bluuebunny/crossref_metadata_2025 huggingface dataset:
CRUSH FRACTURES OF THE LATERAL TIBIAL TABLE
Authors: Porter B. B.
Published: February 2018

1. Sixty-eight crush fractures of the articular surface of the lateral tibial condyle have been analysed.

2. Follow-up examination at a minimum of three years after injury was carried out in all cases.

3. The only factors which appeared to influence the results were the extent of the original depression, and if this was severe, the degree of restoration obtained by the treatment. Prolonged plaster fixation was avoided.

4. At review, no patient complained of symptoms which were attributable to damage to ligaments or menisci and no patient had symptoms of late onset.

5. The results suggest that there is nothing to be gained by open reduction if the lateral condyle is depressed by less than 10 millimetres, as conservative treatment gives good results. If the depression is more severe, however, a good result can only be assured if the articular surface is successfully reconstituted, but this is sometimes difficult to achieve. It is not possible to reconstitute the surface by non-operative means.
FAT EMBOLISM: AN AID TO DIAGNOSIS
Authors: Gurd Alan R.
Published: February 2018

1. A diagnostic procedure is described which is specific for fat embolism. It allows identification of the pathological fat globules On a stained slide.

2. The amount of pathological fat can be estimated by comparing the serum triglyceride levels before and after filtration.

3. The method is simple, reproducible and inexpensive.
HYPEREXTENSION INJURIES OF THE SPINE
Authors: Burke David C.
Published: February 2018

1. The literature on hyperextension injuries of the spine is briefly reviewed.

2. Such injuries in the cervical spine can be subdivided into five groups based on the pathological anatomy, based on the experience of fifty-one patients in the Spinal Injuries Centre for Victoria over the past five years.

3. Extension injuries of the thoraco-lumbar spine are discussed. They are rare and have a poor prognosis.

4. The importance of treatment based on sound clinical and pathological knowledge is emphasised, particularly in order that stable and unstable lesions may be recognised early and managed correctly.
CHONDROMYXOID FIBROMA (FIBROMYXOID CHONDROMA) OF BONE
Authors: Schajowicz Fritz , Gallardo Hector
Published: February 2018

1. A series of thirty-two cases of chondromyxoid fibroma is reported.

2. The clinical, radiographic and pathological features are described.

3. The rarity of the tumour and of malignant change is stressed.

4. Excision or block resection is preferred to curettage as a method of treatment, because of the liability to recurrence after curettage.

5. It is suggested that the designation "fibromyxoid chondroma" is more appropriate than the usual designation "chondromyxoid fibroma".
SPONTANEOUS ANTERIOR FUSION OF VERTEBRAL BODIES
Authors: Butler R. Weeden
Published: February 2018

1. Five patients are reported in whom osteochondritis is shown to have given rise to anterior intervertebral fusion.

2. It is suggested that anterior intervertebral fusion discovered in radiographs of adult spines may arise from osteochondritis rather than from a congenital abnormality or infection.
DISAPPEARING BONE DISEASE WITH ARTHROPATHY AND SEVERE SCARRING OF THE SKIN
Authors: White Augustus A.
Published: February 2018

Four cases are presented of patients seen in a leper colony in South Vietnam. The patients presented with evidence of osteolysis, arthropathies and severe scarrings of the skin. They were without pain and in generally good health. There were no neurologic or vascular deficit. They had positive serological tests for syphilis. Other known types of osteolysis are discussed including leprosy and the treponemal diseases, and the cases are presented as a previously undescribed entity.
HISTIOCYTOSIS X
Authors: Cheyne C.
Published: February 2018

1. The clinical, histological and radiological findings in 129 cases of histiocytosis X have been reviewed and the natural history of the disease is discussed.

2. Certain clinical and histological factors emerge as having prognostic significance.

3. The treatment in thirty-four personally reviewed cases is discussed and some suggestions are made as to the treatment of particular types of case.
PYOGENIC INFECTION OF THE SPINE
Authors: Griffiths H. E. D. , Jones D. M.
Published: February 2018

1. Twenty-eight patients with pyogenic infection of the spine are reported.

2. Diagnosis was by clinical, radiological and bacteriological means. Investigations of the spinal lesions by needle aspiration or open operation was needed in four patients.

3. Treatment consisted primarily of antibiotics and rest.

4. Twenty-five patients were fit and well after follow-up of one to fifteen years. Three deaths occurred, but only one was directly connected with the infection ; urinary infection with paraplegia and haemophilia were the cause in two others.

5. The relatively benign course is stressed, as are some of the diagnostic pitfalls in the early stages, particularly with thoracic lesions.
INTERNAL FIXATION FOR SUPRACONDYLAR FRACTURES OF THE FEMUR IN THE ELDERLY PATIENT
Authors: Brown Austin , D'Arcy J. C.
Published: February 2018

1. A method of internal fixation for the supracondylar fracture of the femur in the elderly patient is presented.

2. The fixation obtained allows the unsupported use of the limb and early partial weightbearing. Convalescence is thereby considerably shortened.

3. The disappointing results of internal fixation previously reported can be largely related to poor methods of fixation.
COLLAGEN SYNTHESIS IN MATURE ARTICULAR CARTILAGE OF THE RABBIT
Authors: Repo Raimo U. , Mitchell Nelson
Published: February 2018

1. The utilisation of labelled proline in normal and injured mature rabbit articular cartilage has been studied and compared simultaneously in one phase of the study with radiosulphate utilisation. The morphologic features of lacerative injury paralleled those reported previously.

2. Labelled proline is actively utilised by mature articular cartilage and can be recovered in time from the matrix as labelled hydroxyproline. This is taken as evidence of collagen synthesis.

3. Evidence is presented to suggest that the rate of formation of labelled hydroxyproline may be augmented after lacerative trauma.

4. Parallel utilisation of radiosulphate and labelled proline suggests that the synthesis of chondromucoprotein and collagen are closely related and that the continual synthesis of both moieties is necessary for the maintenance of normal matrix.

5. Despite evidence of increased chondromucoprotein and collagen synthesis no significant contribution is made to the healing of lacerative defects in mature rabbit articular cartilage.
LUMBO-SACRAL SUBLUXATION
Authors: Dandy D. J. , Shannon M. J.
Published: February 2018

1. Forty-six cases of congenital spondylolisthesis (Newman's Group 1) have been studied. The diagnostic criteria were lumbo-sacral subluxation, deficient development of sacral neural arches and superior facets, and attenuation and elongation of the pars interarticularis, with or without a defect in continuity.

2. Intertransverse lumbo-sacral fusion is a safe and reliable method of treatment.

3. Stabilisation is not complete before two years.

4. Spinal fusion is indicated in all patients with significant symptoms during the period of growth, but in adult patients only if conservative treatment fails.
PERTHES' DISEASE OF THE HIP
Authors: Somerville E. W.
Published: February 2018

1. Perthes' disease is an ischaemic lesion of the ossific nucleus of the head of the femur which may vary both in extent and degree. It is probably never quite complete.

2. When part of the ossific nucleus only is affected, as is usually the case, it is almost invariably the antero-lateral part.

3. The process of absorption of the damaged bone is complete radiologically before there is radiological evidence of reossification.

4. Reossification always occurs in Perthes' disease.

5. The aim of treatment must be to see that the mould in which the head is shaped is the right shape when ossification occurs.

6. The deformity of the head of the femur does not occur from pressure alone, but from pressure combined with subluxation. Full unrestricted weight-bearing can be allowed with safety on a femoral head in which there are ischaemic changes provided the femoral head is well contained.

7. The time of treatment can be very greatly reduced by using operation to correct the subluxation instead of relying on external splintage. This can be achieved by subtrochanteric osteotomy with rotation, or rotation combined with varus angulation.

8. Perthes' disease and avascular necrosis of the head of the femur are different conditions with different characteristics.

9. Suggestions are made as to the nature of the disease in relation to absorption, continued growth and reossification.
PROBLEMS IN THE EARLY DIAGNOSIS AND MANAGEMENT OF CONGENITAL DISLOCATION OF THE HIP
Authors: Mitchell George P.
Published: February 2018

1. Some problems in the early diagnosis and management of congenital dislocation are discussed.

2. In a well-staffed maternity unit one dislocation completely escaped early detection in every 8,000 births over the period 1962 to 1968 inclusive.

3. The complications of early treatment on a Malmö splint are initial failure to obtain reduction, failure to maintain reduction, deformity of the upper femoral epiphysis or metaphysis, and persistent anteversion of the femoral neck.

4. Arthrography suggests that failure of early splintage and deformity of the upper femur are due to attempted reduction in the presence of an inverted limbus.

5. A trial method of treatment of frank displacement in the first year of life has been carried out by combining excision of the inverted limbus with a period in a frog position plaster to correct anteversion. This method avoided changes in the upper femur but failed to correct anteversion in four out of eighteen cases.
TRAUMATIC DISLOCATION OF THE KNEE
Authors: Taylor A. R. , Arden G. P. , Rainey H. A.
Published: February 2018

1. The results have been reviewed of forty-two traumatic dislocations of the knee in forty-one patients, twenty-six of which were treated conservatively.

2. Primary operative repair was carried out in only three cases, although a further ten had operative intervention for various complications.

3. It was not possible to compare the results of operation with those of conservative treatment, because the operative procedures were so diverse in nature.

4. The conservative treatment of twenty-six dislocations yielded surprisingly good results with regard to stability, absence of pain, and range of flexion movement.

5. In general, immobilisation for long periods, like operative repair, led to reduced movement.

6. In the absence of complications, conservative treatment is the method of choice.
DOIGT EN LORGNETTE AND CONCENTRIC BONE ATROPHY ASSOCIATED WITH HEALED YAWS OSTEITIS
Authors: Jones B. S.
Published: February 2018

Two cases are reported in which doigt en lorgnette was associated with features of long-standing yaws. Radiographs showed an unusual bone appearance, believed to be due to superimposition of concentric atrophy with focal dissolution of the distal bones on the lesions of healed yaws osteitis.
DOMINANTLY INHERITED DIGITO-TALAR DYSMORPHISM
Authors: Sallis J. G. , Beighton Peter
Published: February 2018

1. A large Caucasian kindred in South Africa are affected by a previously undescribed inherited deformity of the hands and feet called digito-talar dysmorphism.

2. The principal features of digito-talar dysmorphism are flexion deformities, narrowing and ulnar deviation of the fingers. The thumb may be held in an abnormal position by a soft-tissue web. Rocker-bottom foot may develop, due to vertical talus. The facies is normal and the mentality is unimpaired.

3. The general health is good but orthopaedic measures may be needed for function and cosmesis.

4. The condition is transmitted as an autosomal dominant trait, with varying clinical expression of the abnormal gene.
LOOSENING OF THE CEMENTED ACETABULAR CUP IN TOTAL HIP REPLACEMENT
Authors: Andersson G. B. J. , Freeman M. A. R. , Swanson S. A. V.
Published: February 2018

1. Prosthetic acetabular cups of the Charnley and McKee-Farrar designs were cemented into cadaveric pelves using different procedures for preparing the acetabulum.

2. The torsional moments needed to loosen these cups were measured.

3. The torsional moments so measured were found to be from about four to more than twenty times higher than the frictional moments measured in independent tests on the two designs of prosthesis.

4. It is argued that late looseness of the acetabular component after total hip replacement, in the absence of infection, seems most likely to be due to thermal damage to the bone occurring at the time of polymerisation of the cement, and to subsequent bone resorption.

5. Surgical preparation of the acetabulum should include removal of all the articular cartilage and cleaning of the acetabular fossa, but the drilling of additional holes in the floor of the acetabulum seems unimportant.

6. The possibility of fatigue fracture in bone as a factor contributing to late loosening is an argument in favour of metal-on-polyethylene prostheses with their lower frictional moments, although the importance of this factor cannot be estimated.
LOCALISED ARACHNOIDITIS COMPLICATING LUMBAR DISC LESIONS
Authors: Ransford A. O. , Harries B. J.
Published: February 2018

1. French in 1946 presented eight cases of arachnoiditis complicating a lumbar disc lesion; five further cases are reported here.

2. It is suggested that repeated minor persistent trauma produces the strictly localised changes in the arachnoid, in the same sort of way that it may produce ulnar neuritis at the elbow.

3. The various causes of arachnoiditis are discussed.

4. The place of operation has been found difficult to assess.
FRACTURES OF THE NECK OF THE RADIUS IN CHILDREN
Authors: Jeffery C. C.
Published: February 2018

The case illustrated substantiates the explanation of the rare epiphysial separation of the head of the radius with 90 degrees backward tilting referred to above as Group 2. It suggests also that the initial fall on the hand may loosen the capital epiphysis.

The undesirability of reducing dislocations of the elbow merely by pulling on the hand of the injured limb is emphasised. The dislocation should be reduced by gentle traction accompanied by pressure with the thumbs on the front of the displaced olecranon.
SYNOVECTOMY OF THE ELBOW IN RHEUMATOID ARTHRITIS
Authors: Wilson D. W. , Arden G. P. , Ansell B. M.
Published: February 2018

1. Synovectomy of the elbow affected by rheumatoid arthritis is a worthwhile procedure even in the presence of advanced radiological changes.

2. Relief of pain is good (93 per cent) and movement is retained (87 per cent).

3. Although the follow-up in this series was short, averaging nineteen months, the results seem to be maintained.

4. Good access to the joint may be had through medial and lateral incisions, and division of the olecranon is unnecessary. A lateral incision alone is not recommended.

5. The ulnar nerve should be preserved during dissection. Anterior transposition is needed only if there are neurological symptoms before operation.
THE ROLE OF FLUORINE-18 AND STRONTIUM-87m SCINTIGRAPHY IN THE MANAGEMENT OF INFECTIVE SPONDYLITIS
Authors: Kemp H. B. S. , Johns D. L. , McAlister J. , Godlee J. N.
Published: February 2018

1. An ancillary diagnostic technique using Fluorine-l8 or Strontium-87m is described, and has assisted in the correct diagnosis of fifty-two patients admitted with the provisional diagnosis of infective spondylitis.

2. The technique is of particular value in the assessment of reactivation of chronic spinal infections and in the differential diagnosis of atypical lesions.
DOME FRACTURE OF THE TALUS
Authors: Mukherjee Sadhan Kumar , Young Andrew B.
Published: February 2018

1. Ten consecutive fractures of the dome of the talus are reported. Six were lateral, three medial and one anterior.

2. The injury is most commonly seen in the second and third decades of life, and with the exception of the rare anterior dome fracture, results from an inversion injury of the ankle. The possibility of a dome fracture associated with strain of the lateral ligament of the ankle joint should therefore always be borne in mind.

3. Antero-posterior views in neutral and in plantar fiexion are helpful in diagnosing medial dome fractures. Lateral fractures are best seen in an antero-posterior view taken in neutral flexion with 10 degrees inward rotation of the limb.

4. A large dome fracture with displacement should be accurately reduced by open operation in order to preserve congruity of the joint surface.

5. A small fracture with no displacement may be treated conservatively until radiographically it appears united.

6. A small fracture with marked displacement is best treated by early excision of the fragment to prevent further damage to the ankle joint.
MULTIPLE GIANT-CELL TUMOUR OF BONE
Authors: Sybrandy S. , de la Fuente A. A.
Published: February 2018

1. A case is described of three giant-cell tumours, the first in 1966 in the lower left femur, the second in 1968 in the upper right femur, the third later in 1968 in the upper left femur.

2. None of the tumours could be described as frankly malignant.

3. Despite a lapse of four years it is still not possible to decide whether the first tumour had metastasised or whether all three arose independently by multifocal origin.
SOLITARY MYELOMA OF THE CLAVICLE WITH LONG SURVIVAL AFTER TOTAL EXCISION
Authors: McLauchlan J.
Published: February 2018

1. A case of solitary myeloma of the clavicle is reported. The patient remained well, without signs of dissemination, twenty-four years after excision of the clavicle.

2. Solitary myeloma is rare; the diagnosis depends upon thorough investigation and prolonged follow-up.
ATLANTO-AXIAL SUBLUXATION IN THE MORQUIO SYNDROME
Authors: Beighton Peter , Craig James
Published: February 2018

1. The case is described of an eight-year-old girl with the Morquio syndrome (mucopolysaccharidosis type IV) who died from acute tetraplegia, due to atlanto-axial subluxation which occurred during general anaesthesia.

2. Hypoplasia of the dens of the axis vertebra entails a high risk of vertebral dislocation and spinal cord damage especially in circumstances such as general anaesthesia when excessive movements of the head may occur.
HAEMANGIOMA OF A VERTEBRAL BODY TREATED BY LIGATION OF THE SEGMENTAL ARTERIES
Authors: Bucknill T. , Jackson J. W. , Kemp H. B. S. , Kendall B. E.
Published: February 2018

1. The case is described of a twenty-nine-year-old man with back pain due to an extensive vascular malformation replacing the major part of a vertebral body.

2. Treatment was by transthoracic ligation of the segmental vessels, with irradiation and spinal fusion later.

3. The importance of demonstrating the origin of the thoraco-lumbar supply to the anterior spinal artery is emphasised.
"MATRIX-STREAKS": A PECULIAR PATFERN IN THE CARTILAGE OF THE FEMORAL HEAD OF AGEING HUMAN SUBJECTS
Authors: Lothe K. , Spycher M. A. , Rüttner J. R.
Published: February 2018

1. Human articular cartilage from normal femoral heads and from cases of osteoarthrosis in subjects of various ages has been examined histologically and by electron microscopy.

2. In specimens from middle-aged and old subjects, peculiar "matrix-streaks" have been observed in the deep zone of the pressure areas as oblique bands extending from the pericellubar halos into the adjacent matrix.

3. Ultrastructurally the streaks are correlated with an undulating pattern of the radially oriented collagen fibres.

4. The streaks are considered to result from a focal lack of acid mucopolysaccharide and from natural forces on the articular cartilage. Their appearance is assumed to be an early sign of cartilage disintegration associated with ageing.
THE EFFECT OF OSMIUM TETROXIDE AND NITROGEN MUSTARD ON NORMAL ARTICULAR CARTILAGE
Authors: Mitchell Nelson , Laurin Carroll , Shepard Nora
Published: February 2018

1. Osmium tetroxide and nitrogen mustard were injected into normal adult rabbit joints. Within one week widespread chondrocyte necrosis had occurred as evidenced by electron microscopic examination and radioactive proline uptake autoradiography.

2. Initially, the cartilage matrix was intact but three to seven months later the cartilage surface began to disintegrate.

3. These studies indicate that osmium tetroxide and nitrogen mustard are unsuitable agents for chemical synovectomy.

4. They also indicate that there may be a long latent period between cartilage cell death and cartilage destruction, and that the evaluation of any agent for chemical synovectomy must take this into consideration.
PRIMARY HAEMANGIOPERICYTOMA OF BONE
Authors: Dunlop James
Published: February 2018

1. Two cases of primary skeletal haemangiopericytoma treated by ablative surgery, one in combination with radiotherapy, are reported.

2. A discussion of the management of these tumours includes surgical excision, radiotherapy, a combination of both or a combination of radiotherapy with chemotherapeutic agents.

3. Because of the unpredictable behaviour of these tumours it seems necessary to include ablative surgery if cure is to be expected.
MULTICENTRIC EXTRA-ABDOMINAL DESMOID TUMOURS
Authors: Barber H. M. , Galasko C. S. B. , Woods C. G.
Published: February 2018

1. Two patients with multicentric extra-abdominal desmoid tumours are reported. Multicentric foci have not been described previously.

2. Both cases conform to the usual clinical, macroscopic and microscopic criteria of desmoid tumours in all other regards.

3. Their occurrence in a single limb bud suggests a congenital propensity and leads to the advocacy of radical surgery in such cases.
MULTIPLE OSTEOCHONDROSES OF THE FEET IN A WEST INDIAN FAMILY
Authors: Brown I. D. , Shaw D. G.
Published: February 2018

1. Four cases are described of multiple bony changes in the feet of members of a West Indian family.

2. The basic process is believed to be avascular necrosis of bone. The inheritance appears to be X-linked recessive.
THE TECHNIQUE AND COMPLICATIONS OF UPPER TIBIAL OSTEOTOMY
Authors: Jackson J. P. , Waugh W.
Published: February 2018

1. A series of 226 upper tibial osteotomies is reviewed with special reference to the complications occurring in each of the six different operative techniques that have been used.

2 Wedge osteotomy above the tuberosity is the safest operation, but care must be taken to avoid a fracture into the joint.

3. Wedge osteotomy through the lowest part of the tuberosity may be indicated in the presence of large subarticular cysts or collapse of a tibial condyle.

4. The significance of weakness of dorsiflexion of the foot and the dangers of injury to the anterior tibial artery in osteotomies below the tuberosity are discussed.
THE TREATMENT OF UNSTABLE ANKLE FRACTURES
Authors: Brodie I.A. O.D. , Denham R. A.
Published: February 2018

1. A series of 298 unstable ankle fractures treated during the last ten years is reviewed.

2. Open reduction and rigid fixation with two screws, with early mobilisation after operation and avoidance of plaster, achieved a high percentage of satisfactory results. Accurate reduction diminishes the incidence of traumatic arthritis and pain.
MUSCLE INJURY POTENTIALS: A SOURCE OF VOLTAGE IN THE UNDEFORMED RABBIT TIBIA
Authors: Lokietek W. , Pawluk R. J. , Bassett C. A. L.
Published: February 2018

1. The electric potentials in undeformed rabbit tibiae were measured in vivo and in vitro.

2. Surgically traumatised soft-tissues, particularly muscle, constituted the major source of voltage in vivo (up to 22 millivolts).

3. Electrical insulation of the tibia from attached soft parts abolished the high potentials on the bone.

4. Similarly high voltages could be reproduced in an excised tibia by substituting a battery for the injured muscle.

5. Changes in voltage also could be induced by altering blood flow rates or by rapid infusion of saline into the medullary space.

6. Death of the cellular elements in bone did not alter the voltage significantly.

7. The electrical contributions of the nervous system, and of dipole components of the extracellular matrix (such as collagen), either were inconsequential or of such low magnitude as to be "masked" by the larger "injury" voltages. Supported by grants from the United States Public Health Service (AM-07822) and the National Institute of Arthritis and Metabolic Diseases (TIAM-05408).
SCOLIOSIS IN JUVENILE RHEUMATOID ARTHRITIS
Authors: Rombouts J. J. , Rombouts-Lindemans C.
Published: February 2018

1. Eleven patients with juvenile rheumatoid arthritis, most of them young adults at a terminal stage, were found to have structural scoliosis with curves measuring between 20 and 80 degrees.

2. The common feature was severe and protracted rheumatoid disease.

3. The characteristics of the spinal curves are analysed; the longer curves may have been caused by muscle imbalance and the shorter curves possibly by asymmetrical involvement of the inter-apophyseal joints.

4. It is suggested that juvenile rheumatoid arthritis is an unusual etiological factor of scoliosis.
SPINAL INJURIES IN JUVENILES
Authors: Aufdermaur M.
Published: February 2018

In the necropsy material presented there were, among 100 spinal injuries occurring during the past eight years, twelve in juveniles up to eighteen years of age. In all cases, the growth zone of the cartilaginous end-plate of the spine was fractured. The special histological architecture of the growth zones with their loosened fibrous lamellae might play a decisive role in the localisation of the lesions. The clinical importance of this type of injury and the radiological findings are discussed.
A LONG-TERM FOLLOW-UP OF FOREFOOT ARTHROPLASTY
Authors: Watson Michael S.
Published: February 2018

1. Thirty-eight patients with sixty-two forefoot arthroplasties have been followed up from two to thirteen years after the operation. Eleven were free of pain, thirty-eight had some pain but were improved, and the rest were worse.

2. Patients over the age of fifty or with rheumatoid arthritis did best.

3. Kirschner wire fixation of the great toe often caused late painful stiffness of the metatarsophalangeal joint.

4. Previous interphalangeal fusion of a lesser toe was often the cause of metatarso-phalangeal dislocation of that toe and callous formation.

5. Arthrodesis of the metatarso-phalangeal joint of the great toe gave a high proportion of painless feet, apparently because it prevented both painful stiffness at that joint and dislocation of the same joint of the lesser toes.
INDUCED PAIN PATTERNS ON PASSIVE STRAIGHT-LEG RAISING IN LOWER LUMBAR DISC PROTRUSION
Authors: Edgar Michael A. , Park William M.
Published: February 2018

1. Passive straight-leg raising may induce pain in the back or leg or a combination of both in patients with acute lower lumbar disc lesions. Clinical, myelographic and operative observations were carried out prospectively in fifty such cases to investigate the relation of the pattern of pain on straight-leg raising to the site of the protrusion.

2. In patients with central protrusion straight-leg raising induced mainly back pain. In patients with intermediate protrusion, lying in contact with both dura and nerve root, a combination of back and leg pain predominated. Patients with lateral protrusion usually experienced only pain in the leg. This correlation was found in 80 per cent of cases.

3. Production of pain in the leg by straight-leg raising is of practical significance in lateral protrusions where myelography may be normal.

4. Pain in the back and pain in the leg on straight-leg raising may be related respectively to dural and nerve root sensitivity.
THE MANAGEMENT OF TIBIAL FRACTURES IN ALCOHOLICS AND MENTALLY DISTURBED PATIENTS
Authors: Karlström G. , Olerud S.
Published: February 2018

1. In a series of 129 tibial fractures treated by compression plates, a high incidence of complications causing delay in healing was found in alcoholics and persons with abnormal personality traits.

2. The healing time and time off work for these people were about doubled.

3. The indications for internal fixation in such patients should therefore be sharply defined and, if used, added protection should be given by institutional care and by well controlled plaster casts.
REDUPLICATION OF THE FEMUR
Authors: Cornah M. S. , Dangerfield P. H.
Published: February 2018

1. The case is reported of a girl born by normal delivery whose right lower limb showed reduplication of the femur below the single femoral head.

2. The tibia was absent but the ossific centres in the foot appeared to be normal. We are grateful to Processor Robert Roeaf for permission to publish details of this patient.
REFLECTIONS UPON THE AETIOLOGY OF CONGENITAL PSEUDARTHROSIS OF THE CLAVICLE
Authors: Lloyd-Roberts G. C. , Graham Apley A. , Owen Robert
Published: February 2018

The cause of pseudarthrosis of the clavicle is obscure. Right-sidedness is an almost constant feature. We have proposed that the lesion is sometimes due to pressure upon the developing clavicle by the subclavian artery which is normally at a higher level on the right side. This may be accentuated in the presence of cervical ribs or unduly elevated first ribs, both of which we have observed in association with pseudarthrosis. We have also noted pseudarthrosis on the left side in association with dextrocardia (when the relative positions of the subclavian arteries are reversed) and in the presence of a large left cervical rib.

We have speculated upon the nature of the clavicular defect in cranio-cleido dysostosis, in which disorder the first ribs are habitually elevated. A similar mechanism may be involved.
THE MANAGEMENT OF LOCAL COMPLICATIONS OF TOTAL HIP REPLACEMENT BY THE McKEE-FARRAR TECHNIQUE
Authors: Dandy D. J. , Theodorou B. C.
Published: February 2018

One thousand and forty-two McKee-Farrar prostheses of the present design inserted in Norwich from January 1965 to December 1972 have been reviewed retrospectively to determine the incidence of complications needing revision. Of prostheses implanted for more than two years, 6.6 per cent needed revision for loosening (cup 35 per cent; stem 2.2 per cent; both components 0.9 per cent). Of the total number, 2.3 per cent became infected and 1.9 per cent dislocated. Most dislocations needed only a single closed reduction but 08 per cent were revised. The outcome of revision operations was also assessed. Of revisions for loosening, 40 per cent needed no further operation but 23 per cent required excision; pelvic fracture or bone destruction around the components made success unlikely. Revisions for dislocation were disappointing. Of all revisions 17 per cent became infected. Excision arthroplasty is better than a series of failed revisions in an elderly patient.
OBSERVATIONS ON THE INDUCTION OF BONE IN SOFT TISSUES
Authors: Chalmers John , Gray D. H. , Rush J.
Published: February 2018

Using bone decalcilied with 0.6 N hydrochloric acid as an inducing agent, the inductive capacity of different soft tissue sites was investigated. Muscle and fascia regularly permitted the induction of bone, while spleen, liver and kidney suppressed bone induction. Bone formation could be induced in these organs if living autologous fascia was implanted together with the inducing agent; while bone formation was inhibited when living autologous spleen tissue was implanted with the inducing agent to normally favourable sites. The administration of systemic heparin and the diphosphonate ethane-1-hydroxyl, 1-diphosphonic acid (EHDP) suppressed bone induction.

It is suggested that for bone induction to occur in soft tissues, three conditions must be present: 1) an inducing agent; 2) an osteogenic precursor cell; and 3) an environment which is permissive to osteogenesis. The presence of osteogenic inhibitors in spleen, liver and kidney is postulated.
THE WALLDIUS HINGE ARTHROPLASTY
Authors: Phillips Hugh , Taylor J. G.
Published: February 2018

Eighty-three Waildius arthroplasties, performed by one surgeon as a salvage operation on the knee joint between 1966 and 1972, were independently reviewed. The fifty-seven living patients with sixty-seven arthroplasties were interviewed and examined and the clinical records of the deceased patients were inspected. Sixty-seven arthroplasties (81 per cent) were successful and sixteen failed (19 per cent). Acrylic cement was used to secure the prosthesis on eight occasions only. There were two primary infections (24 per cent) and two delayed (24 per cent). Major loosening occurred in three arthroplasties (36 per cent). Minor loosening was compatible with a good result. Arthrodesis was successful on the two occasions on which it became necessary to remove the implant. There were no disasters. On the basis of these results it is considered that the Walidius arthroplasty can justifiably be offered as an alternative to primary arthrodesis of the knee.
BENIGN CHONDROBLASTOMA OF BONE
Authors: Ross James A. , Dawson Edith K.
Published: February 2018

A benign chondroblastoma of bone is reported. It was unusual because it occurred in an old lady, in a toe, and it was not painful and radiologically resembled a chondroma. The coarsely lobulated tumour showed a varied microscopic appearance, but it consisted chiefly of closely packed sheets of small, round polygonal or fusiform cells. There was some calcification present. The literature is reviewed.
EXCISION OF TUMOURS OF HUMERUS AND FEMUR, WITH RESTORATION BY INTERNAL PROSTHESES
Authors: Burrows H. Jackson , Wilson J. N. , Scales J. T.
Published: February 2018

A personal experience is recounted of operations in cases of tumour involving the humerus or femur with restoration by endoprostheses. Twenty-four patients were treated in this way from 1950 to 1969 inclusive and have been followed up for between four and twenty-four years. The patients selected for treatment have presented chondrosarcoma (ten), so-called benign giant-cell tumour of bone, usually recurrent (nine), angiomatous osteolysis (two), seemingly single thyroid or renal metastasis (two), and ununited pathological fracture after irradiation of a tumour (one). Development of the prostheses from early beginnings is outlined. Some points in surgical management are referred to. The complications and results are recorded.
SURGICAL TREATMENT OF CHRONIC DISLOCATION OF THE STERNO-CLAVICULAR JOINT
Authors: Lunseth Paul A. , Chapman Kenneth W. , Frankel Victor H.
Published: February 2018

The costo-clavicular ligament is always ruptured in dislocation at the sterno-clavicular joint. Anterior, superior or posterior displacement of the medial end of the clavicle may occur. Acute dislocation usually responds to conservative treatment and operation is seldom required. Chronic, or recurrent, dislocation may cause pain and disability on strenuous activity and necessitate surgical treatment. The operation of tenodesis of the subclavius tendon with capsulorrhaphy described by Burrows (1951) has been adopted. The intraarticular meniscus is often damaged and displaced, and may block reduction; its removal is then necessary. In addition, a threaded Steinmann pin transfixing the joint has been found useful to maintain the stability of reduction. The operation has been performed on five patients, four of whom had excellent results. The fifth patient disrupted the repair in a drinking bout shortly after the operation.
BORN UNTO TROUBLE
Authors: Dunn Denis M. , Smith Joan H.
Published: February 2018

We describe unexpected adverse psychological and social results in three adult men with severe Little's disease who were made more mobile by successful surgery.
MYOSIN ATPase ACTIVITY IN MULTIFIDUS MUSCLE FROM CASES OF LUMBAR SPINAL DERANGEMENT
Authors: Fidler M. W. , Jowett R. L. , Troup J. D. G.
Published: February 2018

Biopsies of lumbar multifidus muscles were obtained at operation on seventeen patients aged from fifteen to fifty-eight with lumbar spinal derangement, and further material was taken from the cadavers of three subjects aged from nineteen to fifty-one. Sections were prepared to show the presence of ATPase activity, so distinguishing Fast from Slow types of muscle fibre. The normal mosaic pattern arising from the intermingling of fibres from Fast and Slow motor units was seen in sections from cadaveric material and from many of the biopsies. With age and limited lumbar flexibility, the Fast fibres became relatively smaller but with increasing variation in size, suggesting a reduced capacity for phasic activity. The presence of positive root signs was associated with a greater proportion of Slow fibres, and in some patients with the occurrence of atrophied Fast fibres, giving rise to differences in the populations of the two fibres in neighbouring fascicles. The results suggest that multifidus adopts an increasingly postural role with advancing age and with disabling lesions of the lumbar spine.
THE INFLUENCE OF CORTICOSTEROIDS ON THE NORMAL AND PAPAIN-TREATED EPIPHYSIAL GROWTH PLATE IN THE RABBIT
Authors: Shaw N. E. , Lacey Eve
Published: February 2018

Children undergoing continuous corticosteroid therapy become stunted in height. The mechanism of this inhibition of natural growth has been investigated in the lower femoral epiphysial growth plate of young rabbits on daily corticosteroid. The growth plate became narrow: fewer cells in the germinative zone gave rise to short widely-spaced chondrocyte columns, each with a reduced number of mature and hypertrophic cells; the pattern of trabecular bone in the metaphysis was also disturbed. After even small doses these changes develop very rapidly, and therefore impose a threat to the growth of children receiving treatment with corticosteroids.
THE EFFECTIVENESS OF VARIOUS ANTIBIOTICS IN METHYL METHACRYLATE
Authors: Levin Paul D.
Published: February 2018

The effectiveness of different antibiotics mixed with Simplex P has been tested in vitro. A laboratory model was designed to simulate the constant immersion of bone cement in tissue fluid. Clindamycin, and to a lesser extent Cephalothin, were shown to be effective when used in this manner against Staphylococcus aureus and epidermidis. Effective inhibition of Gram-negative organisms could not be demonstrated with any of the antibiotics tested. The addition of up to 3 grams of antibiotic powder per unit of 40 grams of Simplex P did not appear to alter the expansive properties of the cement. Such release of antibiotic as did occur was thought to be related to the slow absorption of water by the slightly porous methyl methacrylate.
CALCANEO-VALGUS DEFORMITY
Authors: Evans Dillwyn
Published: February 2018

A discussion of the essential deformity in calcaneo-valgus feet develops a theme originally put forward in 1961 on the relapsed club foot (Evans 1961). Whereas in the normal foot the medial and lateral columns are about equal in length, in talipes equino-varus the lateral column is longer and in calcaneo-valgus shorter than the medial column. The suggestion is that in the treatment of both deformities the length of the columns be made equal. A method is described of treating calcaneo-valgus deformity by inserting cortical bone grafts taken from the tibia to elongate the anterior end of the calcaneus.
THE DIAGNOSIS OF PROBLEMS AFTER MENISCECTOMY
Authors: Dandy D. J. , Jackson R. W.
Published: February 2018

The causes of persistent symptoms after meniscectomy have been assessed clinically, radiologically and arthroscopically in 174 knees. The commonest finding was early degenerative arthritis (chondromalacia) of the femoral condyle (40 per cent). Retained fragments of meniscus were less common than expected (13 per cent), and lesions of the other meniscus were rare (5 per cent). The clinical diagnosis was altered in 42 per cent by arthroscopic examination. Arthroscopy was found to be a valuable technique in this group of patients with problems of diagnosis.
SPINAL LESIONS IN BATTERED BABIES
Authors: Cullen John C.
Published: February 2018

The case histories of five young children are presented to demonstrate the radiological appearances of trauma to the spine thought to be the result of maltreatment by either parent or guardian. Four of the children were admitted to hospital within a period of three years, all being under the age of two years.
OBSERVATIONS CONCERNING FRACTURES OF THE LATERAL HUMERAL CONDYLE IN CHILDREN
Authors: Jakob Roly , Fowles John V. , Rang Mercer , Kassab Mohamed T.
Published: February 2018

From an anatomical study and clinical review of fractures of the lateral humeral condyle in children, the following conclusions are drawn. The mechanism of injury is a violent varus force with the elbow in extension, the condyle being avulsed. by the lateral ligament and the extensor muscles. If the fracture is incomplete, with an intact hinge of pre-osseous cartilage medially, the fragment will not be displaced. If the fracture is complete the fragment may be displaced, and open reduction with internal fixation is mandatory.

The results of open reduction more than three weeks after the fracture are no better than those of no treatment at all, and may kill the lateral condylar fragment by damaging its blood supply. The major problem of a neglected fracture is tardy ulnar nerve palsy; to avoid this, immediate anterior transposition of the nerve is recommended, operation for the fracture itself being of no benefit.
THE CLINICAL SYNDROMES AND SURGICAL TREATMENT OF THORACIC INTERVERTEBRAL DISC PROLAPSE
Authors: Benson M. K. D. , Byrnes D. P.
Published: February 2018

Doubt remains as to the safest surgical approach to the prolapsed thoracic intervertebral disc. Laminectomy, lateral rhachotomy and the transthoracic approach all have their protagonists.

Twenty-two patients from the National Hospital for Nervous Diseases, Queen Square, and Atkinson Morley's Hospital have been reviewed. Their clinical presentation is discussed and the ancillary aids to diagnosis assessed. The diagnostic value of disc space calcification is stressed, and the use of air myelography as an adjunct to positive contrast myelography is noted.

Fifteen patients were subjected to laminectomy, and seven to lateral rhachotomy. Each group contained patients with a wide range of neurological deficit. Six of the patients who underwent laminectomy were improved, two were unchanged, six deteriorated and one died. Of the patients who had lateral rhachotomy, six were improved, one was unchanged and none deteriorated. The conclusion is drawn that lateral rhachotomy is a safer procedure.
THE ANATOMY OF THE METACARPO-PHALANGEAL JOINTS, WITH OBSERVATIONS OF THE AETIOLOGY OF ULNAR DRIFT
Authors: Wise K. S.
Published: February 2018

One hundred normal fingers were dissected and arthrographs obtained by injection of a chromopaquegelatin mixture, allowing comparison between the radiographic and macroscopic configuration of the synovial capsule. Synovial recesses protruding from each side of every metacarpo-phalangeal joint were found in relation to the collateral ligaments and corresponding exactly with the site of radiological erosions. A group of bursae lying on the superficial aspect of collateral ligaments were also demonstrated. A rudimentary infra-articular meniscus was found. The results of examination of the insertions of the interossei showed differences from traditional descriptions.

The cause of rheumatoid deformity was suggested to be the rheumatoid process arising in the lateral recesses and lateral bursae, weakening the collateral ligaments, which give way in the directions of the deforming forces. These are derived from the long flexor tendons, which were shown to exert an ulnar and volar strain on the metacarpo-phalangeal joint of every finger during grip.
THERMAL ASPECTS OF SELF-CURING POLYMETHYLMETHACRYLATE
Authors: Jefferiss C. D. , Lee A. J. C. , Ling R. S. M.
Published: February 2018

Bone necrosis adjacent to self-curing polymethylmethacrylate is a matter of accepted fact. Among the possible causes are mechanical and vascular damage from the preparation of the bone cavity, chemical damage from the monomer and free radicals in the cement dough, and thermal damage from the heat of polymerisation, occurring in this order. Consideration of the tissue reaction to this material, theoretical calculation of the heat output from polymerising acrylic and interface temperature proffiles, experimental observations of interface temperatures and maximal temperatures at polymerisation, together with clinical observations, all lead to the view that the bone necrosis is not a consequence of thermal damage, which is unlikely to be a cause of failure of prosthetic fixation. Temperatures recorded from within polymerising acrylic masses are related primarily to the amount of monomer polymerising and are of no clinical significance in the fixation of prostheses. Interface temperatures are related primarily to the surface area of the interface and the thermal characteristics of the cooler material.
Remodelling by asymmetrical epiphysial growth. An experimental study in dogs
Authors: Karaharju EO , Ryoppy SA , Makinen RJ
Published: February 2018

Spontaneous correction of deformity is produced by bone remodelling during the period of growth. The purpose of this experimental study was to find out in which phase and to what extent asymmetrical epiphysial growth participated in the correction of an experimentally produced deformity. Transverse wedge osteotomy was performed in the legs of twenty growing mongrel dogs, the fragments being fixed with bent AO-plates. From radiographs taken at intervals of two weeks the epiphysial and axial angles were measured. Nine dogs were given tetracycline ten to twenty days before death and the cut surfaces were photographed in reflected ultra-violet light. It was found that epiphysial growth played an important role in the remodelling process. This factor accounted for roughly half of the total correction and averaged 12-5 degrees during the observation time of 160 days. The greatest correction occurred during the first weeks. Correction of the epiphysial angle took place with acceleration of growth.
Biochemical changes in the cartilage of the knee in experimental and natural osteoarthritis in the dog
Authors: McDevitt CA , Muir H
Published: February 2018

Biochemical changes in the articular cartilage of the knees of mature dogs, one with natural and four with surgically induced osteoarthritis, have been investigated. The four dogs were killed three, six, nine and forty-eight weeks after division of the right anterior cruciate ligament, the left knees serving as controls. The cartilage of the joints operated on was thicker and more hydrated than the control cartilage; the proteoglycans were more easily extracted and had higher galactosamine/glucosamine molar ratios. The proportion of proteoglycans firmly associated with collagen, and hence not extractable, diminished before fibrillation was demonstrable by indian ink staining of the surface. These biochemical changes were present throughout the entire cartilage of the joints operated on of the dogs killed more than three weeks later, and of the dog with natural osteoarthritis. The results suggest that in response to altered mechanical stresses the chondrocytes synthesise proteoglycans that contain more chondroitin sulphate relative to keratin sulphate than normally, as in immature articular cartilage.