bluuebunny/crossref_metadata_2025 huggingface dataset:
DIAMETRIC GROWTH OF THE EPIPHYSIAL PLATE
Authors: Solomon L.
Published: February 2018

1. Diametric growth and organisation of the epiphysial cartilage plate have been studied by microradiography of human bone and autoradiography of the epiphysial plate in growing rabbits, using sulphur35. These investigations were supplemented by a radiographic study of four patients with dyschondroplasia in whom the progress of the characteristic epiphysial defects were traced during several years' growth.

2. A perichondrial sheath of bone, at the junction of the epiphysial plate with the metaphysis, was demonstrated by microradiography of the distal end of the human femur. Its relationship to epiphysial growth is discussed.

3. Autoradiography, to determine the direction of the cellular proliferation between the epiphysial plate and the overlying perichondrium, demonstrated the appearance of new cartilage cells at the periphery of the plate over a period of six days.

4. The evidence presented strongly favours the postulate that the transverse diameter of the epiphysial cartilage plate increases by appositional growth from the overlying perichondrium and that the same source is responsible for lateral extension of the articular cartilage during growth.
BONE LESIONS IN COMPRESSED AIR WORKERS
Authors: McCallum R. I. , Walder D. N. , Barnes R. , Catto M. E. , Davidson J. K. , Fryer D. I. , Golding F. C. , Paton W. D. M.
Published: February 2018

1. A radiographic investigation of a group of 241 men who had worked in compressed air at pressures up to 35 pounds per square inch gauge on the construction of tunnels under the River Clyde showed that forty-seven men (19 per cent) had one or more lesions of aseptic necrosis of bone.

2. The radiological lesions have been classified as juxta-articular, which may lead to pain and limitation of movement, and head, neck and shaft lesions, which are usually symptomless. In 10 per cent of the men the lesions were juxta-articular and therefore potentially disabling. The treatment ofjuxta-articular lesions is described and reviewed.

3. The environmental factors associated with the occurrence of aseptic necrosis of bone, the radiological and histological appearances, and the pathogenesis of the lesions are discussed. Bone lesions were found to be related directly to the number of times a man had been decompressed, to the height of pressure at which he had worked and to attacks of bends for which treatment was given.

4. When the histological and radiographic appearances of aseptic necrosis of bone in compressed air workers are compared it is clear that a radiograph may not always reveal the full extent of the lesion, and some lesions may not show up at all. The cause of the necrosis is obscure because experimental and direct evidence of bone infarction by gas bubbles is lacking.

5. The currently accepted decompression procedures and treatment of bends used in civil engineering practice, do not prevent the occurrence of aseptic necrosis of bone in compressed air workers.

6. It is suggested that periodic radiological examination of the bones of compressed air workers should be carried out and the results correlated with other information about the men and the contracts on which they have worked in order to elucidate the causative factors in aseptic necrosis of bone. A central registry has been set up by the Medical Research Council in the University of Newcastle upon Tyne to fulfil this function.
TETRACYCLINE LABELLING METHODS OF MEASURING THE GROWTH OF BONES IN THE RAT
Authors: Tapp E.
Published: February 2018

1. Tetracycline labelling methods have been used to measure the rate of growth in length and the rate of growth in width of the tibia of the normal rat.

2. The main limitations of the tetracycline methods are that in very young animals the bands of labelled bone are indistinct and remodelling occurs quickly; in animals nearing maturity, the growth in width is very slow and periods of at least fourteen days are required to give reliable results.

3. The tetracycline labelling methods can be used also to determine changes in the basic processes of bone formation and bone resorption.
SKELETAL CHANGES IN THE HAEMOGLOBINOPATHIES
Authors: Middlemiss J. H. , Raper A. B.
Published: February 2018

1. Bone changes in the haemoglobinopathies are caused by either (a) chronic haemolysis with marrow hyperplasia, or (b) infarction, when Hb S is present in the red cells in amounts sufficient to allow sickling (and therefore vascular occlusion) in vivo.

2. Marrow hyperplasia produces osteoporosis, widening of the medulla, and thinning of the cortex; it may lead to spontaneous fractures and disturbances of growth. Enlargement of the foramina of the nutrient arteries may be seen especially in the phalanges. Infarcts leading to aseptic necrosis occur in the long bones, and may become infected with Salmonella organisms. The range of radiological lesions caused by these processes is illustrated.
THE NUTRITION OF IMMATURE JOINT CARTILAGE IN THE LAMB
Authors: McKibbin B. , Holdsworth F. W.
Published: February 2018

1. Experiments have been carried out in lambs to determine the source of nutrition of the joint cartilage of an immature animal. A wedge of bone with its overlying cartilage was removed from the knee joint and then replaced in its original position, so that the bone was infarcted but the cartilage remained in normal relationship with the joint.

2. In these circumstances degeneration of the cartilage occurred and proliferation ceased until revascularisation of the bone was established.

3. It is therefore concluded that growing cartilage derives a significant part of its nutrition from the underlying bone. The possibility that it also receives a contribution from synovial fluid has not been excluded.
CONE ARTHRODESIS OF THE FIRST METATARSO-PHALANGEAL JOINT
Authors: Wilson J. N.
Published: February 2018

1. A simple cone arthrodesis of the metatarso-phalangeal joint of the big toe based on the Rose and Mann operations is described.

2. New instruments have been devised to simplify the procedure.

3. Thirty-one operations have been performed on twenty-three patients. Bony fusion has occurred in all but one case. There have been no complications.
EXCISION OF CALCANEO-NAVICULAR BAR FOR PAINFUL SPASMODIC FLAT FOOT
Authors: Mitchell G. P. , Gibson J. M. C.
Published: February 2018

1. The results of excision of calcaneo-navicular bars in spasmodic flat feet are reported. The average follow-up was six years. Complete relief of symptoms was achieved in 68 per cent and over 25 degrees of subtalar inversion was restored in 58 per cent of the feet.

2. The results appear slightly more favourable than those of conservative treatment, but it is realised that the period of observation is short.

3. In a selected group of patients operation by a standard technique relieved symptoms and restored subtalar movement in all.

4. It is submitted that excision of the calcaneo-navicular bar is a justifiable procedure in the younger patient with painful spasmodic flat foot of recent origin.
AN OPERATION FRAME FOR SPINAL FUSION
Authors: Relton J. E. S. , Hall J. E.
Published: February 2018

1. The operation of spinal fusion combined with Harrington rod instrumentation is often accompanied by severe blood loss. Factors affecting the degree of blood loss are discussed with emphasis on the adverse effects of partial or complete obstruction of the inferior vena cava during operation.

2. A new scoliosis operating frame is described which is designed to encourage normal venous return during spinal fusion with the patient prone. In addition, it stabilises the patient during the procedure.

3. A standard anaesthetic technique and method of supporting the patient have been used in forty major corrective operations in thirty-eight consecutive cases of scoliosis in the past nine months. The measured blood loss at operation encountered in this series compares favourably with the quantities lost in a previously reported series of cases in which alternative methods of anaesthesia and of support for the patients were used.

4. All operations in both series were performed by the same surgeon (J. E. H.). Although further experience with the surgical technique has helped in reducing the blood loss in the later series, the same basic method of exposure and performance of the instrumentation and fusion has been used in all cases.
TREATMENT OF LUMBAR INTERVERTEBRAL DISC LESIONS BY DIRECT INJECTION OF CHYMOPAPAIN
Authors: Smith Lyman , Brown Joseph E.
Published: February 2018

1. An account of experiences in seventy-five cases with a new method of treatment of low back pain and sciatica caused by intervertebral disc lesions has been presented. The method is based on the fact that chymopapain, a proteolytic enzyme, can break down displaced intervertebral disc material without deleterious effects upon adjacent tissues.

2. Chymopapain was injected into intervertebral discs by the postero-lateral or preferably the lateral approach. Two milligrams per disc constitute an effective dose. The enzyme was administered to seventy-five patients who were potential candidates for laminectomy. These patients were followed for four to thirty months and results were graded as "good" (76 per cent), "fair" (15 per cent) and "poor" (9 per cent).

3. Although untoward reactions have been encountered, none of these has been attributable to chymopapain.

4. Our investigations have convinced us that enzymatic dissolution of a lumbar intervertebral disc lesion is a safe, effective method of relieving sciatica and low back pain in selected cases.
ARTHRODESIS OF THE METATARSO-PHALANGEAL JOINT OF THE GREAT TOE
Authors: Moynihan F. J.
Published: February 2018

1. A long term review of arthrodesis in the management of hallux valgus and rigidus is presented.

2. This is briefly compared with Keller's operation.

3. Eighty-five per cent of patients had a satisfactory result.

4. The reasons for failure and the errors in operative technique are discussed.
A METHOD FOR GRADING HIPS
Authors: Lazansky Mark G.
Published: February 2018

1. A method has been described whereby the disability of hip disease, bilateral or unilateral, can be graded, and the quality of result following arthroplasty assessed, on a scale of numerical values.

2. The grade expresses the condition of the entire patient, rather than that of the hip joint alone.

3. Certain clinical criteria and physical tests have been adopted as the bases for scoring. The calculation of the patient's total score has been weighted to emphasise mobility, and to provide a more critical measure of the success of arthroplasty. Subjective tests (aside from the patient's estimate of his pain) are avoided, to provide as objective and accurate a method of assessment as possible.
TELEMETERING ELECTROMYOGRAPHY OF MUSCLES USED IN WALKING UP AND DOWN STAIRS
Authors: Joseph J. , Watson Richard
Published: February 2018

1. Telemetering electromyography has been used to investigate the pattern of activity of certain muscles of the lower limb and back while the subjects walked up and down stairs.

2. During walking up and down stairs each limb has a supporting and swinging phase in each complete step.

3. Walking up stairs revealed the following facts. Firstly, raising the body on to the stair above is brought about by the contraction of the soleus, quadriceps femoris, hamstrings and gluteus maximus; the gluteus medius at the same time prevents the body falling on to the unsupported side. Secondly, the tibialis anterior dorsiflexes the foot during the swinging phase and helps the limb to clear the stair on which the supporting limb is placed. Thirdly, the hamstrings flex the leg at the knee in the early part of the swinging phase and control the terminal part of extension at the knee at the end of this phase. Fourthly, both erectores spinae contract twice in each step and control the forward bending of the body at the vertebral column.

4. Walking down stairs revealed the following. Firstly, the body is lowered on to the stair below by the controlled lengthening of the soleus and quadriceps femoris; the gluteus medius at the same time prevents the body from falling on to the unsupported side. Secondly, the tibialis anterior inverts the foot at the beginning of the supporting phase as the toe is placed on the stair below and dorsiflexes the foot in the middle of the swinging phase. Thirdly, the hamstrings control the extension of the leg at the knee during the middle of the swinging phase. Fourthly, both erectores spinae contract twice in each step and prevent forward bending of the trunk at the vertebral column.
THE RESULTS OF 100 CASES OF PSEUDARTHROSIS IN THE SCAPHOID BONE TREATED BY THE MATTI-RUSSE OPERATION
Authors: Mulder J. D.
Published: February 2018

1. Operative treatment of scaphoid pseudarthrosis by the Matti-Russe method is a reliable procedure which in our series has given ninety-seven cases of bony union in a total of 100 operations.

2. We do not hesitate to advise operation for this condition as soon as it is discovered, except in cases with severe secondary osteoarthritis. Equally good results have been reported by Murray (1946) from a series of 100 cases treated with cortical grafts from the tibia (blind method) and by Agner (1963) from a series of twenty-four patients treated by Bentzon's operation (interposition of a pedicled soft-tissue flap).

3. In our opinion, Russe's open operation has great technical advantages over Murray's blind method.

4. We have no experience of Bentzon's operation, which seems attractive on account of its technical simplicity and as not more than two weeks' immobilisation in plaster after operation are needed.

5. It would be interesting to see Agner's results confirmed from other sources. It is true that many scaphoid pseudarthroses remain symptomless for years, as London (1961) has pointed out, but many of them sooner or later cause pain, and we do not agree with London's opinion that a few weeks of immobilisation will usually make the wrist painless.

6. Although severe osteoarthritis is very slow to develop in wrists with pseudarthrosis of the scaphoid bone it cannot be denied that these wrists are constantly threatened with suddenly developing pain and by progressive deterioration of function.

7. Therefore, early repair of pseudarthrosis of the scaphoid bone is advisable; it can be expected to save many wrists from progressive loss of function and from final development of severe degenerative change.
EPIDURAL ABSCESS SIMULATING DISC HERNIA
Authors: Keon-Cohen B. T.
Published: February 2018

1. Epidural abscess should be suspected in patients with lumbar and sciatic pain who have a history of staphylococcal skin infections or of diabetes.

2. The diagnosis of epidural abscess should be considered before that of herniation of a disc if the patient presents an otherwise unexplained pyrexia. The absence of radiographic changes is no bar to this diagnosis.

3. The hazards of lumbar puncture in cases of epidural abscess are obvious.

4. Early diagnosis and operation are essential to control the infective lesion and to ensure recovery of the neural lesion.
MEDIAN NERVE ENTRAPMENT AFTER DISLOCATION OF THE ELBOW
Authors: Mannerfelt L.
Published: February 2018

1. A lesion of the median nerve after reduction of a dislocated elbow in a boy of nine is recorded.

2. The nerve lesion was progressive, and at operation on the seventh day after injury the nerve was found to be trapped in the joint between the humerus and the ulna.

3. The nerve was freed and gradual recovery occurred.
HETEROTOPIC OSSIFICATION COMPLICATING PARALYSIS OF INTRACRANIAL ORIGIN
Authors: Roberts P. H.
Published: February 2018

1. Six cases of development of heterotopic bone around joints in association with paralysis from intracranial lesions are presented. It is suggested that such bone may occur more commonly than is realised.

2. The features of these cases are very similar to those seen in association with paraplegia.

3. Extensive new bone is usually associated with fixed contractures.

4. Operation is hazardous in paraplegia but should not necessarily be so in other paralytic conditions.

5. In the presence of returning motor function excision of the bone, allowing correction of the deformity together with some movement, is a worthwhile procedure. In the hip, osteotomy alone usually requires plaster fixation with the attendant risks of venous thrombosis. Previous excision of the bone allows internal fixation of the osteotomy with early mobilisation.
CERVICAL MYELOGRAPHY IN TRACTION INJURIES OF THE BRACHIAL PLEXUS
Authors: Yeoman P. M.
Published: February 2018

1. Sixty myelographs have been obtained in severe traction injuries of the brachial plexus.

2. Seventy-eight traumatic meningoceles were outlined.

3. Multiple meningoceles indicate a gloomy prognosis.

4. In forty patients the results were compared with those obtained with the "axon reflex."

5. Myelography is a valuable aid in obtaining an early prognosis but the results must be correlated with the clinical picture.
THE DIAGNOSIS AND TREATMENT OF PIGMENTED VILLONODULAR SYNOVITIS
Authors: Byers P. D. , Cotton R. E. , Deacon O. W. , Lowy M. , Newman P. H. , Sissons H. A. , Thomson A. D.
Published: February 2018

1. The literature on pigmented villonodular synovitis has been reviewed and a series of eighty additional cases is reported.

2. The condition usually presents either as a nodule in a finger or knee, or as a diffuse lesion in a knee. The lesions, although benign, sometimes erode or invade the tissue of adjacent bones.

3. Distinction from malignant synovioma can be made on the basis of the macroscopic appearance of the lesion at operation (relationship to joints or tendon sheaths: villonodular appearance: pigmentation), and by histological examination.

4. Treatment of the nodular form by excision is satisfactory but extensive synovectomy for diffuse lesions of the knee gives poor results.

5. The etiology of pigmented villonodular synovitis is unknown, but it appears to be a self-limiting process, possibly inflammatory in nature.
BONE LESIONS IN PIGMENTED VILLONODULAR SYNOVITIS
Authors: Scott P. M.
Published: February 2018

1. Five cases of pigmented villonodular synovitis with associated lesions within bone are recorded, two in the hip, two in the knee and one in the elbow.

2. The mode of formation of these intraosseous lesions is explained and methods of treatment are discussed.
DISPLACEMENTS OF TROCHANTERIC FRACTURES AND THEIR INFLUENCE ON REDUCTION
Authors: May J. M. B. , Chacha P. B.
Published: February 2018

1. The radiological appearances of the fragments in 100 trochanteric fractures have been analysed.

2. A simple practical classification enables the correct method of reduction to be chosen.

3. In Type I fractures the proximal fragment consists of the head and neck alone. In Type II fractures the head, neck and a major part of the great trochanter constitute the proximal fragment.

4. The key role of the greater trochanter in influencing the displacement of the fragments is discussed.

5. For reduction, Type I fractures require rotation of the distal fragment to a neutral position. Type II fractures reduce in some degree of lateral rotation.
THE MANAGEMENT OF FRACTURES IN HAEMOPHILIA AND CHRISTMAS DISEASE
Authors: Kemp H. S. , Matthews J. M.
Published: February 2018

1. The management of fractures in seven haemophiliacs and one patient with Christmas disease is described.

2. The problems of management are essentially those associated with haemorrhage into the soft tissues.

3. There is no delay in the healing of fractures, which usually occurs with a relative lack of periosteal callus.

4. The principles of transfusion therapy are discussed.
A SIMPLE METHOD OF FUSION OF THE SUBTALAR JOINT IN CHILDREN
Authors: Brown Austin
Published: February 2018

1. A simple method of subtalar fusion, suitable for use in children, is described.

2. Although it is intended to provide stability for some years until a complete subtalar fusion can be carried out, further operation may not be necessary.

3. Its use is not advocated over the age of eleven or twelve.
THE PATHOGENESIS OF ANTERIOR TIBIAL SYNDROME
Authors: Paton David F.
Published: February 2018

1. A case of hernia of the anterior tibial muscles is described in which repair of the hernia under tension was followed by local muscle necrosis and contracture.

2. This case supports the theory of pathogenesis of the anterior tibial syndrome that increased tension in the compartment embarrasses the blood supply of the contained muscles.
THE CORRECTION OF FOOT DROP IN LEPROSY
Authors: Warren A. Grace
Published: February 2018

1. The complications following standard tendon transfer to provide active correction of drop foot in Chinese patients with leprosy are reviewed.

2. An alternative method of foot drop correction is described in which reactivation of the remaining distal stump of the tibialis posterior tendon is provided to assist in maintaining the stability of the arch of the foot and to help to prevent dropped toes.

3. A review of thirteen patients is given. The indications are that this method is functionally as good as other methods. So far it has shown none of the complications usual in Chinese patients.
TRAUMATIC SEPARATION OF THE UPPER FEMORAL EPIPHYSIS IN YOUNG CHILDREN
Authors: Ratliff A. H. C.
Published: February 2018

1. Thirteen cases of traumatic separation of the upper femoral epiphysis have been studied. Four were previously reported and nine new cases are analysed.

2. This is a rare injury occurring in young children and is due to severe violence.

3. Separation occurred at the epiphysial plate, and severe posterior displacement was frequent. The fracture line does not penetrate the epiphysis.

4. Premature fusion, avascular necrosis or non-union (individually or together) occurred in eleven of the thirteen patients.

5. Separation of the upper femoral epiphysis is a serious injury which is likely to lead to permanent deformity.
DEFECTS IN LONG BONES FROM SEVERE NEGLECTED OSTEITIS
Authors: Griffiths J. C.
Published: February 2018

1. Because of socio-medical deficiencies, osteitis in some parts of the world still conforms to the classical pattern seen before the introduction of antibiotics.

2. One of many complications is loss of continuity from widespread destruction of tubular bone.

3. Twelve patients with this complication are described. The most satisfactory treatment, when practicable, is the transference of an adjoining normal bone into the remnants of the defective one.

4. Two neonates each with a massive defect of the femur are described. This complication of osteitis at this age has not been reported before.

5. The long-term prognosis of lower limb defects is poor when there is failure of bone growth. Nevertheless, reconstructive procedures are still worth attempting because later amputation, if necessary, can be conservative, and prosthetic difficulties may thus be eased.
FRACTURE-DIASTASIS OF THE INFERIOR TIBIO-FIBULAR JOINT
Authors: Colton C. L.
Published: February 2018

1. A low oblique fracture of the libula is described associated with diastasis of the inferior tibio-fibular joint.

2. Seven cases are presented in which this injury was seen.

3. A method of internal fixation is described.

4. The importance of recognising this injury is stressed.
EXPERIMENTS ON THE TENSILE STRENGTH OF THE ANTERIOR CAPSULAR STRUCTURES OF THE SHOULDER IN MAN
Authors: Reeves Brian
Published: February 2018

1. A series of experiments on the tensile strength of the anterior capsular mechanism have been performed. These show that in the young the weakest point is the glenoid labral attachment, whereas in the elderly calcification of tissues makes the capsule and subscapular tendon weaker.

2. It has been shown previously that glenoid labral detachment is the common injury in the young at the time of an acute dislocation, whereas capsular rupture and subscapularis tendon damage occur in the elderly.

3. These findings suggest that in an acute anterior dislocation of the shoulder the shoulder integuments give at their weakest point, and that it is the site of this weakest point and not the mechanism of injury which influences the liability to recurrence.
UNILATERAL LOCALISED GIGANTISM OF THE EXTREMITIES WITH LIPOMATOSIS, ARTHROPATHY AND PSORIASIS
Authors: McCarthy D. M. , Dorr C. A. , MacKintosh C. E.
Published: February 2018

1. A woman of seventy-four presenting with gigantism of the left hand and foot, lipomatosis, progressive arthropathy and psoriasis is described.

2. The associations of the various conditions are examined in the light of the previously reported cases and the differential diagnosis of this condition (macrodystrophia lipomatosa) from other causes of localised gigantism is discussed.
THE EFFECT OF EPIPHYSIAL STAPLING ON GROWTH IN LENGTH OF THE RABBIT'S TIBIA AND FEMUR
Authors: Hall-Craggs E. C. B. , Lawrence C. A.
Published: February 2018

1. Arrest of growth at one proximal tibial epiphysis of young rabbits was obtained by stapling.

2. Radiopaque markers allowed the subsequent growth of both proximal and distal epiphyses of the experimental and contralateral tibiae and of both lower femoral epiphyses to be followed radiographically.

3. The reduction in the normal deceleration of growth rate at the distal epiphysis found after epiphysiodesis of the proximal epiphysis was again observed.

4. This change in growth rate was not encountered in the distal femoral epiphysis lying adjacent to the stapled tibial epiphysis.

5. Removal of the staples after the change in growth rate had become established at the distal tibial epiphysis was followed by a return to an approximately normal growth rate by both proximal and distal epiphyses.

6. It is concluded that a direct relationship exists between the additional growth at the uninjured epiphysis and the deficiency in growth obtained at the stapled epiphysis, and that this change in growth rate is limited to the experimental tibia.
STERNOMASTOID TUMOUR AND MUSCULAR TORTICOLLIS
Authors: Macdonald Donald
Published: February 2018

1. A parallel study has been made of fifty patients presenting with a sternomastoid tumour and fifty-two patients presenting with muscular torticollis.

2. In the birth histories of both these groups there was a high incidence of breech, forceps and primiparous births. The distribution of each was strikingly similar.

3. Sternomastoid tumours were right-sided in three-quarters of all cases and in an even higher proportion of the breech births. There was twice the expected incidence of plagiocephaly. Only one in seven proceeded to muscular torticollis, but in some of the remainder minor residua could be detected.

4. Muscular torticollis presented at any age, but one-third commenced in the first year of life. Only one in five gave a history of previous sternomastoid tumour. The contracture showed a predilection for the clavicular head, and was generally associated with some degree of facial asymmetry.

5. Nine of a combined 102 cases had a first or second degree similarly affected relative.

6. It is concluded that whatever the condition in the muscle at birth, it has three inconstant and variable sequelae. The torticollis may resolve completely; it may become clinically manifest as a tumour; or it may remain clinically latent, subsequently undergoing a variable degree of cicatrisation to produce torticollis.

7. The treatment of established torticollis by open division is described and the follow-up in thirty-six cases recorded.

8. This operation can be relied on to cure the principal deformity, but is accompanied by a number of minor cosmetic defects. Of these the most striking are tight bands apparently due to anomalous reattachment of the clavicular head, and loss of the sternomastoid column of the neck.

9. The method could not be relied on to cure facial asymmetry completely, even in the early years of life. However, there was some evidence to suggest that persistence of asymmetry was allied to persistence of other residua of the torticollis, for example fascial bands.
OSTEOMYELITIS OF THE METATARSAL SESAMOLDS
Authors: Colwill Michael
Published: February 2018

1. Three cases of osteomyelitis of a metatarsal sesamoid bone are described.

2. The diagnosis should be considered in patients with acute pain under the first metatarsophalangeal joint, particularly if the temperature is elevated.

3. Failure ofdiagnosis may lead to persistent disability until sinus formation and sequestration dictate operative intervention.

4. Early antibiotic therapy may lead to resolution of the infection.
DOUBLE OSTEOTOMY FOR THE PAINFUL KNEE IN RHEUMATOID ARTHRITIS AND OSTEOARTHRITIS
Authors: Benjamin A.
Published: February 2018

1. Double osteotomy was performed on 1 50 knees between 1961 and 1969. The first fifty-seven cases were assessed independently.

2. The operation of osteotomy of the upper end of the tibia and the lower end of the femur is described. it is emphasised that the osteotomy sites are close to the bone ends and well within the cancellous expansion.

3. The indications for the operation are pain and loss of function in a mobile arthritic knee joint.

4. Flexion of the knee is important during the operation to allow the popliteal artery to be moved away from bone. Arteriograms at necropsy show the danger of damaging the popliteal artery when the knee is extended.

5. The operation appears to be equally effective in osteoarthritis and rheumatoid arthritis. The proliferated synovium of the active rheumatoid knee regresses rapidly following operation.

6. The operation has resulted in relief of pain and increase in function in many knees which had no deformity. When a deformity did exist before operation recurrence of the deformity did not appear to influence the result.

7. The cause of relief of symptoms after osteotomy is not known, and it is suggested that answers to the following questions should be sought: Why are some arthritic knees painful and some not ? Why does physiotherapy relieve pain ? Why does osteotomy relieve pain? Why is double osteotomy followed by regression of synovial proliferation ? Why does osteotomy sometimes fail ? Would osteotomy of one bone (tibia or femur) be sufficient?
FACIAL PARALYSIS COMPLICATING SPLINTAGE FOR CONGENITAL DISLOCATION OF THE HIP IN THE NEWBORN
Authors: Beddow F. Howard
Published: February 2018

1. Four cases of facial paralysis from the incorrect use of Von Rosen or Barlow type splints are described.

2. Attention is drawn to the subcutaneous and therefore vulnerable position of the facial nerve in the newborn.
THE INCIDENCE AND TREATMENT OF SCOLIOSIS IN CEREBRAL PALSY
Authors: Balmer G. A. , MacEwen G. Dean
Published: February 2018

1. Ten children with scoliosis and cerebral palsy of various types have been reviewed. All underwent operation for correction and stabilisation of the spinal curve, and spinal fusion.

2. Three of the ten patients required supplemental surgery in the form of regrafting, with or without reinsertion of Harrington rods. All have shown considerable correction of the curve, and in all cases the fusion appears to be consolidated. Operation has given these children stable spines which are compensated. Their ability to sit, and in some cases to stand, has improved.

3. In many such cases of scoliosis complicating cerebral palsy Harrington instrumentation and spinal fusion is the only feasible effective form of treatment.
NAIL-PATELLA SYNDROME
Authors: Aggarwal N. D. , Mittal R. L.
Published: February 2018

1. From India a family is reported in which fifteen of fifty-seven were affected by the nail-patella syndrome.

2. Additional coincidental features not described previously were fiexion deformities of both hips and hyperextension of the interphalangeal joints of the fingers.

3. Patients affected by the condition do not always show the same blood group.
VENOUS THROMBOSIS AFTER FRACTURES OF THE UPPER END OF THE FEMUR
Authors: Culver Denis , Crawford J. S. , Gardiner J. H. , Wiley A. M.
Published: February 2018

1. One hundred patients with fractures of the upper end of the femur were investigated clinically and radiographically to ascertain the incidence and site of deep venous thrombosis during convalescence.

2. The technique of phlebography used has its own inherent dangers, but we believe that familiarity with the technique reduces the risk of complications.

3. The investigation revealed thrombi that were clinically unsuspected and indicates a need for further investigation of factors such as manipulation and retraction that may promote deep thrombosis.

4. The study has provided a control series for an investigation of the effect of prophylactic anticoagulants upon the incidence of deep venous thrombosis and pulmonary embolism after fractures about the hip.
EFFECT OF SYNOVECTOMY ON THE CLEARANCE OF RADIOACTIVE XENON (133Xe) FROM THE KNEE JOINT OF PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: Dick W. Carson , Shenkin A. , Freeman P. , Nuki G. , Whaley K. , Buchanan W. W.
Published: February 2018

1. 133Xe clearance rates as a measure of blood flow were determined in the knees oftwo groups of patients.

2. In the first group eight patients with rheumatoid arthritis were studied before, three months after and one year after synovectomy. Blood flow values were significantly lower three months after operation but the values recorded one year after operation did not differ significantly from those before operation.

3. In the second group (twenty-one patients with rheumatoid arthritis) blood flow values were determined two to three years after synovectomy. The values obtained differed from those obtained in normal joints and fell within the range of values obtained in forty-three patients with rheumatoid arthritis who did not have synovectomy.
ANNOTATIONS ON THE ETIOLOGY AND TREATMENT OF TIBIA VARA
Authors: Kessel Lipmann
Published: February 2018

1. It is suggested that early weight-bearing on physiologically bowed legs in infants leads to slowing of growth of the tibia and consequent increase of the differential length between fibula and tibia.

2. Such differential growth can produce both varus and medial rotation, leading to established tibia vara or Blount's disease.

3. Stimulation of tibial growth by simple metaphysial forage can correct this deformity if performed at an early age.
SEVERE SUBLUXATION OF THE CERVICAL SPINE IN RHEUMATOID ARTHRITIS
Authors: Crellin R. Q. , Maccabe J. J. , Hamilton E. B. D.
Published: February 2018

1. Nineteen patients with classical rheumatoid arthritis complicated by severe subluxation of the cervical spine are reported.

2. Thirteen patients had atlanto-axial subluxation. This was the only level ofinvolvement in ten.

3. The next most frequent level to be involved was C.4-5. This occurred in five patients.

4. Eleven patients required surgery for symptoms or signs of spinal cord compression or vertebral artery insufficiency.

5. Operations included six posterior fusions, three anterior fusions and two laminectomies.

6. The differential diagnosis, the radiological findings, the indications for surgery and the results of treatment are discussed.
FRACTURES OF THE FEMUR IN PAGET'S DISEASE OF BONE
Authors: Grundy Michael
Published: February 2018

1. Sixty-three fractures of the femur occurring in forty-eight patients with Paget's disease are presented.

2. In patients with Paget's disease the femur is the bone most often fractured, although the risk of fracture is probably not much greater than that of the normal population.

3. Many femoral fractures in Paget's disease are spontaneous and are preceded by pain. Extension of a stress fracture is the most likely cause.

4. All eleven femoral neck fractures in this series failed to unite; it is suggested that neither operation nor prolonged conservative treatment is indicated.

5. Subtrochanteric fractures, if severely displaced, are best treated by intramedullary nailing.

6. Most shaft fractures may be satisfactorily treated by conservative means. Deformity of the shaft can be corrected in fractures treated by external splintage.

7. The time required for union has been neither unduly short nor unduly prolonged.

8. The long-term results in this series have been acceptable. Sarcomatous change as a complication of fracture was not observed.
RUPTURE OF THE AXILLARY ARTERY COMPLICATING DISLOCATION OF THE SHOULDER
Authors: Curr J. F.
Published: February 2018

1. Complete rupture of the axillary artery caused by dislocation of the shoulder in a man aged seventy-four is reported. There was severe arteriosclerosis and the simple operation of ligation of the artery was performed with success. There was excellent function of the shoulder and hand on review thirteen years later.

2. Previously recorded cases are reviewed.
LOCALISED HVPERTROPHY OF THE SEMIMEMBRANOSUS MUSCLE SIMULATING POPLITEAL CYST
Authors: Symeonides Pan. P. , Paschaloglou Constantine
Published: February 2018

1. Two cases of swelling in the popliteal fossa due to a local hypertrophy of the semimembranosus muscle are described and two further cases thought to be of similar nature are noted.

2. The swelling was soft, not tender, fairly well circumscribed, and without signs of inflammation. Its most characteristic feature was an increase in size and hardening of the swelling during active flexion of the knee.

3. This condition should be considered in differential diagnosis of swellings of the popliteal fossa.
ACUTE SUPPURATIVE ARTHRITIS IN INFANCY AND CHILDHOOD
Authors: Paterson Dennis C.
Published: February 2018

1. A regime of treatment for acute suppurative arthritis in childhood has been proposed. This consists of: urgent arthrotomy of the affected joint, if possible within five days; skin closure without drainage; antibiotics; and immobilisation of the joint for six weeks.

2. Fifty hips have been treated by this regime: all are clinically and radiologically normal The failure to achieve these results with other forms of treatment is due to delay in diagnosis, inadequate drainage together with lack of immobilisation of tile affected joint, and inadequate treatmellt with antibiotics.

3. Early diagnosis determines the ultimate prognosis. It is suggested that in doubtful cases exploratory arthrotomy is indicated. Eleven hips were found to Ilave some other cause for the signs and symptoms, but the children have suffered no ill effects from the arthrotomy.

4. Diagnostic aspiration is an unsatisfactory method, especially ill the case of tile hip, and should be avoided. Incision is preferable.

5. Acute suppurative arthritis of infancy is a serious condition. Diagnosis is difficult and is often delayed, so that the affected joint may be destroyed. In this small series of nine, seven affected joints were destroyed.
SUPERIOR MIGRATION OF THE HUMERAL HEAD
Authors: Weiner Dennis S. , Macnab Ian
Published: February 2018

1. A radiological study of the acromio-humcral interval in sixty normal shoulders and in fifty-nine shoulders with known tears of the rotator cuff is reported.

2. The normal acromio-humeral interval was found to be seven to fourteen millimetres, a range that is consistent with previous observations.

3. Narrowing of this interval is a frequent concomitant of a tear of the rotator cuff.

4. An interval of five millimetres or less should be considered compatible with a tear of the rotator cuff until proven otherwise.

5. An explanation of the pathomechanics of the observation has been proposed.
THE MICROVASCULAR PATTERN OF THE ROTATOR CUFF
Authors: Rathbun James B. , Macnab Ian
Published: February 2018

1. The avascular zone in the tendon of the supraspinatus near its insertion was not seen in the other tendons comprising the rotator cuff, except for the superior portion of the insertion of the infraspinatus which, on occasions, showed a small avascular area. The biceps tendon, however, also showed an avascular zone as it coursed over the head of the humerus. It is suggested that the anatomical disposition of these tendons makes them subject to constant pressure from the head of the humerus, which tends to wring out the blood supply to these tendons when the arm is held in the resting position of adduction and neutral rotation.

2. Although this study did not produce any evidence that the relative avascularity of the tendons over a prolonged period could be indicted as the sole cause of the degenerative changes that so commonly occur, it was noted that the degenerative changes occurred first and that they were always most extensive in the areas of avascularity. It was also observed that the zones of relative avascularity preceded, and were not the result of, the degenerative changes.

3. With the onset of tendon degeneration, secondary vascular phenomena were observed. Firstly, there was a reaction that appeared to be a foreign body inflammatory response with the development of vascular tufts of granulation tissue. It was thought that these vascular changes were secondary to the breakdown in the tendons and were not the cause of the breakdown as previously suggested by Anderson and Moore. it was noted, moreover, that with the progression of degenerative changes in the supraspinatus tendon, the tendon became much attenuated and, as it did so, the zone of relative avascularity appeared to extend. This secondary shut-down of the vascular bed might well be caused by an increased tension in the tendon. In those tendons in which spontaneous rupture had occurred, it was noted that the major part of the tendon proximal to the rupture was avascular and showed evidence of much degenerative change. This study therefore suggests that in the operative repair of such lesions it is necessary to excise the degenerate avascular tendon in order to effect a sound repair. It is also suggested that detachment of the supraspinatus muscle from the supraspinous fossa in order to advance the whole muscle belly is the only technique possible to enable the surgeon to replace healthy tendon directly into bone, as suggested by Debeyre and his colleagues.
PROGNOSIS IN SPONTANEOUS OSTEONECROSIS OF THE KNEE
Authors: Muheim Georges , Bohne Walther H.
Published: February 2018

In fifty-two knees with spontaneous osteonecrosis the diagnosis was based on a subchondral transradiancy in the weight-bearing surface of the medial femoral condyle. Strontium-85 scintimetry showed a unique pattern, indicating a lively repair reaction by localised high values. Thirteen of fifteen knees followed between two and twenty-three years developed osteoarthritis. The prognosis was based on the size of the transradiancy and the focality of the lesion as determined by scintimetry. It is suggested that scintimetry permits differentiation between primary osteoarthritis and arthritis secondary to osteonecrosis.
TRAUMATIC ISCHAEMIA IN A HAEMOPHILIAC
Authors: Robins Robert H. C. , Murrell J. S.
Published: February 2018

A case is reported of fracture of the tibia in a haemophiliac, complicated by severe ischaemia. Extensive decompression of the limb followed later by skin grafting was required. The haematological management which made such surgery practicable is described. It involved the use of cryoprecipitate for a period of seven weeks.
PROLONGED EXTERNAL PRESSURE AS A CAUSE OF ISCHAEMIC CONTRACTURE
Authors: Conner Alan N.
Published: February 2018

1. Six patients are reported in whom ischaemic muscle contractures followed prolonged external pressure.

2. Systemic hypoxaemia may be a predisposing factor in patients with overdoses of central nervous system depressants.

3. If treatment is to be successful, early diagnosis is required, and the most important factor is an awareness of the condition.

4. The treatment of the late case is discussed.
THE TREATMENT OF DUPUYTREN'S FRACTURE-DISLOCATION OF THE ANKLE
Authors: Colton C. L.
Published: February 2018

1. A retrospective clinical and radiological study has been undertaken of forty-six cases of closed Dupuytren fracture-dislocation of the ankle joint in adults.

2. The final results are analysed with reference to the methods of treatment employed.

3. The problems of this injury are discussed referring both to the results of this investigation and to the past literature.
A STUDY OF FEMORAL TORSION IN CHILDREN
Authors: McSweeny Anthony
Published: February 2018

1. After exclusion of the well known causes of torsion such as congenital dislocation of the hip, Legg-Perthes' disease, cerebral palsy and congenital talipes equinovarus, examination of 1,320 nearly normal children disclosed an incidence of 13·6 per cent toeing-in or toeing-out.

2. There was a female preponderance of seven to three on presentation decreasing to four to three in uncorrected cases.

3. There was persisting upper femoral torsion of greater than 10 degrees in two-thirds of all cases of toeing-in whether corrected or uncorrected.

4. When correction of toeing-in occurred it took place between four and seven years of age, but mainly at five years.

5. There was a normal angle of anteversion in one-third of children whose toeing-in was not corrected. This suggests the possibility of acetabular maldirection.

6. Uncorrected torsional stresses may play a part in the later development of osteoarthritis.
POLYCENTRIC KNEE ARTHROPLASTY
Authors: Gunston Frank H.
Published: February 2018

1. A concept and design of polycentric knee arthroplasty based on the biomechanics of normal knee movement is presented. The diseased articular surfaces of the femoral condyles and tibial plateaus are replaced separately by prosthetic implants secured with cement. The collateral and cruciate ligaments are retained to maintain joint stability.

2. The early results from this arthroplasty in twenty-two knees are assessed. The operation gave relief of pain in twenty-two, a range of movement greater than 90 degrees in thirteen, no lateral instability in sixteen of twenty-two knees and an increased degree of mobility for nineteen of twenty individuals (two bilateral arthroplasties).

3. Operative complications consisted of delayed wound healing in four knees and common peroneal nerve palsy in one. One knee was subsequently arthrodesed for lack of functional improvement.
OSTEOCHONDRAL FRACTURES AND THEIR RELATIONSHIP TO OSTEOCHONDRITIS DISSECANS OF THE KNEE
Authors: Aichroth Paul
Published: February 2018

1. In sixty mature rabbits osteochondral fractures of various types were made in the medial femoral condyle.

2. The fractures or fragments which remained stable united but those in which movement occurred progressed to non-union.

3. An ununited osteochondral fragment resembled osteochondritis dissecans in the human both radiologically and histologically.

4. Experiments in the cadaveric knee show that the patella articulates with the classical site on the intercondylar aspect of the medial femoral condyle in full flexion of the joint and here an osteochondral fracture could be sustained.

5. It is concluded that the fragment in osteochondritis dissecans follows an osteochondral fracture which remains ununited.
THE EARLY MANAGEMENT OF VARUS FEET IN MYELOMENINGOCELE
Authors: Walker Geoffrey
Published: February 2018

1. A conservative approach to the varus deformity of anaesthetic feet in infants with myelomeningocele is advocated. Thirty-three of thirty-five varus feet treated by this method, supplemented when necessary by a minor operation to correct equinus, responded satisfactorily in this prospective study of twenty-four infants treated from birth.

2. A rotation flap incision has proved of considerable advantage in the rare instances when an extensive medial release is required.
THE MECHANISM OF TARSO-METATARSAL JOINT INJURIES
Authors: Wiley James J.
Published: February 2018

1. Twenty cases of tarso-metatarsal joint injury have been studied with regard to the mechanism of injury, and experiments have been done on cadavers to confirm clinical impressions.

2. Injuries of the tarso-metatarsal joints occur by direct and indirect mechanisms, the latter being more common.

3. Indirect injuries occur in at least two ways-namely, acute abduction of the forefoot and plantar-flexion of the forefoot.

4. Most of the indirect injuries occur when the ankle joint is in a plantar-flexed position.

5. Whereas this foot injury once gained prominence on the field of battle amongst cavalrymen, it is currently associated with the motor car, the step ladder, the toboggan, the joy-rider, and commonly the simple misguided step.