roaf Robert
Published: February 2018

Severe kypho-scoliosis, lateral curvature and lordo-scoliosis are ultimately caused by disturbance of vertebral growth. The results of treatment by destroying the growth potential opposite the area of growth inhibition have been encouraging. When the operation has been adequate further deterioration has been prevented; in younger children there has been improvement with further growth. It is important that the growth arrest should be at the right site and that it should be sufficiently extensive. Accurate pre-operative diagnosis of the type and extent of the curve is important.
THE GENETIC FACTOR IN DUPUYTREN'S DISEASE
Authors: Ling R. S. M.
Published: February 2018

1. The families of fifty patients with Dupuytren's disease have been investigated for its presence.

2. Familial occurrence has been found to be considerably higher than has been reported hitherto.

3. The findings suggest that genetic factors are of extreme importance in the pathogenesis of the common form of Dupuytren's disease.

4. A single gene, behaving as a Mendelian dominant, is likely to be involved.

5. Dupuytren's disease may not be a homogeneous condition from the pathogenic standpoint.