bluuebunny/crossref_metadata_2025 huggingface dataset:
DISLOCATION OF THE UPPER END OF THE FIBULA
Authors: Harrison R. , Hindenach J. C. R.
Published: February 2018

1 . Dislocation of the upper end of the fibula is probably less unusual than the paucity of the published reports suggests.

2. Dislocation may be anterior or posterior, anterior dislocation occurring about twice as often as posterior. Rarely the fibula moves proximally.

3. In most cases a closed manipulation suffices for reduction, and a full and rapid return of normal function follows.

4. Five cases are described. In one case operative reduction was required.
A COMPARATIVE RADIOLOGICAL STUDY OF REITER'S DISEASE, RHEUMATOID ARTHRITIS AND ANKYLOSING SPONDYLITIS
Authors: Mason R. M. , Murray R. S. , Oates J. K. , Young A. C.
Published: February 2018

The radiological appearances in twenty-five patients with Reiter's disease have been compared with those in eighty-one with rheumatoid arthritis and thirty-eight with ankylosing spondylitis. The similarities and differences have been analysed. Changes of periosteal new bone in the calcaneum appear to be the only significant differentiating factor, although minor differences in incidence and distribution occur elsewhere. Sacro-iliitis is a common radiological feature of long-standing Reiter's disease.
EXPERIMENTAL EPIPHYSIAL INJURY AND FREIBERG'S DISEASE
Authors: Braddock G. T. F.
Published: February 2018

1. Experiments show relative weakness of the second metatarsal epiphysis at a certain stage of epiphysial maturation.

2. It is shown that at this stage Freiberg's infraction is likely to occur.

3. It has been demonstrated that even gross comminution with disruption of the articular cartilage of the second metatarsal head is compatible with a radiograph of almost normal appearance.
BILATERAL CORACO-CLAVICULAR ARTICULATIONS IN THE AUSTRALIAN ABORIGINAL
Authors: Ray L. J.
Published: February 2018

1. A pair of clavicles and the corresponding scapulae were found to possess definite articular facets indicating the presence, in life, of a coraco-clavicular joint.

2. The bones are described and illustrated.

3. These cases are compared with others reported in the literature.
TREATMENT OF PARALYSIS OF THE FLEXORS OF THE ELBOW
Authors: Segal Anne , Seddon H. J. , Brooks D. M.
Published: February 2018

1 . Twenty-one cases of poliomyelitis and twenty cases of brachial plexus injury in which muscle transplantations had been performed to restore elbow flexion have been reviewed. The average follow-up period was four and a half years.

2. The results were graded objectively and subjectively. They were better when passive extension of the elbow was limited; such limitation always occurs after Steindler's operation, but infrequently after pectoral transplantation.

3. The results of pectoral transplantation are good when there is no significant shoulder paralysis; if there is shoulder weakness arthrodesis of the joint may be required to control medial rotation and adduction of the shoulder on flexion of the elbow. In brachial plexus lesions the results of pectoral transplantation may be marred by simultaneous contraction of the triceps. This can be overcome by transplanting triceps into the flexor apparatus. Triceps transplantation is rarely indicated because loss of active extension of the elbow is a grave disability.

4. Subjective results tended to be worse than objective results in brachial plexus lesions because impairment of sensibility in the hand often limited the usefulness of the limb. In striking contrast the subjective results were in general far better than the objective in patients who had had poliomyelitis. In them the smallest gain can be of functional value.
CORRECTION OF THE OUTWARDLY ROTATED LEG FROM POLIOMYELITIS
Authors: Pauker Emil
Published: February 2018

1. A method of correcting poliomyelitic lateral rotation deformity of the thigh by transplant of one or more of the hamstring muscles to the femur is described.

2. The results in seven cases are recorded.

3. Though it is emphasised that this is no more than a preliminary communication and the number of patients so treated is small, the satisfactory results suggest that the procedure is mechanically and physiologically sound.
STUDIES ON THE PATHOLOGY OF LOW BACK PAIN
Authors: Hirsch Carl
Published: February 2018

Disc degeneration starts as an avascular necrosis. In the lower lumbar area the discs deteriorate early because of mechanical stresses. During certain early periods of degenerative changes a mechanical disorder between the annulus and the posterior longitudinal ligament may cause tiredness and pain. When the disc is completely degenerated and has lost its physical properties backache disappears.
POSTERIOR FUSION OF THE SPINE FOR SCOLIOSIS
Authors: Winchester Ian W.
Published: February 2018

1. Posterior fusion of the spine in scoliosis cannot be relied upon to maintain correction of the curve or to prevent progression of a vicious resistant curve. It can, however, hold to some extent the correction of a mobile curve and the compensation of a fixed curve.

2. Despite generally poor results as assessed radiographically, the clinical improvement is often gratifying. Most patients claim to be greatly improved: the spine feels stronger, there is less fatigue, and balance is better controlled. Moreover, visible deformity may be improved markedly even though the anatomical correction as observed radiographically is slight (Figs. l0 and 11).

3. It is believed that the true cause of relapse is that the bone formed from sliver grafts remains immature for a long time. Even when incorporated with the immature bone of the child's spine or the mature bone of the adult spine, it remains soft and resilient. When subjected to the stresses and strains of weight bearing and gravity, and then to the unnatural forces which initiated or perpetuated the scoliosis, this immature bone undergoes remodelling to Wolff's Law—like the neck of the femur after slipping of the upper femoral epiphysis. The forces that alter the grafted bone are not only lateral forces but also—perhaps more important—rotational forces. There seems to be a definite link between the degree of rotation and the amount of relapse, correction being maintained best when rotation is least.
PHOSPHATASE ACTIVITY IN THE LIMB BONES OF GROWING RABBITS
Authors: Jeffree Grace M.
Published: February 2018

1. A quantitative study of phosphatase distribution in the limb bones of growing rabbits is reported.

2. Alkaline phosphatase is present in high concentrations in areas of deposition of new bone. Both local concentrations and the total alkaline phosphatase content of a bone are found to decrease with age. There is good correlation between total alkaline phosphatase activity and monthly increment of weight.

3. Acid phosphatase is present in these bones in greatly less concentrations than alkaline phosphatase.

4. The acid phosphatase of bone shows nearly full activity in the presence of 0·5 per cent formaldehyde. It can be subdivided into two enzymes with characteristically different distributions by the effect of M/100 tartrate on activity.

5. The formaldehyde-stable and tartrate-stable acid phosphatase of rabbit bone (FTS) has a distribution very similar to that of alkaline phosphatase, though very much less in amount, and, like the latter, declines in activity as the bone matures.

6. Tartrate-inhibited, formaldehyde-stable acid phosphatase (FSTI) is found mainly in red marrow and cancellous bone, and full activity persists in mature bone. This enzyme may be associated with resorption and remodelling of bone, or it may represent residual activity under these conditions of the acid phosphatase of developing erythrocytes in the marrow.
VERTEBRA PLANA (CALVÉ)
Authors: Weston W. J. , Goodson G. M.
Published: February 2018

1. A case of vertebra plana (Calvé) is described and serial radiographs throughout the course of the disease are presented.

2. The initial radiographs showed a vertebra of normal depth which collapsed to a thin disc in fifteen days. Since the symptoms had begun twelve days before the first examination the total time taken to reach this stage was twenty-seven days.

3. The literature has been reviewed for evidence of the underlying pathology of vertebra plana. In the case described biopsy of the affected vertebral body was not carried out, and thus the nature of the underlying change could not be determined.
EARLY DRAINAGE OF PARASPINAL TUBERCULOUS ABSCESSES IN CHILDREN
Authors: Karlen A.
Published: February 2018

The following preliminary conclusions seem possible.

1. In early cases of Pott's disease of the thoracic spine in children the treatment should include chemotherapy, recumbency and costo-transversectomy. An exception may be made if severe destruction has led to subluxation of the column, when more radical surgery is indicated.

2. Combination of conservative treatment with costo-transversectomy can prevent spread of the disease along the vertebral column, and can lead to regression of this "spondylitis anterior."

3. The abscess can be totally eradicated and the risk of recrudescence therefore diminished.
BILATERAL HEREDITARY MICRO-EPIPHYSIAL DYSPLASIA OF THE HIPS
Authors: Elsbach L.
Published: February 2018

1. A family is described of which several members in four generations suffered epiphysial growth disturbances of an unusual kind in the capital epiphyses of the femur, with shortness of stature.

2. This disorder forms one of a group of epiphysial growth disturbances which embraces several recognised disorders, whose effects on the epiphyses vary in severity. They may occur sporadically or they may be inherited as recessive or dominant characters.

3. Differentiation depends on the behaviour of the joint line–in other words, whether the epiphysis starts to show defects through inability to sustain the stress of weight bearing. In the most serious cases the picture is that of Morquio-Brailsford's disease; when the changes are less severe the appearance may be that of bilateral Perthes' disease. Differential diagnosis is no longer possible in later life, because the ultimate condition of the defective femoral heads is the same. Only in the hereditary cases is one able, by studying the capital epiphyses of the hip in childhood, to differentiate between the changes like those of Perthes' disease on the one hand, and micro-epiphysial dysplasia without necrosis on the other.
EARLY SKELETAL AND VASCULAR CHANGES IN RATS FED ON SWEET PEA (LATHYRUS ODORATUS) SEEDS
Authors: Amato V. P. , Bombelli R.
Published: February 2018

The main findings in this experimental work on rats fed on lathyrus odoratus (sweet-pea) meal are as follows:

1. Growth is retarded.

2. The growth plate is disorganised and normal ossification at the metaphysis is interfered with.

3. The small blood vessels are seriously affected and probably contribute quite largely to the disorganisation and lack of calcification.

4. Alkaline phosphatase activity is increased.

5. Raising of the periosteum and laying down of new bone result in exostoses. The possible underlying etiology and the role of cement substance, endocrine factors and the blood vessels are discussed.
THE PATHOLOGY OF SLIPPED UPPER FEMORAL EPIPHYSIS
Authors: Rennie A. M.
Published: February 2018

1. Epiphysial tilt commonly precedes slipping.

2. This tilt is due to a diminished or arrested growth from compression of the back of the epiphysial plate.

3. The stresses on the upper end of the femur are such that the upper femoral epiphysial plate is peculiarly liable to compression.

4. A primary abnormality of the cartilage of the epiphysial plate renders it susceptible to the effect of compression.

5. Because this abnormality is diffuse, deformities due to a similar pathology may be found elsewhere, notably in the spine.
THE SURGICAL TREATMENT OF SLIPPING OF THE UPPER FEMORAL EPIPHYSIS
Authors: Newman P. H.
Published: February 2018

Simple pinning to fix the epiphysis in those patients in whom the position is acceptable is a valuable surgical procedure. It is safe and gives good results. It eliminates the danger of further displacement, promotes fusion of the epiphysial plate and allows the patient to return to full activity within one month, thus avoiding joint stiffness, muscle atrophy, osteoporosis and interference with growth at other sites.

Fixation by small pins is preferable to the use of the trifin nail, the latter giving excessive trauma and predisposing to subtrochanteric fracture. Gentle replacement of the epiphysis, when loose, into an acceptable position is a valuable method of treatment. It is essential that replacement is not undertaken by force.

The problem of major displacement of the epiphysis which cannot be so replaced is unsolved. Conservative treatment in this group is useless and harmful. Intra-articular osteotomy can give good results in most cases but is risky and may cause stiffening of the hip. Subtrochanteric osteotomy does not give a good anatomical result but in most cases the function of the hip is satisfactory.

Slipping of the upper femoral epiphysis, however slight, should be regarded as a surgical emergency.
DIAMETRIC FRACTURES OF THE PELVIS
Authors: Dommisse G. F.
Published: February 2018

1. The strength of the pelvic arch depends on the integrity of the anterior interpubic ligament, whose strength has been demonstrated by dissections. Once that ligament is divided the sacro-iliac ligaments offer little resistance to opening out of the pelvis.

2. The structure of the pelvis and hips is compared to an arcade formed by a central and two lateral arches. The weight of the trunk is transmitted to the lower limbs through this arcade.

3. Fractures of the pelvis are classified according to the mechanism of production. The case for anatomical reposition and internal fixation is stated, and case histories are given to illustrate the disabilities due to persistent deformity.

4. Reduction can be achieved as late as two or three weeks after injury. However, if early operation for visceral injury is necessary, there is a strong case for combining this with open reduction and fixation. In some cases the patient's general condition may preclude such procedures, but more usually the additional manipulations cause little additional operative shock and are fully justified by the subsequent increased comfort of the patient and the greater ease of nursing.
NEONATAL SCIATIC PALSY FROM INJECTION INTO THE UMBILICAL CORD
Authors: Shaw N. E.
Published: February 2018

1. Three new cases of neonatal sciatic palsy are reported in twins. They received identical treatment after birth; in the case of the first two for identical difficulties occurring after delivery. In twins there is a greater liability to neonatal shock and so a greater incidence of umbilical injections.

2. The clinical evidence and the necropsy findings in Case 3 support the hypothesis that intra-arterial thrombosis is caused by the injection of an analeptic into the umbilical artery.

3. The clinical picture is described, with a discussion on the pathology, treatment and the reason for recovery in some cases.
EXTRA CENTRE OF OSSIFICATION FOR THE MEDIAL MALLEOLUS IN CHILDREN
Authors: Powell H. D. W.
Published: February 2018

1. Two boys complaining of pain in the ankle were shown to have centres of separate ossification for the medial malleoli. These were present bilaterally, but discomfort was unilateral.

2. In one, followed for fifteen months, the extra centre became wholly incorporated into the normal lower tibial epiphysis.

3. in a series of 100 children between the ages of six and twelve, without any known disease or injury of the ankles, radiographs showed that 20 per cent had a separate medial malleolar centre on one side. In 13 per cent this finding was present bilaterally. In one child a separate lateral malleolar centre was also found.

4. The significance of this finding is discussed, and it is considered to be a normal variant.

5. Occasionally one of these centres may remain unfused into adult life. Attention is drawn to the possible implications of this persistence.
THE CHEMICAL BACKGROUND OF INTERVERTEBRAL DISC PROLAPSE
Authors: Mitchell P. E. G. , Hendry N. G. C. , Billewicz W. Z.
Published: February 2018

Two groups of intervertebral discs, one normal, as obtained from the post-mortem room, the other prolapsed, as removed at operation, have been compared by chemical analysis of their principal constituents. There is a progression of chemical changes associated with the ageing of the normal disc. This shows not only the expected slight increase in collagen as age advances, but also, surprisingly, that the polysaccharide content rises to a maximum in the fourth decade, in the same way as does polysaccharide in costal cartilage. In prolapsed discs the ageing process is superseded by a different and distinctive progression, which advances, not according to age, but according to the duration of the prolapse. There is a critical level to which the polysaccharide content must apparently fall, irrespective of the normal level for the patient's age, before a prolapse occurs. Normal ageing probably consists in the breakdown of a particular polysaccharide/protein linkage, with coincident "maturation" of collagen. In the prolapsing disc multiple, and possibly different, linkages are rapidly broken down. This depolymerisation of a gel structure must be presumed to be the basis of the decreased imbibition capacity of the nucleus pulposus, and to be the source of the hydrostatic abnormalities which result in disc prolapse.

In both normal and prolapsing discs the products of mucopolysaccharide breakdown appear to participate in the metabolism of collagen.
FRACTURE MECHANICS
Authors: Alms Michael
Published: February 2018

1. Linear fractures of the shaft of the long bones are divided into four basic types: 1) transverse; 2) oblique transverse; 3) spiral; and 4) oblique.

2. The mode of production of these fractures is deduced on the grounds of simple mechanical theory: 1) transverse fractures are a result of angulation; 2) oblique transyerse are the result of angulation with axial loading; 3) spiral fractures are the result of axial twists with or without axial loading; 4) oblique fractures are the result of angulation and axial twisting in the presence of axial loading.
TRAUMATIC DISLOCATION OF THE HIP IN CHILDHOOD
Authors: Piggot J.
Published: February 2018

1. Nine cases of traumatic dislocation of the hip in children have been reviewed.

2. There was one instance of avascular necrosis of the femoral head, which became apparent six months after injury.

3. In one case fracture of the femur on the same side led to four days' delay in recognition and treatment of the dislocation.

4. At the time of review all patients were free from symptoms.
TRAUMATIC DISLOCATION OF THE HIP WITH FRACTURE OF THE SHAFT OF THE IPSILATERAL FEMUR
Authors: Wadsworth Thomas G.
Published: February 2018

1. A brief summary is given of the literature on patients with a dislocated hip and a fractured femur on the same side.

2. One further patient is reported, treated by closed reduction of the hip and the fracture.

3. A warning is given on the frequency with which the dislocation is not diagnosed in this double injury.
CRYPTOCOCCOSIS (TORULOSIS) OF BONE
Authors: Durie E. Beatrix , MacDonald L.
Published: February 2018

1. A case of cryptococcosis (torulosis) of bone is described.

2. The diagnosis was established by microscopical examination of pus and culture of the organism.

3. The literature is briefly reviewed.
ELECTRODIAGNOSIS
Authors: Parry C. B. Wynn
Published: February 2018

1. The results of electrodiagnostic tests reveal the level and progress of nerve lesions.

2. The findings in a myopathic lesion are: a) a normal SD curve; b) no fibrillation on the E.M.G.; c) on volition a full interference pattern-because motor units have not been lost, but only muscle fibres within the units; d) the action potentials are short in duration, polyphasic and of low amplitude; e) conduction times are normal.

3. In peripheral nerve affections these findings are evidence of denervation: a) a sluggish response to a long duration current; b) a kinked SD curve; c) fibrillation at rest on the E.M.G.; d) a reduced interference pattern of motor unit action potentials on volition; e) a preponderance of polyphasic action potentials of long and short duration; f) slowing of conduction times.

4. Evidence of reinnervation is given by: a) a kink in the SD curve; b) the appearance of a response in the muscle to nerve stimulation; c) a progressive increase in conduction velocity; d) the appearance of polyphasic action potentials on volition; e) fibrillation becoming more difficult to detect.

5. The following findings suggest a lesion of the anterior horn cell: a) difficulty in detecting fibrillation, and a relatively normal SD curve in the presence of marked wasting. (Intact axons have "mopped up" denervated fibres.) b) Marked reduction in interference pattern with ‘giant units’. c) Normal conduction velocity.
MADURA FOOT
Authors: Oyston J. K.
Published: February 2018

1. Twenty cases of mycetoma pedis are described.

2. Most patients had the disease in an early stage and were cured by simple excision.

3. The importance of early diagnosis and treatment in order to avoid amputation is emphasised.
A CASE OF NEUROPATHIC ARTHRITIS CAUSED BY INDIFFERENCE TO PAIN
Authors: van der Houwen H.
Published: February 2018

1. A twenty-five-year-old man who developed neuropathic arthritis because of indifference to pain is described. He presented at the age of thirteen with degenerative changes in the light knee with analgesia only in the right leg below the knee.

2. A painless fracture of the ulna developed non-union and was associated with a neuropathic arthritis of the elbow joint.

3. Later the other knee and the lumbo-sacral spine became affected. The analgesia became generalised with all other senses staying intact. Apart from tonic pupillary reactions and diminished corneal sensibility no other neurological signs could be found.

4. A deceased sister may also have suffered from the same condition.
CAUSES OF FAILURE AFTER REPAIR OF THE MEDIAN NERVE
Authors: Mackenzie I. G. , Woods C. G.
Published: February 2018

1 . The clinical results in forty cases of repair of the median nerve at the wrist have been examined. Almost half were unsatisfactory.

2. The factors that may have predisposed to failure of adequate re-innervation are discussed.

3. The results might be improved by the use of radio-opaque markers for early detection of separation at the suture line, and by the use of frozen sections to determine the adequacy of resection.
REGIONAL OSTEOPOROSIS IN OSTEOLD OSTEOMA
Authors: Spence A. J. , Lloyd-Roberts G. C.
Published: February 2018

1. Regional osteoporosis is a common finding in osteoid osteoma. It may in fact be a constant feature because it was present in all the patients reported in this paper and was suspected in others who have not been included in this report because of insufficient information.

2. Five of our six cases showed osteoporosis about the hip. Osteoporosis is more likely to be noticed in this region than in other parts of the extremities because both hips are usually radiographed on one film. We have seen several instances in which we suspected generalised osteoporosis of an extremity but Case 5 was the only one in which comparable radiographs had been taken of both feet.

3. When there is osteoporosis in the region of a joint with symptoms referred to that joint an osteoid osteoma may be the cause. The nidus may lie at some distance from the joint surfaces and may not be seen in standard radiographs of the joint (Case 4). Additional radiographs including a wider area than usual may be necessary to show the lesion, and tomography is sometimes required.
DELAYED OPERATION IN THE OPEN REDUCTION OF FRACTURES OF LONG BONES
Authors: Charnley John , Guindy Adly
Published: February 2018

1. The findings in this series of fractures of the shaft of the femur treated by intramedullary nailing confirm the observation of Smith (1959) that the incidence of non-union is significantly diminished when operative intervention is postponed more than one week from the time of the injury.

2. The series is too small to afford conclusive proof, and it offers no explanation of the opposite findings of Smith and Sage (1957), but it indicates that this very important aspect of the operative treatment of fractures ought to be submitted to thorough investigation by many more observers.
FRACTURES OF THE FOREARM TREATED BY RIGID FIXATION
Authors: Hicks J. H.
Published: February 2018

1. A series of fractures of the forearm has been treated by exceptionally rigid internal fixation with a special plate and screws.

2. The plate and screws are described.

3. The results of rigid fixation are found to be: i) reliability of union, and ii) good final function.

4. The lessons learned regarding the application of the plate and the after-treatment of the forearms are recounted.
THE ETIOLOGY OF CHONDROMALACIA PATELLAE
Authors: Outerbridge R. E.
Published: February 2018

1. Chondromalacia of the patella starts most frequently on the medial facet.

2. The anatomy of the medial femoral condyle is described, including the rim at its superior border, and the different arrangement at the upper border of the lateral femoral condyle.

3. Rubbing of the medial patellar facet on the rim at the upper border of the medial femoral condyle can explain in part the etiology of chondromalacia.
LOCKING OF THE METACARPO-PHALANGEAL JOINTS
Authors: Goodfellow J. W. , Weaver J. P. A.
Published: February 2018

1. Five cases of locked metacarpo-phalangeal joint are described.

2. The anatomy of this joint is described and its bearing on the mechanism of locking discussed.

3. A method of treatment is suggested.
RUPTURE OF THE AXILLARY ARTERY COMPLICATING ANTERIOR DISLOCATION OF THE SHOULDER
Authors: Johnston G. W. , Lowry J. H.
Published: February 2018

1. A case is described ofcomplete rupture ofthe second part of the axillary artery complicating anterior dislocation of the shoulder in a woman aged fifty years.

2. Interesting features were that the patient was comparatively young, that the rupture was a result of the dislocation and not of the reduction, that the axillary vein remained intact, and that a satisfactory circulation returned after ligation of the artery.
STUDIES IN THE TRANSPLANTATION OF BONE, III. The Immune Responses of Lymph Notes Draining Components of Fresh Homologous Cancellous Bone and Homologous Bone Treated by Different Methods
Authors: Burwell R. Geoffrey , Gowland G.
Published: February 2018

1. The antigenicity of cancellous bone has been investigated in ninety-seven rabbits.

2. The immune responses of lymph nodes draining fresh homografts of cancellous bone (Burwell and Gowland 1961b) has been used as a histological indicator of the antigenicity of components of fresh homologous cancellous bone and also of the antigenicity of homologous bone subjected to a variety of physical or chemical treatments.

3. The principal antigenic component of a fresh homograft of iliac cancellous bone is the nucleated cells of the red marrow.

4. Homologous marrow-free cancellous bone does not usually produce cytological evidence of an immune response in the lymph node draining the graft, unless new homograft bone formation occurs.

5. The treatment of marrow-containing cancellous bone by boiling, freezing at - 20 degrees Centigrade, freeze-drying, irradiation or by merthiolate solution impairs the transplantation antigenicity of the tissue as a homograft.

6. The immersion of cancellous bone in a glycerol-serum-Ringer solution which is then slowly cooled to - 79 degrees Centigrade, stored for one week and then rapidly thawed, allows considerable preservation of the antigenicity of the red marrow.

7. Knowledge concerning the antigenicity of fresh and treated homologous bone is discussed.

8. Evidence is presented to show that the large and medium lymphoid cell response of lymph nodes draining homografts is due principally to the T-antigens, rather than H-antigens, of the grafts.

9. The changes which occur in the first regional lymph nodes draining tissue homografts may provide another test system to assess the transplantation antigenicity of foreign tissues or extracts of foreign tissues other than bone.
DIAGNOSIS AND TREATMENT OF CONGENITAL DISLOCATION OF THE HIP JOINT IN THE NEW-BORN
Authors: von Rosen Sophus
Published: February 2018

1. Congenital dislocation of the hip can be diagnosed clinically immediately after birth and the diagnosis confirmed radiologically by a special technique.

2. If the affected joint is reduced during the first two or three days after birth and held reduced for a period not exceeding three months, the joint will remain stable.

3. This treatment probably leads to normal development of the hip joint.

4. The cause of congenital dislocation of the hip may be laxity of the soft tissues of the joint and not a primary dysplasia of the acetabulum.
MEDULLARY NAILING FOR FRACTURE OF THE SHAFT OF THE TIBIA
Authors: Alms Michael
Published: February 2018

1. A method of medullary nailing of fractures of the shaft of the tibia with a straight clover-leaf nail of large calibre is described. The nail is introduced, without exposure of the fracture, through the deep infrapatellar bursa. No external splint is used and the patient is usually allowed to walk as soon as the wound is healed. The technique is essentially that of Küntscher.

2. The results obtained in the first fifty patients so treated are described. The average period of absence from work for those twenty-five whose treatment was satisfactory was eleven weeks. There were no cases of sepsis or non-union; the only difficulties encountered were mechanical ones.
CHANGES IN DENSITY OF THE HUMAN FEMORAL CORTEX WITH AGE
Authors: Atkinson P. J. , Weatherell J. A. , Weidmann S. M.
Published: February 2018

1. Discs of bone from two fixed sites on the front of the femur were taken from ninety-one necropsy subjects and the density, width and histological appearance of the cortical bone were examined.

2. Cortical thickness, and the density of the femoralcortex, decreased with increasingage of bone.

3. There was an increase in the rate of resorption of the bone cortex from both sexes after the fifth decade.

4. The difference between the density of the metaphysial cortex and that from the diaphysis increased for both sexes after the age of fifty, because of the greater metaphysial resorption.

5. There was no change in the degree of mineralisation of the cortical bone with age. The decrease in density with age is, therefore, accounted for by resorption.
CHONDROECTODERMAL DYSPLASIA
Authors: Ellis R. W. B. , Andrew J. Douglas
Published: February 2018

1. Two cases are reported showing the syndrome of chondrodysplasia, manual polydactyly, ectodermal dysplasia affecting the teeth and nails, and congenital heart disease.

2. Particulars of thirty-eight cases are tabulated, and the features of the syndrome are discussed.

3. The syndrome is regarded as showing an autosomal recessive mode of inheritance.
INTRAOSSEOUS GLOMUS TUMOURS
Authors: MacKenzie D. H.
Published: February 2018

Two cases of intraosseous glomus tumour of a terminal phalanx are described and the literature is reviewed.
THE "HALO" TRACTION APPARATUS
Authors: Thompson Harral
Published: February 2018

1. The "halo" traction apparatus and its method of application are described in detail.

2. Its use in nine patients with subluxation or fracture-dislocation of the cervical spine, and in one patient with extensive vertebral disease, is recorded.

3. The indications for using the "halo" traction apparatus are outlined.
LUBRICATION WITHIN LIVING JOINTS
Authors: Barnett C. H. , Cobbold A. F.
Published: February 2018

1. By the use of a device that allows movement of a human finger joint to take place uninfluenced by muscle activity, the coefficient of friction has been determined between living articular surfaces.

2. The force of friction rises as the range of movement is increased, because of the tension then developing in the ligaments and the soft tissues surrounding the joint.

3. Measurements have also been made of the forces of friction within the ankle joint of the dog and within four types of reciprocating bearings (plastic, oil-lubricated, "floating" and hydrostatic).

4. By altering the load borne by the joints and bearings it has been shown that joints resemble in their behaviour those bearings in which a film of fluid is maintained between the fixed and moving surfaces, rather than bearings depending wholly or in part on boundary lubrication.

5. It is suggested that joints normally owe their great freedom of movement to a special type of fluid film lubrication that has been termed "weeping lubrication," supplemented by "floating lubrication," though on occasions boundary conditions may prevail.
OSTEITIS PRODUCED EXPERIMENTALLY IN MICE BY THE VIRUS OF TICK-BORNE ENCEPHALITIS
Authors: Markowa Janina
Published: February 2018

Experiments on white mice were undertaken to determine the reaction of bone to the intramedullary introduction of the virus of tick-borne encephalitis. The following conclusions were drawn.

1. The tick-borne encephalitis virus S47, when introduced intraosteally in white mice, provokes osteitis.

2. Inflammation may lead to acute necrosis of bone, preceded by marked medullary oedema and subsequent proliferation, or it may take a milder form with haemorrhagic effusion into the marrow tissue and subsequent hyperplasia of connective tissue.

3. Damage to the epiphysial and articular cartilage may ensue in the course of acute necrotic osteitis.

4. Skeletal and extra-skeletal osteogenesis is a characteristic feature of viral osteitis.

5. In radiographs in acute viral osteitis with extensive necrosis the expanded bone appears to be thickened.

6. Viruses of the S47 strain introduced intraosteally preserve their affinity for brain tissue after three passages through bone.

7. Viruses introduced into the bony tissue preserve their toxicity and are found in the bony tissue after ten days in quantities lethal for young mice when inoculated intracerebrally.

8. The tick-borne encephalitis virus S47 is pathogenic when inoculated into the marrow in white mice.

9. In osteitis of non-bacterial origin in man the possibility of viral infection should be considered.
OS INTERMETATARSEUM AND A POSSIBLE RELATIONSHIP TO HALLUX VALGUS
Authors: Henderson Robert S.
Published: February 2018

1. A group of cases is presented in which the os intermetatarseum took the form of an intermetatarsal spur, from which (in members of one family) there arose a tendon-like structure whose distal attachment was to the lateral aspect of the proximal phalanx of the great toe. The suggestion is made that this may represent a lost first plantar interosseous muscle.

2. Another effect of the presence of an os intermetatarseum is the production of metatarsus primus varus by its action as a wedge which spreads apart the bases of the two metatarsal bones. A very small wedge may at times produce considerable deviation (Case 4), and resection of the os can result in satisfactory correction.

3. It is also felt that over-development of extensor hallucis brevis may at times contribute to the formation of hallux valgus.
RETROSTERNAL DISLOCATION OF THE CLAVICLE
Authors: Tyer H. D. D. , Sturrock W. D. S. , Callow F. McC.
Published: February 2018

Retrosternal dislocation of the clavicle is an uncommon yet easily induced injury which may cause grave disability. Manipulation is rarely successful and usually open reduction with stabilisation of the joint is required. The literature on this subject is reviewed and an additional two cases are reported.
A STUDY OF THE NUTRIENT FORAMINA OF THE HUMERAL DIAPHYSIS
Authors: Carroll S. E.
Published: February 2018

The nutrient foramina in seventy-one adult humeri were examined. The foramina were most concentrated in a small area on the medial aspect of the distal half of the middle third of the shaft. Non-union commonly occurs in this same region. The site of the entrance of the nutrient artery to the humerus is predictable with fair reliability. Certain practical applications have been indicated.
THE TREATMENT OF RELAPSED CLUB FOOT BY THE INSERTION OF A WEDGE INTO THE CALCANEUM
Authors: Dwyer F. C.
Published: February 2018

1. In a club foot the small inverted and elevated heel is considered to be the most important deforming influence in preventing complete correction and in promoting relapse.

2. Correction of the varus and an increase in the vertical height of the heel are achieved by opening up the medial aspect of the calcaneum and inserting a wedge of bone. This abolishes the inverting action of the calcaneal tendon and brings the heel down on to the ground directly under the line of the tibia so that it touches first in walking. The weight is then shifted on to the forefoot, as in the normal gait, thus producing gradual correction of supination and adduction.

3. The operation may have to be repeated, but with the varus fully corrected and a plantigrade heel there is no chance of relapse, and progressive improvement, not only in gait and shoe wear but also in the development of the foot and leg, can be expected.

4. Skin closure is a difficulty, and though the resulting scar is sometimes conspicuous, it is masked to some extent by being on the postero-medial aspect of the ankle.

5. The ideal age for the operation is about three to four years, but there is virtually no upper age limit.

6. In older patients presenting severe residual deformity it may be necessary to correct the heel and then the equinus of the forefoot by a tarso-metatarsal wedge, thus avoiding damage to the mid-tarsal and subtalar joints.

7. By adopting these principles, soft-tissue release operations, so often disappointing and sometimes damaging, can be avoided and in no patient should there ever be the need to resort to the mutilating "triple wedge" resection.

8. The most important feature of the operation is correction of the varus; it is better to over-correct than to under-correct (Figs. 20 and 21). It is a simple matter to deal with the valgus later if necessary.
PATHOLOGICAL OSSIFICATION IN TRAUMATIC PARAPLEGIA
Authors: Hardy A. G. , Dickson J. W.
Published: February 2018

1. Ectopic ossification is commonest in, but not confined to, traumatic paraplegia. It occurs also in many other neurological disorders which have in common a gross disturbance of spinal cord reflex activity. It is a true ossification and must be distinguished from calcification.

2. The neurological lesion may lie anywhere from the cerebral cortex to the mixed peripheral nerve. It may involve motor tracts, sensory tracts or a mixture of both.

3. The ossification is localised and self-limiting. It occurs mainly in the lower limbs and is restricted to certain muscles or muscle groups, the nerve supply of which is always below the level of the central neurological lesion.

4. The blood chemistry is usually normal.

5. A true arthropathy is rare except as part of a secondary suppurative arthritis.

6. The resemblance to myositis ossificans progressiva or to ossifying haematoma is only superficial, although the pathological process at cellular level may be the same.

7. The period of onset after paraplegia is variable. The earliest recorded example is in one of our own cases in which ossification occurred nineteen days after injury. Other patients have developed ossification after several years.

8. The condition is commonest in acquired nervous disease rather than in congenital disorders, and so far as we know it has not been described in the myopathies. The presence of muscular spasticity or flaccidity is relevant only in that it indicates a disturbance of reflex activity.

9. Soft-tissue ulceration appears to be frequently associated with ectopic ossification. The type of new bone formation associated with large chronic ulcers is not to be compared with the new bone formation in the muscles of a paraplegic patient in otherwise good general condition.

10. The occurrence of urinary tract infections with calculi and generalised sepsis is not specifically related to the onset of new bone formation.

11. Localised soft-tissue oedema often precedes the formation of new bone. Its appearance is undoubtedly important, but the mechanism of its origin is obscure.

12. It is not yet known what initiates ectopic ossification, what limits its spread and what finally causes it to stop.

13. We have described 100 examples of ectopic ossification in 603 paraplegic patients.

14. Surgery has been required in only eight patients. The only indication for surgery is bony ankylosis of the hip in an unacceptable position.
REHABILITATION AFTER FRACTURES OF THE SHAFF OF THE FEMUR
Authors: Nichols P. J. R.
Published: February 2018

1. The results of rehabilitation of 181 patients with fractures of the shaft of the femur are analysed

2. The results are mainly dependent on the severity of the fracture and the method of reduction and immobilisation. It is stressed that full-time rehabilitation can help to attain the best results.

3. The advantages of intramedullary nailing of fractures of the femoral shaft are discussed.
MAJOR ARTERIAL INJURY COMPLICATING FRACTURE OF THE FEMORAL SHAFT
Authors: Kirkup J. R.
Published: February 2018

1. Three cases of injury to the femoro-popliteal artery complicating fracture of the femoral shaft are described.

2. In all three cases restoration of peripheral circulation by arterial repair carried out within ten hours of injury succeeded in saving the limb from permanent damage.

3. The importance of adequate resuscitation, early diagnosis and early adequate surgical intervention is stressed.

4. The mechanism of injury and the clinical features of help in early diagnosis are discussed.

5. The place of internal fixation of the femoral fragments is discussed and its advantages and disadvantages are compared with those of treatment by skeletal or skin traction.
THE ROLE OF THE VESSELS IN OSTEOGENESIS
Authors: Trueta J.
Published: February 2018

We have attempted to summarise in a short space investigations that have occupied several years, and we realise that whatever the merits of such an effort the results can only be modest. Many important aspects of the osteogenetic process still remain a mystery and thus are subjected to theory and controversy. Such is the case with this constant attendant at osteogenesis which is alkaline phosphatase. But of one thing we are certain, namely that bone is an organised "soft" tissue of which only part has been made rigid by the deposit of calcium salts. The organiser is the osteogenetic vessel from which springs the syncytial frame of cells and their connections on which the bone architecture is established. Endothelial cell, intermediate cell, osteoblast, osteocyte, osteoclast; these constitute the normal sequence of cellular phylogeny in the constant elaboration and removal of the bone substance. The initial cells on which the whole process rests are those of the capillary-sinusoid vessel which is responsible for providing the transudates on which the life and health of the whole syncytium depends.

If our findings were confirmed, a better understanding of the nature and characteristics of primitive malignant bone tumours would be possible. Each type of tumour from endothelioma to malignant osteoclastoma, including reticulum-cell sarcoma and osteogenic sarcoma, would be initiated by a different cell of the syncytium, but in its monstrous deviation from the normal would still preserve most of the characteristics of its healthy ancestor. Thus the endothelioma causes bone expansion, bone reaction and even bone necrosis, but not proper bone formation, whereas the osteogenic sarcoma or osteoblastoma forms bone; and with the same fidelity to their origin osteoclasts are seen in the malignant osteolytic tumour.

Over thirty years ago the late Sir Arthur Keith (1927) expressed his suspicion that the cells which assume a bone-forming role are derived from the endothelium of the capillary system. We hope we have contributed to show that his suspicion was right.
PROGNOSIS IN SUPRACONDYLAR FRACTURES
Authors: Mann T. S.
Published: February 2018

1. During two years eighty-five children with supracondylar fractures of the humerus were admitted to a children's hospital. This paper is a study of the severe fractures which occurred in twenty-three children of whom fifteen had a deformity at review.

2. The only deformity found after treatment by closed manipulation was an alteration in the carrying angle. It is considered that cubitus varus was caused by medial angulation of the distal fragment.
CONGENITAL HYPOPLASIA OF THE UPPER FEMUR
Authors: Lloyd-Roberts G. C. , Stone K. H.
Published: February 2018

1. The surgical management of two children with congenital hypoplasia of the upper end of the femur is described.

2. Early exploration is advocated to establish the nature and extent of the anomaly and to attempt its correction.

3. The preliminary results are sufficiently encouraging for us to recommend that further attempts at surgical treatment be considered in patients with this disorder.
EOSINOPHIL GRANULOMA OF BONE IN TWO ADJACENT THORACIC VERTEBRAE
Authors: Gibson R. Myles , Eisen A. A.
Published: February 2018

A case of eosinophilic granuloma of bone in a man of thirty-three, involving the tenth and eleventh thoracic vertebrae, is described. The presenting symptom was pain and he had spinal compression with spastic paraparesis. Improvement followed operation. The operative findings and the histological features are described. The literature and the unusual features of this case are discussed.
THE ARTERIAL PATTERN OF THE ROTATOR CUFF OF THE SHOULDER
Authors: Moseley H. Fred , Goldie Ian
Published: February 2018

Study of the morphological pattern of the arteries in the rotator cuff does not produce any evidence that the "critical zone" for ruptures and calcified deposits is much less vascularised than any other part of the tendinous cuff. This work, however, does show conclusively that the "critical zone" of the rotator cuff corresponds to the zone of the anastomoses between the osseous and tendinous vessels. Age does not seem to have a decisive influence on the morphology of the vascular pattern.
OSTEOCHONDRITIS OF THE HUMERAL CAPITULUM
Authors: Smith M. G. H.
Published: February 2018

1. Two boys with osteochondritis of the humeral capitulum are described.

2. Similarities between this condition and Perthes' disease are noted.

3. From a review of the reported cases it is concluded 1) that osteochondritis of the capitulum occurs almost exclusively in boys between the ages of four and ten years; 2) that treatment and immobilisation are unnecessary; and 3) that advanced maturation of the epiphysis of the radial head is a possible sequel.
ARTERITIS AND LOCALISED PERIOSTEAL NEW BONE FORMATION
Authors: Ball J. , Grayzel A. I.
Published: February 2018

1. Three patients with localised periosteal new bone formation associated with periosteal arteritis and other evidence of systemic lupus erythematosus are described.

2. Systemic steroid therapy was valuable in the management of this condition.
THE ETIOLOGY OF QUADRICEPS CONTRACTURE IN CHILDREN
Authors: Lloyd-Roberts G. C. , Thomas T. G.
Published: February 2018

1. Six cases of quadriceps contracture in children are described. All were either premature or suffered severe illnesses soon after birth.

2. Some additional information is given about cases of the same condition previously published by other authors.

3. It is suggested that injections and infusions given to newborn babies are sometimes the cause of the condition.

4. Some of the therapeutic substances and measures which may be responsible are discussed. These include antibiotics, vitamin K preparations and "subcutaneous" fluid therapy.
FAMILIAL OCCURRENCE OF OSTEOCHONDRITIS DISSECANS
Authors: Stougaard J.
Published: February 2018

1. A family, in which ten members of the second and third generations had osteochondritis dissecans, is described.

2. It is probable that the disease also occurred in the first and fourth generations.