bluuebunny/crossref_metadata_2025 huggingface dataset:
PERONEAL SPASTIC FLAT FOOT
Authors: Blockey N. J.
Published: February 2018

1. This paper reports the investigation and the results of a line of treatment in thirty feet showing the peroneal spastic flat foot deformity. The questions that have aroused controversy are discussed, the evidence for previous opinions is examined, and some phenomena in relation to this condition are described.

2. It is suggested that previous opinions on this condition have been misleading, and have in many cases been made after incomplete investigation of too few cases.

3. Peroneal spastic flat foot can occur without a developmental tarsal anomaly.

4. The presence of a tarsal anomaly does not necessarily mean that the foot is incorrigibly stiff, and some of these feet show a full range of movement under anaesthesia.

5. There is no evidence from this series of cases to suggest that organic nervous disease or psychiatric disturbances played a significant part in the production of the deformity.

6. There is no evidence to suggest that the deformity is a manifestation of generalised rheumatoid arthritis.

7. This investigation does not reveal the cause of the deformity when the tarsal skeleton is normal, nor does it help to explain the reason for the onset of symptoms in a developmentally abnormal foot.

8. It is suggested that a tarsal anomaly makes the foot more likely, under average stress, to break down in this way, and that this deformity is also assumed by architecturally normal feet under heavy stress. In view of the frequency of minor tarsal anomalies among this series of thirty feet, it seems likely that all feet presenting the deformity of peroneal spastic flatness are to some degree structurally abnormal, although the exact site of the abnormality may escape us.
DISLOCATION OF THE FIFTH CARPO-METACARPAL JOINT
Authors: Ker H. R.
Published: February 2018

Descriptions of four previous cases of antero-lateral dislocation of the fifth carpometacarpal joint are reviewed and a further case is reported. Suggestions are made on treatment.
THE OS TRIGONUM
Authors: McDougall A.
Published: February 2018

1. Previous papers on the subject of the os trigonum are reviewed.

2. Evidence is produced to show that the posterior part of the talus normally develops from separate centres.

3. An explanation is given for the presence in adults of separate ossicles (the so-called os trigonum) in one or both ankles and for the variety of shapes adopted by them.

4. Contrary to opinions expressed by previous writers, these ossicles may give rise to symptoms.
SKELETAL SARCOMATA AND GIANT-CELL TUMOUR
Authors: Thomson A. D. , Turner-Warwick R. T.
Published: February 2018

1. One hundred and seventy-nine cases of primary malignant bone tumour and giant-cell tumour seen at the Middlesex Hospital since 1925 are reviewed. Tumours arising from non-skeletal tissues in bone have been excluded.

2. The following histological classification is used. Osteosarcoma (osteoblast sarcoma): This tumour is not synonymous with osteogenic (bone-forming) sarcoma. The essential feature is the formation of osteoid tissue by malignant osteoblasts, with no intermediate matrix of cartilage or fibrous tissue. It is the most malignant bone tumour and only four of the thirty-two patients survived three years. Chondrosarcoma: These tumours are composed of cartilage, and some show secondary ossification. The behaviour of this group is related to the degree of cartilaginous differentiation. In general, compared with the osteosarcoma, it is of low-grade malignancy. More than half of the sixty-eight patients survived four years. Fibrosarcoma: The essential feature of this tumour is the production of collagen by malignant fibroblastic tumour cells. Tumours of this type invading the medullary cavity have an average prognosis between that of an osteosarcoma and a chondrosarcoma. Nine of the thirty-four patients survived three years. Spindle-cell sarcoma: These tumours are composed of spindle cells which produce no diagnostic matrix. In spite of the lack of differentiation the outlook is not hopeless. Six of the eleven patients survived for five years or more. Giant-cell tumour: This tumour is composed of a cellular stroma with diagnostic giant cells resembling osteoclasts. It is by no means a benign lesion, for half the tumours recurred after treatment and a quarter of the patients died with metastases.

3. The subdivision of primary malignant skeletal tumours into groups according to the histological pattern appears to be reflected in the behaviour of the individual tumours after treatment. The prognosis of each group has been stated in the appropriate sections.
AN AUTORADIOGRAPHIC STUDY OF MUCOPOLYSACCHARIDE AND PHOSPHATE COMPLEXES IN BONE GROWTH AND REPAIR
Authors: Duthie Robert B. , Barker Audrey N.
Published: February 2018

1. A method is described of demonstrating in vivo the utilisation of radioactive sulphur35 and of radioactive phosphorus32 during bone growth and repair.

2. The relationship between labelled chondroitin sulphuric acid and labelled phosphate complexes has been studied, the importance and significance of vascularity and the localisation of the enzyme alkaline phosphatase being noted.

3. It was found that bone growth by external accretion, both epiphysial and periosteal, was accompanied by an increased utilisation of radioactive chondroitin sulphuric acid and calcium phosphate complexes.

4. During repair in a fracture site, although there was deposition of radioactive phosphate, no preferential localisation of radioactive sulphur was observed and the possible explanations of this are discussed.
BENIGN CHONDROBLASTOMA OF BONE
Authors: Treasure E. R.
Published: February 2018

A case of benign chondroblastoma in the upper end of the humerus is described. A plea is made that radiotherapy should be avoided in the treatment of this tumour. It is suggested that biopsy should be performed in every case.
METABOLISM OF BONE SALT INVESTIGATED BY SIMULTANEOUS ADMINISTRATION OF 45Ca AND 32P TO RATS
Authors: Bauer GoÌran C. H. , Carlsson Arvid
Published: February 2018

After the simultaneous administration of radiocalcium and radiophosphorus to young rats the rate of deposition of calcium and of phosphorus in various skeletal parts was computed. Agreement was found between the two sets of data. No difference was thus found in the metabolism of the calcium and of the phosphorus of the bone salt.
SUDECK'S ATROPHY IN THE HAND
Authors: Plewes L. W.
Published: February 2018

1. The incidence of Sudeck's syndrome in the hand is about once in 2,000 accidents of all kinds.

2. The onset of signs and symptoms occurs some weeks after injury and the typical radiographic changes (spotty atrophy) appear six to eight weeks later.

3. Conservative treatment by heat, elevation and graded function is effective if initiated within six weeks of the onset of symptoms.

4. There is some close relationship between Sudeck's atrophy and thickening of the palmar fascia.
FIBROGENESIS IMPERFECTA OSSIUM
Authors: Baker S. L.
Published: February 2018

1. A description is given of the pathology of a generalised skeletal disease characterised by a defect in the formation of the collagen fibres of the bone matrixâ"fibrogenesis imperfecta ossium."

2. Material from two cases, a woman of fifty-six and a man of sixty-four, was examined. All the samples of bone from both patients showed the same defect, which was severe in most of the specimens, and there was radiographic evidence of similar widespread bone changes in both cases.

3. The defect is clear-cut and striking histologically, provided that sections are examined with a polarising microscope, and/or by reticulin methods.

4. As a result of the defect in the bone matrix this fails to calcify, or calcifies imperfectly, showing wide osteoid borders as in severe osteomalacia. But the fibre defect separates it quite clearly from osteomalacia, in which the fibre structure of the osteoid tissue is normal. Moreover neither the biochemical findings (Case 2) nor the radiographic appearances correspond with those of osteomalacia.

5. The collagen fibre defect is confined to the bone matrix; no defect was found in the soft tissue collagen, and even the periosteum shows a normal fibre structure.

6. Both the clinical and the histological evidence indicate that the disease is not congenital, but was, in these two patients, apparently acquired during middle age. There was no family history of bone disease.

7. The cause of the condition is quite obscure. It is not inflammatory or neoplastic, nor is there histological or clinical evidence of a toxic origin. If it is a deficiency disease it is unlike any known vitamin or other chemical deficiency.
THE TREATMENT OF GAPS IN LONG BONES BY CANCELLOUS INSERT GRAFTS
Authors: Nicoll E. A.
Published: February 2018

1. A method of bridging gaps in long bones is described, using cancellous insert grafts supplemented by internal fixation with a metal plate.

2. The experimental work on transplantation of bone is reviewed in so far as it affects the practical problem of bone grafting.

3. Twenty-seven cases have been treated, with no failures. Seven of these are presented as illustrations.
A MUSCLE-TENDON TRANSPOSITION FOR PARALYSIS OF THE LATERAL ABDOMINAL MUSCLES IN POLIOMYELITIS
Authors: Clark John M. P. , Axer Anatol
Published: February 2018

1. A dynamic muscle-tendon transposition is described for supplementing the power of weak lateral abdominal muscles, and the details of the operative technique are given.

2. A clinical assessment of the results in a series of twenty-four patients is given.

3. The indications for the operation in poliomyelitis are suggested.
SOLITARY EOSINOPHILIC GRANULOMA OF BONE
Authors: Hunter T.
Published: February 2018

1. Eight cases of solitary eosinophilic granuloma of bone are described, along with two possible complications.

2. The main pathological, clinical, and radiographic features of the condition, and its treatment, are discussed.

3. The essentially benign course of the solitary lesion, even in the presence of complications, is confirmed.
ARTERIAL DISEASE AS A CAUSE OF PAIN IN THE BUTTOCK AND THIGH
Authors: Bonney George
Published: February 2018

1. Ten patients are described in whom pain due to arterial obstruction simulated pain caused by bone or joint disease or by disorder of the intervertebral disc.

2. The importance is stressed of arterial obstruction at the aortic bifurcation or in the iliac vessels as a possible cause of pain in patients attending orthopaedic clinics.
NON-OSTEOGENIC FIBROMA OF BONE
Authors: Maudsley Roy H. , Stansfeld Alfred G.
Published: February 2018

1. Ten cases are recorded of the entity known as non-osteogenic fibroma of bone.

2. We believe the evidence is in favour of the condition's being a localised disturbance of bone growth (metaphysial fibrous defect) rather than a true neoplasm.

3. The disorder usually pursues a symptomless course and in many instances the lesion disappears spontaneously.
FRACTURES OF THE ODONTOID PROCESS OF THE AXIS
Authors: Blockey N. J. , Purser D. W.
Published: February 2018

1. Fifty-one cases of fracture of the odontoid have been analysed. Forty were reported by other surgeons; eleven were new cases first reported by us.

2. Fracture of the odontoid in young children is an epiphysial separation. It occurs up to the age of seven years. As in epiphysial separations elsewhere, it unites readily, and remodelling occurs when reduction has been incomplete, so that normal anatomy is restored.

3. In adults forward displacement is twice as common as backward displacement.

4. Immediate paralysis is commoner if backward displacement occurs, but late neurological disorders are seen only after fractures with forward displacement.

5. Failure of bony healing is not dangerous if treatment has resulted in firm fibrous union, for there is neither excessive abnormal mobility nor progressive subluxation, either of which could injure the spinal cord or medulla. Neurological disorders developing after the fracture are the result of mobility from inadequate early treatment. It is the results of inadequate early treatment which have given this fracture a sinister reputation.

6. The fracture should be reduced by skeletal traction through a skull caliper. The reduction should be maintained for six weeks by continuous traction, and this should be followed by a period of six weeks in a plaster.

7. The increasing definition of the fracture-line seen in the radiographs of some patients indicates non-union.
POST-IRRADIATION FRACTURES OF THE NECK OF THE FEMUR
Authors: Stephenson W. H. , Cohen B.
Published: February 2018

Twenty-one post-irradiation fractures of the femoral neck are reported in seventeen patients who had been treated by radiotherapy for carcinoma of the uterus.

The clinical and radiological appearances are described and the diagnosis, prognosis and treatment of this type of fracture are discussed.

Histological material has been studied in three cases.

It is concluded:

1. That there is a characteristic clinical picture in which premonitory pain is of paramount significance.

2. That when the diagnosis is considered, the likelihood of irradiation damage should take precedence over the remote possibility of metastatic invasion.

3. That the disability varies, but in general the prognosis is favourable.

4. That there is no specific line of treatment applicable to these fractures.

5. That avascularity is not the underlying cause of this lesion.
CALCIFICATION OF ARTICULAR CARTILAGE
Authors: BunjeÌ Henry , Cole W. R.
Published: February 2018

1. Idiopathic calcification of articular cartilages is described in a Jamaican woman of thirty-one years who had intermittent joint pains for ten years and who had evidence of past gonococcal infection. She was otherwise normal.

2. The etiology of the condition is unknown.

3. Previous literature is reviewed.
A METASTASISING ADAMANTINOMA OF THE TIBIA
Authors: Morgan A. D. , MacKenzie D. H.
Published: February 2018

1. The so-called adamantinoma of long bones is a clinico-pathological entity, the pathogenesis of which is still in doubt. The case for its being a synovial sarcoma showing epithelial differentiation is in our view unconvincing.

2. The tumour is slowly growing, and of low grade malignancy. Apparent cure has been effected in a third of the total cases recorded by amputation or resection of the diseased bone.

3. These means, however, have not prevented metastases to the lungs and skeleton in a similar number.

4. A case is presented in which a metastasis appeared in the chest twenty-two years after amputation of the leg. This was sensitive to telecobalt irradiation, and is the first case in which a distant metastasis has been proved microscopically.
PERSISTENT FOETAL ALIGNMENT OF THE HIP
Authors: Somerville E. W.
Published: February 2018

1. The condition of persistent foetal alignment is discussed both as an entity and in its relationship to the development of a normal hip, and also to the varying degrees of congenital dislocation of the hip. A possible connection with osteoarthritis is also mentioned.

2. The secondary deformities to which it may give rise are discussed, and the way in which both primary and secondary deformities may be corrected is described.

3. The importance of estimating rotation with the hip in full extension is emphasised.

4. The results in eight patients so treated are mentioned.
TUBERCULOUS TENOSYNOVITIS
Authors: Pimm L. H. , Waugh W.
Published: February 2018

1. Forty-four patients with tuberculous tenosynovitis have been reviewed.

2. The lesions (fifty-two in all) are classified and described according to their anatomical sites.

3. Particular reference is made to the natural history of the condition and the results of treatment.

4. Early and extensive excision of the affected tendon sheaths combined with the use of anti-tuberculous drugs is recommended.
AIR EMBOLISM AS A COMPLICATION OF MEDULLARY NAILING
Authors: LeÌcutier M. A. , Smith A. H.
Published: February 2018

A case of fatal air embolism after KuÌntscher nailing of a fractured femur is described. Necropsy indicated that the only possible means of air entry was through the bone marrow. Subsequent discussion between the surgeon and the pathologist indicated that air must have been forced into the venous circulation through the marrow by repeated removal and reinsertion of nails, which allowed air to fill the punched-out marrow space when the nail was removed, the same air being forced into the marrow sinusoids when the nail was reinserted and hammered into position. This danger may be overcome 1) by allowing the site of operation to flood with blood by placing the patient in a "head up" position; 2) by flooding the operation site with saline; or 3) by assessing the calibre of nail required by radiological means rather than by trial and error.
THE USE OF TIBIALIS POSTERIOR AS A DORSIFLEXOR
Authors: Gunn D. R. , Molesworth B. D.
Published: February 2018

1. Fifty-six cases of tibialis posterior transplant for drop foot are reported.

2. The results are known to be satisfactory in forty-nine of the fifty-six cases.

3. Serious complications have been few.

4. Re-education has been easy in the great majority of cases.
MARCH GANGRENE
Authors: Blandy John P. , Fuller Robert
Published: February 2018

1. Three cases are described in which ischaemic necrosis of certain leg muscles followed exercise.

2. Previous reports of this condition are analysed, and the histology is discussed.

3. The term march gangrene is suggested for this condition.

4. The treatment advised is early and extensive fasciotomy.
ARTHRITIS OF HIP COMPLICATING OSTEITIS PUBIS
Authors: Coates H. B. , Rose B. S.
Published: February 2018

1. A case of arthritis of hip complicating osteitis pubis after retropubic prostatectomy is described.

2. It seems likely that bacterial infection was responsible in this case, although it was not proved.

3. Antibiotics did not appear to influence the course of the disease.

4. The progress of the disease was followed clinically and radiologically to its conclusion by natural healing with absorption of the femoral head, leaving a painless joint with good function.
THE ROLE OF ABDOMINAL PRESSURE IN RELIEVING THE PRESSURE ON THE LUMBAR INTERVERTEBRAL DISCS
Authors: Bartelink D. L.
Published: February 2018

1. Since the publication by Bradford and Spurling in 1945 of The Intervertebral Disc, there has been argument about the figure of 1,600 pounds that they calculated as the load on each lower lumbar intervertebral disc when a person lifts a heavy load with the trunk flexed, especially since experiments have shown that intervertebral discs subjected to increasing pressures yield at values well below this figure. In the author's experiments the discs were destroyed by pressures ranging from 350 to 1,400 pounds, with a mean of 710 pounds.

2. It occurred to the writer that the spine is not necessarily the only structure in the body that can transmit pressure forces from the shoulder to the pelvis. A raised intra-abdominal pressure impacts a thrust under the diaphragm, which will be transmitted to the thoracic spine and the shoulders by means of the ribs. This thrust can take care of part of the lifted weight and thus decrease the load on the spine.

3. In experiments in which the intra-abdominal pressure was measured by means of a small balloon in the stomach it was found that the pressure rose proportionally with the amount of weight lifted.

4. It is suggested that the abdominal fluid ball can exert a longitudinal force only if there is no contraction of the longitudinal muscles (at least anteriorly). Electromyographic studies of the abdominal muscles during weight lifting showed that the transverse and possibly the oblique abdominal muscles contract, but not the recti.

5. It thus seems that the load on the intervertebral discs is not necessarily so great as Bradford and Spurling calculated, but can remain within safe limits. It is hard to give accurate figures for the amount of load that is taken off the spine in this way, but an estimate would put it at several hundred pounds. The importance of a reflex contraction of the abdominal wall during effort as a protective mechanism for the spine must therefore be appreciated. Voluntary contraction may also be called upon to increase the intra-abdominal pressure and so reduce the load on the discs. This is done by many weight lifters.
NON-UNION OF THE EPIPHYSIS OF THE LATERAL CONDYLE OF THE HUMERUS
Authors: Jeffery C. C.
Published: February 2018

1. Thirteen cases of non-union of the epiphysis of the lateral condyle of the humerus were studied. Ten followed minor lateral luxations of the epiphysis; three were sequelae of open reduction and soft-tissue suture of major displacements.

2. In three cases in which non-union developed while the patient was under observation, union was secured after bone grafting by a technique described.
OBJECTIVE METHODS FOR DETERMINING THE FUNCTIONAL VALUE OF SENSIBILITY IN THE HAND
Authors: Moberg Erik
Published: February 2018

1. It was observed clinically that tactile gnosis varies directly with the sudomotor function in the hand.

2. Two methods of fingerprinting were elaborated to register the sudomotor function, and consequently the tactile gnosis objectively. They are sensitive, simple to perform and suitable for clinical work. Their anatomical background, sources of error and relative value are discussed.

3. The correspondence between the sudomotor function, determined with these methods, and the tactile gnosis was established. This was done by, firstly, comparing the regions which did not perspire with the ones which became insensible on total denervation of a region of the hand; secondly, by examining the loss of function after nerve block; and thirdly, by comparing the tactile gnosis and sudomotor function in cases of residual median nerve defect.

4. These two qualities do not accompany each other in skin grafts. Grafts regain sudomotor function but never tactile gnosis.

5. A practical procedure for determining the functional value of the cutaneous sensibility in the hand is described.

6. Cases are related illustrating the usefulness of objective study of the sensibility in the hand.
PRIMARY BONE-FORMING TUMOURS AND THEIR RELATIONSHIP TO SKELETAL GROWTH
Authors: Price C. H. G.
Published: February 2018

1. Analyses are presented of comparable groups of the two commonest bone-forming tumoursâosteochondroma and osteogenic sarcomaâderived from the following sources: Bristol Bone Tumour Register; British Empire Cancer Campaign Annual Report (1949); Stocks and Barrington (1925); Meyerding (1927); and Geschickter and Copeland (1949).

2. From this study, the following features emerge as characteristic and common to both tumours. 1) Both tumours are commoner in the male during the age periods 0-34 years, and over fifty years, with the possible exceptions of tumours of the humerus during early life and tumours of the pelvis. 2) The male preponderance is most marked for the appendicular long bones. 3) The male preponderance is greatest during the age period 15-34 years. 4) In the separate bones, these tumours tend to arise at a somewhat earlier age in the female. 5) In both sexes both tumours tend to arise at an earlier age in the bones of the upper arm and shoulder girdle than in those of the lower limb and pelvis. 6) Both tumours are related to an aberration of endochondral growth in length of bone.

3. The greater growth of the male, and differences in skeletal development in the two sexes, offer a simple and reasonably consistent explanation of these peculiarities and make it possible to discern the interplay of the three factors of age, sex and site of origin of the tumour.

4. From this concept it is possible to make a crude estimate of the factors of time and bulk of tissue which when combined may well account for the observed male preponderance of these tumours, and their anatomical distribution.
PARALYTIC CLAW HAND
Authors: Brand Paul W.
Published: February 2018

1. The intrinsic paralysis that occurs in leprosy has been treated by the sublimis transfer of Stiles and Bunnell for the past nine years. Since 1951 300 hands have been operated upon, and 150 patients selected geographically have been followed up in this study.

2. The patients have been assessed by a standard method involving: 1) Measurement of range of movement of the interphalangeal joint (unassisted movement, assisted active movement and passive movement); 2) grasp index; and 3) photographs of each hand in six standard positions.

3. Assessment of the open handâThe Stiles-Bunnell procedure is effective in achieving a fully open hand: 73 per cent of the fingers scored good or excellent results. A defect in the operation is that it sometimes hyperextends the interphalangeal joint, producing an "intrinsic plus" hand.

4. Assessment of sequence of joint flexionâThe Stiles-Bunnell operation restores satisfactory mechanism of closure of the hand in 93 per cent of casesâthat is, the metacarpo-phalangeal joints flex before the interphalangeal joints.

5. The closedfist assessmentâAbout 30 per cent of patients had some defect in the complete closure of the fist after operation. In 5 per cent of cases the fingers did not reach the palm after operation.

6. ComplicationsâThe "intrinsic plus" defect is commonest in the best and most mobile hands. This is a late complication which gets worse in succeeding years. It can be corrected by Littler's operation together with a profundus tenodesis in the middle segment of the finger. Lateral deviation of fingers due to radial-side attachment of the transferred tendon can be avoided by ulnar-side attachment of the tendon used for the index finger. Bowstringing of the sublimis stump in the flexor sheath may be avoided by division of the sublimis at it insertion. Weakness of grasp and pinch from loss of sublimis may be avoided by using only one or two sublimis tendons split into several strands. The index finger sublimis should be left in position.

7. It is concluded that the sublimis transfer of Stiles and Bunnell is a very powerful corrective of intrinsic paralysis of the fingers. Its chief defect is that it is too powerful and produces the opposite deformity. For this reason the use of this operation should be restricted to fingers in which there is some limitation of passive extension. For fully mobile fingers an operation should be selected which does not remove the sublimis from its normal position.
FAMILIAL JOINT LAXITY AND RECURRENT DISLOCATION OF THE PATELLA
Authors: Carter Cedric , Sweetnam Rodney
Published: February 2018

The family we record draws attention to an association between recurrent dislocation of the patella and joint laxity, which is not confined to the knee. This may pass unrecognised if specific inquiry is not made. In this and other families reported, the joint laxity is inherited, as though due to a dominant gene, but some only of those affected suffer recurrent dislocation of the patella. It is probable that there are other genetically determined causes of recurrent patellar dislocation. In three other families we have seen more than one subject of patellar dislocation, but none had lax ligaments, and two other families have been recorded with no mention of associated joint laxity.
INTERNAL FIXATION IN THE TREATMENT OF FRACTURES OF THE SHAFTS OF THE RADIUS AND ULNA IN ADULTS
Authors: Smith J. E. M.
Published: February 2018

The place of internal fixation in the treatment of fractures of the shafts of the radius and ulna in adults is discussed, and the results in 130 fractures treated by internal fixation are reviewed.

Non-union was found to be the most frequent and serious complication after internal fixation.

The incidence of non-union can be greatly reduced if operation is delayed for at least one week, and preferably two to three weeks after injury.

Evidence is presented to support the value of delayed operation in the promotion of union of fractures.
LATE RESULTS OF REMOVING THE MEDIAL HUMERAL EPICONDYLE FOR TRAUMATIC ULNAR NEURITIS
Authors: King Thomas , Morgan Francis P.
Published: February 2018

The operation has the advantage of simplicity, and it avoids the slight danger of secondary cicatricial contracture of the nerve when it is transplanted anteriorly and implanted in muscle. There is a slight hazard from external injuries because the nerve is unprotected by the epicondyle.
LOW BACK PAIN DUE TO ARTERIAL OBSTRUCTION
Authors: Filtzer David L. , Bahnson Henry T.
Published: February 2018

A considerable proportion of patients with thrombosis of the aorta or its bifurcations exhibit low back pain either alone or in conjunction with other symptoms of this disease. Arterial obstruction should be considered in every patient presenting himself with low back pain. The importance of the history in making this diagnosis cannot be overemphasised. Back or leg pain, or both, coming on after exertion should suggest the diagnosis even in the absence of the other well recognised symptoms of arterial insufficiency. Therefore, to affirm or deny this suspicion, it is essential that palpation of the femoral and peripheral pulses be made a routine and integral part of every orthopaedic examination in patients complaining of low back pain. When pulses are not palpable or are diminished, and in the absence of other clear musculo-skeletal disease, consideration should be given to further and more specific diagnostic procedures, such as aortography. Only in this way can an occasional baffling and elusive case of troublesome backache be fully understood and the appropriate treatment instituted.
LUMBAR SPINAL OSTEOTOMY
Authors: Law W. Alexander
Published: February 2018

1. The indications for correction of severe rigid kyphosis by lumbar osteotomy are described.

2. The fatal complications in a series of a hundred cases are listed. With more experience of this operation they should be considerably reduced.

3. Among the non-fatal complications the low incidence of recurrence of the deformity severe enough to require further operation is noteworthy.
A METHOD OF FOREFOOT RECONSTRUCTION
Authors: Fowler Alan W.
Published: February 2018

1. An operation is described for the relief of irreversible claw toes associated with prominent and painful metatarsal heads.

2. The operation is suggested as an alternative to amputation of the toes.

3. The results of the operation done on twenty patients who have been followed up for a year or longer are reported.
COMPRESSION ARTHRODESIS OF THE ANKLE
Authors: Ratliff A. H. C.
Published: February 2018

1. The results of compression arthrodesis of the ankle performed on fifty-five patients (four bilateral) are presented.

2. Fifty per cent of these ankles were immobilised for a total period of no more than eight weeks.

3. Bony fusion occurred in 91 per cent.

4. The subjective result was good or excellent in 88 per cent.

5. The theoretical disadvantages of the transverse incision are not serious in practice.

6. The best position for arthrodesis of the ankle is at, or close to, the right angle.
THE ACETABULAR INDEX
Authors: Laurenson Rae Duncan
Published: February 2018

What is the present position? There is no doubt that the meaning of Kleinberg and Lieberman has been misconceived. With the passing of years their cautious conclusion concerning the acetabular index has been transformed into a firm conviction. Even so, it is apparent from the literature that the use of the acetabular index is a matter of controversy, and that, to a lesser degree, the normal values of the index are a matter of debate.

It is concluded that the measurement is not an absolute index of a predisposition to congenital dislocation of the hip and cannot be divorced from other radiological signs. Nevertheless, so long as there is a feeling of uncertainty about the most reliable early signs of congenital dislocation of the hip, it would be folly to ignore a high acetabular index, especially in an infant over six months of age.

It seems that to radiograph every infant at birth is not justified. The radiological signs at birth are not only unreliable because of problems of technique, but also equivocal because of the small size of the structures and the fact that they consist largely of cartilage. Until the radiographic technique is standardised it would be advisable to continue to regard 30 degrees as the upper limit of normal for the acetabular index in the newborn.

To make recommendations concerning treatment is beyond the scope of this paper. Nevertheless it is worth stating that the presence of a high index alone is not necessarily regarded as an indication for immediate treatment. But an infant found to have a high acetabular index should be kept under close observation and should be thoroughly examined at regular intervals before the beginning of full weight bearing.
THE VASCULAR ANATOMY OF THE SPINE AND ITS RELATIONSHIP TO PYOGENIC VERTEBRAL OSTEOMYELITIS
Authors: Wiley A. M. , Trueta J.
Published: February 2018

1. Vascular anatomical studies of the spine are described and the possibility of spread of infection from pelvis to spine through the paravertebral venous plexus is discussed.

2. Though a venous route does exist, our studies do not support the supposition that infection is likely to spread by this route; nor is there any clear clinical, pathological or anatomical evidence that such spread occurs.

3. Nineteen cases of pyogenic osteomyelitis of the spine are recorded, six of which followed urinary infections. The condition is compared with osteomyelitis as it occurs in the other bones of adults.
RADIOACTIVE ISOTOPES IN FRACTURES OF THE NECK OF THE FEMUR
Authors: Arden G. P.
Published: February 2018

1. A method is described for measuring blood flow to the head of the femur after fracture of the femoral neck, by estimation of the rate of uptake of radioactive phosphorus.

2. Of one hundred cases investigated the readings in fifteen were incomplete, and in seventeen were unreliable. Reasons are given for discarding the latter seventeen cases. After two years seven patients had died, leaving sixty-one available for analysis.

3. The results in sixty-one surviving patients with a follow-up of not less than two years are analysed. In twenty of these radioactivity was measured by bone sampling and in forty-one by direct readings with a needle counter.

4. The twenty-one intertrochanteric fractures studied were used as controls. In these the P32 ratio varied from 0·4 to 3·0. Union occurred in all patients and none developed avascular necrosis.

5. Of the forty patients with displaced fractures of the femoral neck twenty-eight showed a low P32 ratio. In twenty-three of these (82 per cent) the fracture united.

6. Twelve patients with fractures of the femoral neck showed a borderline or abnormal P32 ratio. In ten of these there was subsequent avascular necrosis or non-union.

7. The possible reasons for the discrepancy between expected and actual results are discussed.

8. Almost 40 per cent of the cases investigated had to be abandoned because of technical faults and in one-fifth of the remaining cases the expected results failed to agree with the clinical results. The method of investigation is therefore not of much practical value at the present time. Improvements in apparatus and technique might make the method more reliable and more useful.
FAMILIAL EPIPHYSIAL DYSPLASIA OF THE LOWER LIMBS
Authors: Weinberg H. , Frankel M. , Makin M. , Vas E.
Published: February 2018

1. A family of six generations, consisting of 114 members affected by epiphysial dysplasia of the lower extremities, is described.

2. Twenty-two males and twenty-three females were affected, while thirty-two males and thirty females were unaffected. Seven members of the family could not be traced.

3. Variations from Fairbank's description of dysplasia epiphysialis multiplex are discussed. In the family here reported the lower limbs only were affected and the severity of the disease was very variable.

4. Long term follow-up studies are presented.
CHARNLEY STABILISATION OF THE HIP
Authors: Piggot J.
Published: February 2018

1. Ninety-one patients with Charnley stabilisation have been reviewed.

2. The patients' ages ranged from fifteen to seventy-eight, with an average of fifty-seven years.

3. Patients have been followed up for at least one year, the average period being almost three years.

4. Early complications included low grade pyrexia (33 per cent), femoral thrombosis (10 per cent) and pulmonary embolus (5 per cent).

5. Fifty-four per cent of patients had no backache, 36 per cent had slight and 10 per cent had troublesome backache.

6. Sound bony fusion occurred in 72 per cent, unsound union in 19 per cent and stress fracture in 9 per cent.

7. Stress fracture and unsound union occurred most frequently in those over sixty years of age.

8. In eighteen patients under fifty there was one unsound fusion and no stress fracture.
McMURRAY OSTEOTOMY
Authors: Robins Robert H. C. , Piggot James
Published: February 2018

1. Nine out of ten patients who undergo McMurray osteotomy may expect lasting relief of pain. Seventy-five per cent should have a satisfactory functional result. It is rare for a patient to be made worse.

2. Osteoarthritis of the hip and ununited fracture of the femoral neck are good reasons for operation; avascular necrosis after fracture is not.

3. Internal fixation shortens the time in plaster and in hospital, and reduces the incidence of stiffness of the knee.

4. The common observation that the joint space may be increased after osteotomy is due often to the altered position of the femoral head. Occasionally there occurs a true increase in joint space, presumably indicating regeneration of articular cartilage, and an accompanying regression in the changes of osteoarthritis.
LONGITUDINAL STRESS FRACTURES
Authors: Devas M. B.
Published: February 2018

Six patients with longitudinal stress fractures of the tibia and femur are described. The difficulties of diagnosis and its confirmation are emphasised.
ANTERIOR DISLOCATION OF THE ULNA AT THE INFERIOR RADIO-ULNAR JOINT
Authors: Rose-Innes A. P.
Published: February 2018

1. Two cases are reported of the uncommon condition of simple anterior dislocation of the head of the ulna at the inferior radio-ulnar joint.

2. The literature concerning the condition and its treatment is reviewed.

3. The mechanism of the inferior radio-ulnar joint is discussed with particular reference to the function of the triangular fibrocartilage.

4. The mechanism of injury is discussed and a new idea of this mechanism is put forward.
CHONDROMYXOID FIBROMA OF BONE
Authors: Hutchison J. , Park W. W.
Published: February 2018

1. A case of chondromyxoid fibroma of the tibia is reported.

2. Initial removal by curettage was followed by regrowth of residual foci; these were removed by a second curettage three years later. Re-examination after a further three years shows no evidence of regrowth, and suggests that cure has been achieved.

3. Some histological features of the neoplasm are briefly described.
SUPPURATIVE ARTHRITIS OF INFANCY
Authors: Lloyd-Roberts G. C.
Published: February 2018

1. Attention is drawn to the powers of resistance of the growing ends of bones in suppurative pyogenic arthritis of the knee and hip in infancy.

2. It is emphasised that a translucent zone in the radiograph does not necessarily mean that this part of the bone, epiphysial cartilage or plate is destroyed.

3. Diagnostic criteria are described to confirm that cartilage or decalcified bone has survived the infection in the knee joint.

4. The prognosis for the knee joint is discussed.

5. The hip joint presents greater difficulties in diagnosis and greater issues are at stake. It is recommended therefore that the hip joint be manipulated or explored if the radiograph and the physical signs suggest that destruction of the joint has either caused dislocation or has so damaged it that dislocation is likely to occur in the future. In favourable cases stability may be restored to the hip. In the others a diagnosis of irreparable destruction is established and the surgeon is satisfied that an opportunity to help the patient has not been lost.
EXPERIMENTAL PROGRESSIVE SCOLIOSIS IN THE RABBIT
Authors: Langenskiöld A. , Michelsson J.-E.
Published: February 2018

1. By unilateral resection of the posterior ends of the sixth to eleventh ribs including the costal parts of both costo-vertebral joints, progressive scoliosis can regularly be provoked in young rabbits. Rotation of the vertebrae is prominent in the experimental deformity.

2. Although severe progressive scoliosis can be provoked by a surgical procedure we do not yet know the deforming forces which are released by the operation, but the way lies open for accurate studies on these factors.

3. It seems possible that studies on experimental progressive scoliosis may provide us with new methods to counteract or cure scoliosis in children. The goal is a means to reverse the deforming forces during growth so that the child's spine is straight when growth ceases.
THE SURGICAL TREATMENT OF CERVICAL SPONDYLOTIC MYELOPATHY
Authors: Rogers Lambert
Published: February 2018

An operation is described for mobilising the whole extent of the cervical part of the spinal cord into an enlarged spinal canal in cases of spondylosis with myelopathy. The procedure is indicated to relieve symptoms and arrest their progress, and it has proved effective in practice.
DISPLACEMENT OSTEOTOMY IN THE TREATMENT OF OSTEOARTHRITIS OF THE HIP
Authors: Nicoll E. A. , Holden N. T.
Published: February 2018

1. Almost all patients with osteoarthritis of the hip who consult the surgeon do so because they wish to be relieved of pain. They all have limitation of movement in varying degrees but most of them will be either unaware of it or will have accepted it. What is more important, they would not have sought medical advice because of stiffness if there had been no pain. The primary objective of operative treatment must therefore be to relieve pain.

2. Displacement osteotomy will give substantial relief from pain in a high proportion of cases and the relief is lasting. Perhaps that explains why this operation, advocated by McMurray and Malkin twenty-five years ago, is being practised more widely than ever to-day while its competitors (neurectomy, capsulectomy, arthroplasty) have steadily diminished in popularity.

3. The disadvantages of the operation are all related to post-operative immobilisation in plaster, which may induce further stiffness of the hip, even to the extent of ankylosis, or stiffness and pain in the knee. These disadvantages may be overcome to a considerable degree by internal fixation followed by sling suspension and early active movement. But when, under anaesthesia, the range of hip flexion is reduced to 45 degrees or less, the operation is always liable to result in ankylosis, and it is wise in these circumstances to take this possibility into account and warn the patient beforehand.
TORULOSIS
Authors: Allcock E. A.
Published: February 2018

1. The natural history of cryptococcal infection is discussed in relation to the findings in a woman of fifty-six with lesions in the right radius and right fourth metatarsal. A diffuse lesion found in the right lung with a calcified gland at the right hilum was believed to represent the initial site of infection.

2. There was a general tendency for normal bone architecture to be restored after the destructive phase of the disease had finished.

3. Specific treatment with the fungicide amphotericin B had to be stopped because of severe systemic reaction.

4. The significance of the rare association of Boeck's sarcoid with torulosis is discussed.
CERVICAL KYPHOSIS FROM POSTERIOR HEMIVERTEBRAE WITH BRACHYPHALANGY AND CONGENITAL OPTIC ATROPHY
Authors: Berk M. E. , Tabatznik B.
Published: February 2018

1. An unusual congenital anomaly of the cervical spine is described. This lesion caused a localised cervical kyphosis and resulted in the development of a mild tetraparesis.

2. The case reported is believed to be the first on record in the English literature of multiple posterior hemivertebrae in the cervical region.

3. The neck deformity was associated with an unusual combination of developmental anomalies–namely, brachyphalangy and bilateral congenital optic atrophy.

4. The importance of differentiating between congenital and acquired causes of kyphosis is emphasised.

5. The radiographic appearances of posterior hemivertebra are described, and the differential diagnosis is considered.

6. The development of the vertebral body, and the relationship between coronal cleft vertebra and posterior hemivertebra, are discussed. The possible role of a disturbance of vascular supply in pathogenesis is mentioned.

7. This report augments the growing literature on congenital skeletal anomalies occurring in combination with isolated congenital ocular defects.
EXCISION OF THE LUNATE BONE IN KIENBÖCK'S DISEASE
Authors: Gillespie H. S.
Published: February 2018

1. Twenty-four cases of excision of the lunate bone in Kienböck's disease have been reviewed.

2. In general, the results have been favourable, with 88 per cent excellent or good and 12 per cent fair or poor.

3. Abnormal contact between the triquetrum and the styloid process of the ulna appeared in many cases, but this contact did not appear to prejudice the results.

4. Excision after prolonged symptoms of the disease gave disappointing results.
ACETABULAR DYSPLASIA
Authors: Sharp Ian K.
Published: February 2018

A simple method of measuring the degree of acetabular development in the radiograph of the adult pelvis is described and arguments for its validity are advanced. This measurement is referred to as the acetabular angle. The normal values for this angle are between 33 and 38 degrees. Angles below 32 degrees are uncommon and probably of no clinical significance, whereas angles from 39 to 42 degrees are in the upper limit of normality. An angle of 47 degrees is shown in a hip with congenital subluxation. The prognosis for hip joints with acetabular angles between 42 and 47 degrees is under investigation.
ENGELMANN'S DISEASE
Authors: Lennon Evan A. , Schechter Mannie M. , Hornabrook Richard W.
Published: February 2018

Engelmann's disease appears to be a familial and probably hereditary systemic condition, in which most of the manifestations can be attributed to a disorder in the osseous and muscular systems. At present the nature of the pathological process is obscure. The manifestations may present soon after birth or become apparent later in life. There is evidence that it is progressive but it may become arrested in some patients.

In order that this very incomplete state of knowledge may be improved it will be necessary to observe patients and their relatives throughout their lifetime.
RESTORATION OF SENSIBILITY IN THE HAND BY NEUROVASCULAR SKIN ISLAND TRANSFER
Authors: Tubiana R. , Duparc J.
Published: February 2018

In ten cases definitive loss of sensibility in an important territory of the hand has been treated by a hetero-digital, neurovascular skin island transfer. Operative technique and results obtained are reported. Although not enough patients have been treated to allow us to give precise indications for the procedure, two such indications clearly emerge: 1) the treatment of insensitive digits; 2) the reconstruction of the thumb or fingers. The procedure could probably be used elsewhere than in the hand.
BRACHIAL PLEXUS INJURIES: TREATMENT OF THE FLAIL ARM
Authors: Yeoman P. M. , Seddon H. J.
Published: February 2018

1 . Thirty-six patients with complete irrecoverable brachial plexus lesions have been studied.

2. Function has been compared after 1) arthrodesis of the shoulder with amputation through the arm, 2) so-called reconstructive procedures, and 3) no operative treatment.

3. The results of reconstructive operations have been so disappointing that we believe that this type of treatment should be abandoned.

4. Amputation-arthrodesis offers a better functional result than either reconstruction or no operation. Its value depends to a considerable extent on the manual dexterity of the patient.

5. A clerical worker who is not mechanically minded is less likely to use an artificial limb, and in this type of patient operation is perhaps best avoided.