bluuebunny/crossref_metadata_2025 huggingface dataset:
BILATERAL PROXIMAL RELEASE OF THE HAMSTRINGS IN CEREBRAL PALSY
Authors: Seymour N. , Sharrard W. J. W.
Published: February 2018

1. In children with cerebral palsy and spastic paraplegia or tetraplegia with no fixed fiexion of the knees, tightness of the hamstrings may limit the stride, restrict passive straight leg raising and cause inability to sit up with the knees extended.

2. Nine such children have been treated by bilateral release of the hamstrings from the ischial tuberosity, with marked benefit in all patients.
THE RESULTS OF TRACTION INJURIES TO THE COMMON PERONEAL NERVE
Authors: White J.
Published: February 2018

1. A series of six traction lesions of the common peroneal nerve in association with a severe adduction force to knee is described.

2. The reasons for failure of the nerve repair are discussed.

3. A new system of radiological marking of the anastomosis is described.

4. A less pessimistic view of the prognosis is taken than heretofore, and the management of the injury is discussed with a recommendation that a more conservative resection be done three months after the injury.
LIGATURE OF THE INTERNAL ILIAC ARTERY FOR MASSIVE HAEMORRHAGE COMPLICATING FRACTURE OF THE PELVIS
Authors: Horton R. E. , Hamilton S. G. I.
Published: February 2018

1. Three cases of severe retroperitoneal haemorrhage complicating fractures of the pelvis are described. In two patients haemorrhage was immediately controlled by ligation of the internal iliac artery. The third patient died before the bleeding could be controlled.

2. Ligature of the internal iliac artery may be a life-saving measure when fracture of the pelvis is complicated by severe haemorrhage.
A NEW PROSTHESIS FOR DISARTICULATION AT THE HIP
Authors: Gillis Leon
Published: February 2018

1. A prosthesis which is useful in unilateral disarticulations of the hip and highly advantageous in cases of bilateral disarticulation is described.

2. It makes use of the principle of a swing door and makes walking possible with the assistance of elbow crutches in cases of bilateral hip disarticulation and amelia.
ACUTE ISCHAEMIA COMPLICATING LIMB TRAUMA
Authors: MacGowan William
Published: February 2018

1. Experience with twelve cases of arterial trauma are presented.

2. Six limbs were amputated and six limbs saved.

3. Delay in effective treatment was the major cause of failure to save the limb.

4. Five types of limb injury involving vessels are described.
ARTHROPLASTY OF THE KNEE BY THE WALLDLUS PROSTHESIS
Authors: Jones G. Blundell
Published: February 2018

1. Forty-five arthroplasties of the knee with the Walldius prosthesis are reported in forty-two patients, thirty-seven with rheumatoid arthritis and five with osteoarthritis.

2. There has been no structural failure of the prosthesis.

3. Sepsis required removal of the prosthesis in three cases, but arthrodesis was obtained in two of the three.

4. Serious loosening of the prosthesis occurred in one case only. Varus deformity occurred in one patient.

5. Radiological evidence of some movement of the prosthesis was present in six other cases but this did not seem to affect function.

6. It is concluded that this operation has a place in the treatment of the more seriously disabled patient, but should not be used when heavy demands are likely to be made on the joint.
IMPACTED FRACTURES OF THE NECK OF THE FEMUR
Authors: Bentley G.
Published: February 2018

1. Seventy patients with impacted fractures of the femoral neck treated from 1953 to 1965 have been reviewed. Forty-seven were treated conservatively and twenty-three by primary internal fixation.

2. The complications of both methods of treatment are recorded.

3. The prognosis following impacted femoral neck fractures is good. Seventy-nine per cent treated conservatively and 96 per cent treated by primary internal fixation had excellent or good results.

4. Primary internal fixation is the treatment of choice.
HARRINGTON'S INSTRUMENTATION AS A SALVAGE PROCEDURE FOR PSEUDARTHROSES IN SPINE FUSIONS FOR SCOLIOSIS
Authors: Berkin C. R.
Published: February 2018

1. Twelve patients with suspected pseudarthroses in previous spine grafts were subjected to operation.

2. Correction of the curves was produced by Harrington's instrumentation at the sites of pseudarthroses, osteotomies and fractures.

3. A significant increase in stature was produced in all the patients.

4. Harrington's hooks were safely inserted into cavities cut in intact portions of previous grafts.

5. Most patients were able to leave hospital in less than four weeks.

6. Deliberate bending of the Harrington rods has not led to subsequent fracture of the rod.

7. A sliding scoliosis fusion frame is described. It reduces friction during correction and it reduces haemorrhage during surgery.
THE CRUSH SYNDROME IN COAL MINERS
Authors: Bentley G. , Jeffreys T. E.
Published: February 2018

1. Three cases of traumatic anuria following muscle ischaemia ("crush syndrome") are reported.

2. The pathogenesis and treatment of the condition are discussed.

3. A scheme of management directed to the prevention of renal failure is proposed.
THE NARROW LUMBAR CANAL
Authors: Jones R. A. C. , Thomson J. L. G.
Published: February 2018

The syndromes associated with a narrow lumbar spinal canal are described and discussed. In thirteen cases two main groups were evident, the larger group having mainly backache and root pain, the smaller group having intermittent claudication. A method of recognising the narrow spinal canal on plain radiographs is described, and a comparison made with normal controls. The findings at operation are reported and the importance is emphasised of making a wide laminectomy for decompression. Our thanks are due to the neurosurgeons of the South-West Neurosurgical Unit, Mr G. L. Alexander, Mr D. G. Phillips and Mr A. Hulme, who kindly allowed us full use of their clinical notes. We would also like to thank Mr G. Banham for the reproductions, Mr E. Turnbull for the drawing and the secretarial staff for their patient co-operation.
SPINAL STENOSIS, A CAUSE OF CAUDA EQUINA COMPRESSION
Authors: Schatzker Joseph , Pennal George F.
Published: February 2018

1. The syndrome of spinal stenosis is due to compression of the cauda equina from structural narrowing of the lumbar spinal canal.

2. Patients with this syndrome present symptoms of cauda equina claudication or of unremitting bizarre back pain and sciatica.

3. The compression of the cauda equina is always posterior and postero-lateral and is caused by narrowing of the lateral recesses and of the dorso-ventral diameter of the spinal canal.

4. The diagnosis can be made only by myelography. The only form of successful relief of the nerve root compression in spinal stenosis is adequate lateral and longitudinal decompression.
THE PROXIMAL INTERPHALANGEAL JOINT
Authors: Kuczynski K.
Published: February 2018

During flexion of the joint from the fully extended position the collateral ligaments soon become tight as they pass over the apex of angulation of the side margin of the head and remain tight as they move over more vertical plane of the side of the head.

From measurements on the dissected fingers, from measurements on radiographs and from tracings of photographs of the proximal phalanx it was not possible to draw any definite conclusions about the sagittal cam effect comparable to those relating to the metacarpo-phalangeal joint. A few specimens exhibited some degree of this cam but most did not. This may be related to functional variations of individual fingers and requires more detailed study.

If the joint is immobilised for some time in flexion with the collateral ligaments well below the apex of angulation, the slack volar part of the collateral aspects of the capsule with fibres running to the lateral and palmar tubercies of the middle phalanx and the dorsal fibres of the flexor sheath may become contracted. Shortening of the fibres of the lower part of the collateral portions of the capsule (A) and of the most dorsal fibres of the flexor sheath (B) was a constant finding. Curtis (1964) advocated excision of a portion of flexor sheath over the joint in dealing with flexion contracture.

Dissection of two fingers affected by extension contracture suggests that it takes a long time to produce shortening of the soft and pliable more dorsal part of the capsule.

It appears therefore that if immobilisation of the proximal interphalangeal joint cannot be avoided, it should be for as short a period as possible, with the collateral ligaments just riding over the apex of the side margin on the head when fibres A and B are only slightly slack. The results of immobilising the injured finger with the proximal interphalangeal joint flexed not more than 15 degrees might be compared with those after immobilisation with the joint more flexed. Splintage of the joint in extension was advised by Stewart (1962) on functional and clinical grounds. He noted the importance of flexion of the metacarpo-phalangeal joint and used the position of extension in all cases except those of: 1) gross damage leading inevitably to stiffness; and 2) division of flexor tendons or infection in the tendon sheath.

It is suggested that in correction of contracture of the proximal interphalangeal joint caused by Dupuytren's affection it may be advisable to excise fibres A and B.
COMPLETE REPLACEMENT ARTHROPLASTY OF THE HIP BY THE RING PROSTHESIS
Authors: Ring P. A.
Published: February 2018

1. A complete replacement arthroplasty of the hip is described in which both components are inherently stable.

2. The arthroplasty does not require the use of acrylic cement.

3. It is appropriate for the treatment of the severely arthritic hip in which arthrodesis is not indicated, and for the mobilisation of two stiff and painful hips at any age.

4. It can be performed on both sides at the same time.

5. It produces a stable, pain-free and mobile joint in a high proportion of cases, and has appeared not to deteriorate over periods of up to four years.
SPONTANEOUS PARALYSIS OF THE ANTERIOR INTEROSSEOUS NERVE
Authors: Vichare N. A.
Published: February 2018

1. Four cases of spontaneous interosseous nerve palsy are reported.

2. The condition is commoner than is usually thought.

3. Recovery is quick after operation done to excise or exclude a band causing mechanical compression.
THE OSTEOGENIC EFFECT OF BONE TRANSPLANTS IN RABBITS
Authors: Bohr H. , Ravn H. O. , Werner H.
Published: February 2018

1. Transplantations of autografts and of Kiel bone to the iliac bone and to muscle tissue were performed in rabbits. Through labelling with two tetracycline compounds which have different fluorescent colours in ultraviolet light, bone formation between the labelling periods could be followed.

2. It was shown that bone formation between the fifth and the tenth day after transplantation to bone took place in about 50 per cent of the fresh autografts. Storage of the transplants in saline for one hour before replacement had little adverse effect, whereas exposure to air for one hour seemed to reduce the osteogenic effect of the grafts. Bone formation was not observed in grafts of Kiel bone during this period.

3. The fact that new bone formation in fresh autografts could be demonstrated even during the first four days after transplantation to bone indicates that osteogenic cells from the fresh autografts continue their activity under favourable conditions. This is supported by microradiographic and histological evidence.

4. The amount of callus which developed in close contact with the grafts during the first ten days after transplantation to bone was more pronounced both in fresh autografts and in autografts kept in saline than in autografts exposed to air for one hour. Callus developing at a later stage showed no significant difference between the various grafts, including those of Kiel bone.

5. In fresh autografts transplanted to muscle tissue callus formation could be demonstrated in most cases by the tenth day, indicating either survival of osteoblasts or the transformation of more primitive cells from the graft or from the host bone into osteogenic cells. No bone formation was observed when Kiel bone was embedded in muscle tissue.
ATTRITION RUPTURES OF FLEXOR TENDONS IN RHEUMATOID ARTHRITIS CAUSED BY BONY SPURS IN THE CARPAL TUNNEL
Authors: Mannerfelt L. , Norman O.
Published: February 2018

1. Bony spurs resulting from erosion of the scaphoid bone and trapezium in rheumatoid arthritis can pierce the floor of the carpal tunnel and cause attrition rupture of flexor tendons–most often the flexor pollicis longus tendon.

2. It is difficult to show these spurs on conventional radiographs, but using a special tomographic technique we have been able to explore the floor of the carpal tunnel in three planes. Using this technique we have been able to guard the flexor pollicis longus against attrition rupture by early excision of a spur from the scaphoid bone.

3. Our findings support the recommendation of free division of the flexor retinaculum in rheumatoid arthritis. When doing this the surgeon should always look for a bony spur piercing the floor of the carpal tunnel.
MONOSTOTIC FIBROUS DYSPLASIA
Authors: Henry Adrian
Published: February 2018

1. Monostotic fibrous dysplasia in the long bones occurs most frequently in adolescence. In the jaws it is found mainly in early adult life. It presents later in the ribs, probably because it is often asymptomatic in this site.

2. The disease is equally distributed in both sexes.

3. Reactivation may occasionally occur in later life and in pregnancy.

4. Successful surgical treatment is by no means always easily achieved, and requires, in addition to the problems of fracture fixation and the correction of deformity, careful consideration of the age of the patient, the activity of the lesion and the extent to which it involves the cortical bone.
SYRINGOMYELIA AND SCOLIOSIS
Authors: Huebert H. T. , MacKinnon W. B.
Published: February 2018

1. In this analysis of forty-three patients with syringomyelia, twenty-seven (63 per cent) had scoliosis. This association is probably due to the early involvement of the ventro-medial and dorso-medial nuclei of the spinal cord by expanding lesions.

2. The literature makes no reference to the treatment of scoliosis associated with syringomyelia. Two cases are presented of attempts to correct this scoliosis–one because of increasing deformity, the other for increasing backache.

3. Due to the presence of cystic lesions characteristic of syringomyelia, corrective operative treatment of scoliosis may present an added risk.

4. Because of the high incidence of scoliosis in patients with syringomyelia, any patient with scoliosis should be examined for evidence of neurological deficit.
DYSMELIA
Authors: Henkel Lothar , Willert Hans-Georg
Published: February 2018

A classification of a group of malformations of the extremities is given and an underlying common pattern is developed from a survey of 693 deformed limbs. It is characterised by a certain reduction tendency of the affected bones and the malformed extremity, an axis of malformation and an interdependence between the proximal and peripheral parts of the deformed limbs. The group, called dysmelia, has a common morphology, but morphologically identical types have been seen caused by thalidomide and as hereditary or sporadic cases. An attempt has been made not only to name and classify these deformities but also to clarify the underlying principles of their morphology. This will enable the teratologist to see the pattern of these malformations in comparison with that of normal development of the limbs and of experimentally induced limb defects.
THE CLINICAL SIGNIFICANCE OF THE EXTENSOR DIGITORUM BREVIS MANUS
Authors: Ross James A. , Troy Chester A.
Published: February 2018

1. A case of bilateral extensordigitorum brevismanuscausingsymptomsisdescribed. A review of the literature has revealed fourteen previous cases in which the anomaly was recognised.

2. The phylogenetic and morphological significance of this atavistic structure is considered.

3. Observations are made on the clinical features of the condition. It usually presents in a young male manual worker who complains of pain and swelling on the dorsum of the hand after heavy work. There is a visible swelling with the physical characteristics of a small fleshy extensor muscle.

4. Various methods of treatment are discussed. If the symptoms warrant operation total ablation of the muscle is suggested.
LOCKING OF THE METACARPO-PHALANGEAL JOINT FROM A LOOSE BODY
Authors: Honner Richard
Published: February 2018

1. Locking of the metacarpo-phalangeal joint from articular derangements is rare.

2. A case due to an intra-articular loose body is described.

3. The literature is reviewed. The commonest cause is catching of the volar capsule or collateral ligaments on osteophytes about the metacarpal head, but intra-articular bands, incongruities of the articular surface and entrapment of the sesamoid have also been described.

4. An analysis of the reported cases suggests the likely cause in the individual patient.

5. Operation is usually required to restore joint motion.
RUPTURE OF PATELLAR LIGAMENT AFTER STEROID INFILTRATION
Authors: Ismail. A. M. , Balakrishnan R. , Rajakumar M. K.
Published: February 2018

1. A case of disruption of patellar ligament is described.

2. An association with previous steroid infiltration is present in this case.
THE MANAGEMENT OF GAS GANGRENE WITH HYPERBARIC OXYGEN THERAPY
Authors: Colwill M. R. , Maudsley R. H.
Published: February 2018

We are grateful to Dr Robert A. Goldstone of Paterson, New Jersey, for pointing out an error in the article by M. R. Colwill and R. H. Maudsley on "The Management of Gas Gangrene with Hyperbaric Oxygen Therapy" in this Journal of November 1968, 50-B, 732. On page 742, the second line should read "They recommend the use of/ow molecular weight dextran (dextran 40, Rheomacrodex) to prevent the sludging and thrombosis that also occur . . ." The correction is important because high molecular weight dextran (dextran 70, Macrodex) would not be expected to have the desired effect.
INFANTILE PSEUDARTHROSIS OF THE TIBIA
Authors: Eyre-Brook A. L. , Baily R. A. J. , Price C. H. G.
Published: February 2018

1. Three cases of infantile pseudarthrosis of the tibia treated successfully by delayed autogenous by-pass graft are reported.

2. The delayed autogenous graft is stouter, stronger and more easily handled and has enhanced osteogenic properties than a graft transferred immediately.

3. The by-pass graft commends itself, firstly, because it does not disturb the pseudarthrosis, which in consequence helps the immobilisation of the graft; secondly, because it is well embedded in healthy bone above and below, well away from the abnormal bone; thirdly, because it lies under compression and, ideally, is vertically disposed between the knee and the ankle; and fourthly, because there is no devitalising stripping of periosteum or introduction of foreign bodies.

4. Support to the grafted leg is needed for at least five years, but only by a polythene splint after four to six months.

5. With early grafting the deformity straightens out and shortening is overcome, as there is early return to normal use of the limb.

6. Prolonged follow-up is called for lest the basic lesion in the tibia should extend.

7. Fibrous dysplasia and similar fibrous lesions of bone account for many cases of infantile pseudarthrosis of the tibia. Many of these lesions are congenital and subsequently lead to fracture.

8. Postponement of surgery should not be countenanced.
VASCULAR INSUFFICIENCY COMPLICATING TRAUMA TO THE LOWER LIMB
Authors: Doporto J. Michael , Rafique Mohamed
Published: February 2018

I. Five cases of fracture and dislocation in the lower limb complicated by vascular injury are described and discussed.

2. Suspicion of arterial injury is an urgent indication for exploration. Conservative measures must not be undertaken without radiological evidence of an undamaged main limb artery.

3. The eventual outcome of arterial reconstruction cannot be forecast, but it is always worth while attempting unless the limb is obviously beyond hope of survival.
DEVELOPMENTAL ANOMALIES AND PROGNOSIS IN INFANTILE IDIOPATHIC SCOLIOSIS
Authors: Conner Alan N.
Published: February 2018

1. A family study of sixty-one children with infantile idiopathic scoliosis to determine the relationship of other developmental anomalies to the behaviour of the curve is reported.

2. Of the thirty-nine children with resolving curves only one had another defect.

3. Twelve out of twenty-two children with non-resolving curves had at least one other developmental anomaly.

4. The presence of such defects may indicate that the curve is likely to progress.
RECURRENT OSTEOID OSTEOMA
Authors: Dunlop J. A. Y. , Morton K. S. , Elliott G. B.
Published: February 2018

1. A case of osteoid osteoma which recurred twice after block excision is reported.

2. It is postulated that recurrence is almost certainly caused by incomplete removal of the nidus, either by curettage or by incomplete block excision.

3. Why curettage is successful in most cases but not in others is obscure, but it may be that the arterial supply to the tumour is interrupted.

4. Block excision with adequate radiographic control to ensure its completeness is the treatment of choice.
ANATOMICAL FACTORS IN THE STABILITY OF THE HIP JOINT IN THE NEWBORN
Authors: McKibbin B.
Published: February 2018

The findings in a child with bilateral congenital dislocation of the hips who died shortly after birth are described. The only significant abnormality present was redundancy of the capsular ligaments and elongation of the ligament of the femoral head. The relationship between the orientation of the femoral neck and of the acetabulum was within normal limits. The significance of these findings in relation to etiology and management are discussed.
ACUTE OSTEOMYELITIS IN CHILDREN
Authors: Blockey N. J. , Watson J. T.
Published: February 2018

1. Acute osteomyelitis is defined.

2. An analysis of 113 cases is given.

3. An effective programme of treatment was evolved from experience over a period of nine years.

4. Recommendations regarding a programme of treatment are given.
VENOUS THROMBOSIS IN PATIENTS WITH FRACTURE OF THE UPPER END OF THE FEMUR
Authors: Hamilton H. W. , Crawford J. S. , Gardiner J. H. , Wiley A. M.
Published: February 2018

1. Seventy-six patients with fracture of the upper end of the femur were examined phlebographically for evidence of thrombosis. The patients were randomly divided into two groups : one was given phenindione post-operatively ; the other acted as a control.

2. Analysis of the select series showed that the incidence of venous thrombosis in the anticoagulation group (19 per cent) was significantly less than that in the control group (48 per cent).

3. However, analysis of the complete series failed to show that the incidence of venous thrombosis in the anticoagulation group was significantly less than in the control group.

4. The number of bleeding complications in the anticoagulation group (47 per cent) exceeded those in the control group (16 per cent). The only life-endangering haemorrhage occurred in a patient who had not received an anticoagulant for five months.

5. We were unable to show that the fracture significantly influenced the site or the incidence of venous thrombosis.

6. No correlation was found between the clinical and phlebographic diagnosis of venous thrombosis.

7. It is concluded that the early use of a prophylactic anticoagulant is an effective means of reducing the incidence of venous thrombosis in patients with a fracture about the hip.
PERIOSTEAL GANGLION
Authors: Byers Paul D. , Wadsworth Thomas G.
Published: February 2018

1. Four cases of periosteal ganglion are described. Their relationship to other mucin-filled cysts of connective tissue, both in soft tissues and in bone, is discussed and the fact that they all result from mucoid degeneration of fibrous tissue is emphasised.

2. Treatment is by surgical excision, with removal of a margin of apparently normal periosteum as well as the lesion itself. The lesion may recur, even after apparently adequate excision, by mucoid degeneration taking place in the periosteum immediately adjacent to the operative site or in the connective tissues occupying the surgical defect.
FURTHER EXPERIENCE IN THE MANAGEMENT OF CHRONIC OSTEOMYELITIS
Authors: Rowling D. E.
Published: February 2018

1. The treatment of twenty-nine consecutive patients suffering from chronic osteomyelitis is reviewed. With the advent of an antibiotic, Fucidin, which has the ability to penetrate in significant amounts into tissues carrying a poor blood supply, a more limited surgical procedure has become possible.

2. A successful outcome, as judged by primary healing, was achieved in 86 per cent of patients treated with a combination of surgery and Fucidin with penicillin. This compares favourably with the results achieved in a previous series in which more radical surgery was undertaken.

3. Although Fucidin has advanced the treatment of chronic osteomyelitis, it is still essential to use surgery as well.

4. Fucidin caused no toxic effects despite an average total dose of seventy to eighty grammes. Resistance of the staphylococcus developed in vitro in one patient, without affecting a satisfactory clinical outcome.
AN UNUSUAL CAUSE OF CARPAL TUNNEL SYNDROME
Authors: Jackson Ian T. , Campbell John C.
Published: February 2018

An unusual case of median nerve compression within the carpal tunnel ascribed to thrombosis in a dilated artery is described.
PARTIAL RUPTURE OF THE TENDO CALCANEUS WITH HETEROTOPIC OSSIFICATION
Authors: Fisher T. R. , Woods C. G.
Published: February 2018

1. A case of ossification and partial rupture of the tendo calcaneus is reported.

2. The possible etiology of the ossification and its relationship to the rupture is discussed.
STRETCH INJURY OF PERIPHERAL NERVE
Authors: Haftek Jan
Published: February 2018

1. Forty-seven tibial nerves of rabbits were stretched, twenty-four gradually by the Instron machine and twenty-three suddenly by dropping a load. The stretched nerves were examined histologically throughout their length.

2. Nerve trunks possess a high degree of elasticity, which is mainly a feature of the epineurium.

3. The initial elongation of the nerve is due to extension of the epineurium and straightening of the funiculi and of the nerve fibres. Such elongation is "physiological" in the sense that it does not affect the nerve fibres.

4. The first structure to be ruptured during stretching is the epineurium ; this occurs when the nerve trunk has reached its limit of elasticity.

5. Before rupture of the epineurium the damage to the nerve fibres is either neurapraxia or axonotmesis, because the endoneurial sheaths and Schwann tubes remain intact.

6. Beyond the limit of elasticity very severe damage of the nerve trunk occurs; all elements of the nerve may be ruptured. If less violent force is applied, some funiculi may survive. The longitudinal extent of the lesion is always great, reaching 2 to 5 centimetres in the rabbit.
DISPLACED FRACTURES OF THE LATERAL HUMERAL CONDYLE IN CHILDREN
Authors: Conner Alan N. , Smith M. G. H.
Published: February 2018

1. Thirty-nine displaced fractures of the lateral humeral condyle in children are reported. In one-third of the children the injury was accompanied by postero-lateral dislocation of the elbow. In some cases there was evidence that dislocation had occurred even when there was little persistent displacement of the condylar fragment.

2. All the fractures were treated by internal fixation with a specially designed screw. Thirtyfive children attended for review.

3. lt is concluded that all displaced fractures should be treated by internal fixation and that the method described is simple and reliable. Undisplaced fractures, or those with little displacement, may be treated conservatively when there is no evidence of associated dislocation of the elbow.
INTRACAPSULAR FRACTURES OF THE NECK OF THE FEMUR
Authors: Klenerman L. , Marcuson R. W.
Published: February 2018

1. A study of fifty femoral heads removed at operation for primary prosthetic replacement showed a remarkable constancy of the fracture line.

2. It is suggested that two sub-groups of this fracture-subcapital and transcervical-have been described as a result of radiological interpretation without consideration of the effects of varying degrees of rotation.
A GANGLION ARISING FROM A LUMBAR ARTICULAR FACET ASSOCIATED WITH LOW BACK PAIN AND SCIATICA
Authors: Gritzka Thomas L. , Taylor Thomas K. F.
Published: February 2018

A case of a ganglion arising from a distal lumbar articular facet joint associated with low back pain and sciatica is reported and the pertinent literature reviewed.
THE FATE OF CHONDROCYTES IN ENDOCHONDRAL OSSIFICATION IN THE RABBIT
Authors: Bentley George , Greer Robert B.
Published: February 2018

1. The epiphyses of the metatarsal heads of 250-gramme rabbits were separated at the zone of cell columns, stripped of perichondrium, labelled with tritiated thymidine and transplanted into the back muscles of the same animals.

2. Endochondral ossification started in the grafts at four days, was well established by seven days and progressed until fourteen days, the end of the study.

3. Progressive passage of the label down the zone of cell columns and into the hypertrophic zone was observed.

4. The tritiated-3H thymidine label had disappeared from the cartilage cells by ten days. No labelling was observed in the bone cells at any stage.

5. It was not possible to demonstrate from the experiment that growth plate chondrocytes are precursors of osteoblasts in the process of endochondral ossification in rabbits.
TUBERCULOSIS OF THE SPINE
Authors: Martin Norman S.
Published: February 2018

1. The long-term results of 740 European patients suffering from spinal tuberculosis and treated without and with specific anti-tuberculous drugs have been surveyed.

2. The results of treatment by conservative methods and by conventional surgical methods have been compared in the two periods. The attainment of spinal stability as judged by serial examination of radiographs was the main criterion in assessing healing.

3. Although the results of conventional treatment have improved since the advent of chemotherapy, the credit is mainly due to the influence of more frequently and more expertly applied operations.

4. With chemotherapy the well tried medical and surgical procedures produce stable spines in three-quarters of cases. With early operation on the lesion the results are better and more quickly obtained. Of eighty spines on which focal surgery was performed during the past twelve years before the lesions had become extensive, seventy-seven (9·62 per cent) healed by bone. The average duration of hospitalisation after such operation was four and a half months. No patient has had to be readmitted.

5. The difficulties and possible dangers of these methods must be emphasised. The operations are difficult and dangerous when the lesions have been allowed to get out of hand and become unduly extensive. They are contra-indicated in cases where there is very marked deformity.

6. Training in special techniques of operation is necessary. Duplicated drainage of the hemithorax after thoracotomy is essential, and skilled after-care is important if good results are to be obtained.
PATHOLOGY OF THE KNEE JOINT IN RHEUMATOID ARTHRITIS
Authors: Mills Kingsley
Published: February 2018

The morphological changes in bone and articular cartilage destruction have been described in sixteen consecutive cases of rheumatoid arthritis in which biopsy material was obtained during synovectomy of the knee. The following observations were made.

1. Bone and cartilage is replaced by fibrous granulation tissue which proliferates from periosteal and perichondrial fibroblasts.

2. These proliferative changes are distinct from the chronic synovitis of rheumatoid disease, but a chronic synovitis is necessary for them to appear.

3. Synovectomy does not remove the cells replacing bone and cartilage but its performance in some ways leads to their regression.
BRACHYDACTYLY WITH ABSENCE OF MIDDLE PHALANGES AND HYPOPLASTIC NAILS
Authors: Cuevas-Sosa Alejandro , García-Segur Francisco
Published: February 2018

1. A seven-generation family is described which presented an autosomal dominant hereditary disorder characterised by brachydactyly, hypoplastic nails from the index to the little fingers, normal toe nails, absent middle phalanges in the fingers and lateral four toes, variable degrees of hypoplasia of the distal phalanges in the fingers with normal thumbs and normal big toes.

2. Less frequently syndactyly between middle and ring fingers on the left and narrowing of the proximal phalanges of the ring and little fingers are also found.

3. This disorder seems to represent a new hereditary syndrome.
TUMOUR-SPECIFIC ANTIGENS : THEIR POSSIBLE SIGNIFICANCE IN THE ETIOLOGY AND TREATMENT OF MALIGNANT DISEASE
Authors: Moore Michael
Published: February 2018

1. That viruses may be involved in the causation of human tumours has long been suspected but not yet proved. The discovery that osteogenic sarcoma can be induced by viral agents in mice and hamsters makes the proposition that human sarcomas may also have a viral origin basically tenable on presently available evidence. In order to distinguish between passengers and causative agents it will probably be necessary to demonstrate antigenic cross-reactivity in tumours of similar type collected from different geographical areas, and the oncogenicity in subhuman primates of extracts containing virus from human tumours. Such information is likely to become available in the next few years.

2. The demonstration of tumour-specific immune reactions in an increasing number of patients with various forms of neoplasm, including skeletal sarcomas, and the correlation of these reactions with the clinical status of the disease sustains the hope that eventually immunotherapy may contribute to the control of cancer in man.

3. Animal experiments have revealed that the potentiation of immune responses may lead to the elimination of small foci of neoplastic cells. The role of immunotherapy in the treatment of cancer may therefore be as an adjunct to surgery, radiotherapy and chemotherapy (Alexander 1968). Once the primary tumour has been removed it may be possible to employ immunotherapeutic measures to destroy the relatively few remaining cells that give rise to late metastases; this is particularly apposite to juvenile osteosarcoma.
EXPERIMENTAL FATIGUE FRACTURE OF THE HUMAN CADAVERIC FEMORAL NECK
Authors: Griffiths W. E. G. , Swanson S. A. V. , Freeman M. A. R.
Published: February 2018

1. Thirty-seven specimens of the proximal third of the human femur were subjected to cyclically varying loads applied in a physiological direction to the femoral head, having maximum values of from four to thirteen times body weight.

2. Ten of these specimens sustained subcapital fractures of the femoral neck after numbers of cycles of loading varying from 123 to 8,193.

3. The maximum value of cyclic load needed to give fatigue fracture after 10,000 or fewer cycles was found to vary from about twelve times the body weight at ages twenty to fifty to about five times the body weight at age seventy or more.

4. In youth and in middle age the load levels mentioned above are greater than those encountered in normal living, but are comparable to those which may be applied to the femoral head during activities known to produce "fatigue" fractures clinically in young adults.

5. In the elderly the load levels mentioned above are within the range that can be applied in normal living. It is inferred that some femoral neck fractures in the elderly may be fatigue fractures caused by the cyclic loading of normal walking.
PRIMARY PROTRUSIO ACETABULI
Authors: Macdonald Donald
Published: February 2018

1. The literature of primary or idiopathic protrusio acetabuli is reviewed with particular reference to familial and racial influence on pathogenesis.

2. The radiological criteria of a "deep" acetabulum and of a "protruded" acetabulum are discussed.

3. Four generations of a family are presented in which all three members of the second generation showed marked protrusio acetabuli. In the remaining generations most members appeared to have abnormally deep acetabuli.

4. It is concluded that this family shows a strong familial tendency to deep or intruded acetabuli. The family tree, though incomplete, suggests a genetic influence ofa dominant type.
MALREDUCTION AND AVASCULAR NECROSIS IN SUBCAPITAL FRACTURES OF THE FEMUR
Authors: Garden R. S.
Published: February 2018

1. The long-term results in a consecutive series of 323 healed subcapital fractures of the femur show that, with few exceptions, the capital fragment maintains its integrity when the fragments are aligned within the narrow limits of good reduction, but undergoes superior segmental collapse when reduction is poor.

2. The effect of malreduction on the congruity of the hip joint is examined, and a remodelling response to malalignment of the aspherical femoral head in the imperfectly round acetabulum is proposed as an alternative interpretation of the radiological changes now considered to be the result of capital ischaemia.
VULNERABILITY OF THE POSTERIOR INTEROSSEOUS NERVE DURING RADIAL HEAD RESECTION
Authors: Strachan J. C. H. , Ellis B. W.
Published: February 2018

From the experimental evidence above, it is clear that in the upper four centimetres of the forearm the posterior interosseous nerve moves up to one centimetre or more medially relative to the radius on pronation of the forearm. This movement becomes of importance when considered in relation to methods of operative approach for excision of the radial head.

Operative approaches have been described in which emphasis has been placed on the position of incision, but in none of these is there any mention of the position of the forearm.

We suggest that the following precautions should be taken. 1) During excision of the radial head the forearm should be kept in full pronation. 2) The incision should be as posterior as possible to ensure that it is well clear of the nerve. 3) With the forearm pronated the incision extends from a little above the lateral epicondyle along the postero-lateral aspect of the forearm for not more than 5 centimetres; proportionately less in a child. 4) The surgical assistant's attention should be brought to the damage that the posterior interosseous nerve might sustain from undue pressure–for instance by retraction, especially by bone levers–in the anterior part of the wound.
THE PATHOLOGICAL ANATOMY OF CONVEX PES VALGUS
Authors: Drennan James C. , Sharrard W. J. W.
Published: February 2018

1. The pathological anatomy in a case of convex pes valgus in a patient with myelomeningocele is described.

2. A neuromuscular imbalance between the tibialis posterior and the evertors of the foot is suggested as the underlying cause of this type of foot deformity.
BILATERAL SPONTANEOUS AND SIMULTANEOUS RUPTURE OF THE QUADRICEPS TENDONS IN GOUT
Authors: Levy M. , Seelenfreund M. , Maor P. , Fried A. , Lurie M.
Published: February 2018

1. A case of bilateral spontaneous and simultaneous rupture of the quadriceps tendons is described.

2. The underlying cause was found to be gouty affection of the tendons.

3. So far as is known, a similar case has not previously been recorded.
GELATIN AS AN EXPERIMENTAL MODEL FOR HYALURONATE
Authors: Sweet M. B. E. , Solomon L.
Published: February 2018

1. The hyaluronate of synovial fluid is an acidic linear polymer which can effectively resist the diffusion of other macromolecules into its domain. Gelatin was used as an experimental model for hyaluronate, to investigate its effect upon the diffusion of protein-polysaccharides from cartilage slices.

2. The concentration of protein-polysaccilaride in the extracting medium was quantitated by uronic acid estimation and liquid scintillation spectrometry of 35sulphate-labelled proteinpolysaccharide.

3. Concentrations of gelatin in excess of 20 per cent (W/v) significantly retarded diffusion of protein-polysaccharides out of cartilage slices, but evidently not the movement of these molecules within cartilage.

4. It is suggested that disaggregation of both the protein-polysaecharide molecules of cartilage and the hyaluronate of synovial fluid contribute to cartilage breakdown.
THE BLOOD SUPPLY OF THE LUMBAR SPINE AND ITS APPLICATION TO THE TECHNIQUE OF INTERTRANSVERSE LUMBAR FUSION
Authors: Macnab Ian , Dall Desmond
Published: February 2018

1. Intertransverse fusion in the lumbar spine appears to have many advantages over previously described techniques.

2. The disadvantage of profuse bleeding can be overcome by the use of a Hastings frame and by an operative technique designed to demonstrate constant muscular and articular branches of the lumbar arteries.

3. Coagulation of these vessels by cautery and avoidance of dissection anterior to the plane of the transverse processes ensure that the operative procedure can be carried out with a blood loss averaging less than 500 millilitres.
PAGET'S DISEASE AT THE HIP WITH OSTEOARTHROSIS: RESULTS OF LNTERTROCHANTERIC OSTEOTOMY
Authors: Roper Brian A.
Published: February 2018

1. The results of fourteen intertrochanteric osteotomies in thirteen patients with painful arthrosis of the hip with Paget's disease of the related bones have been analysed.

2. The findings suggest that osteotomy carried out in this condition before the femoral head collapses has much the same prognosis as osteotomy carried out at a similar stage of idiopathic osteoarthrosis.
TARSAL BONE DISINTEGRATION IN LEPROSY
Authors: Warren Grace
Published: February 2018

1. Tarsal bone disintegration is a progressive disorder that affects a high proportion of leprosy patients.

2. Early detection and treatment by immobilisation permit healing with minimal deformity or disability.

3. Feet with advanced lesions can be similarly treated with a satisfactory outcome and amputation is not needed.
NEUROFIBROMATOSIS, GIGANTISM AND SUBPERIOSTEAL HAEMATOMA
Authors: Kullmann L. , Wouters H. W.
Published: February 2018

Two cases of neurofibromatosis with gigantism of a lower limb complicated by subperiosteal bleeding, and exuberant subperiosteal bone formation are reported. Both patients were young boys. Five similar cases were found in the literature.
FEMORAL NERVE NEUROPATHY COMPUCATING ILIOPSOAS HAEMORRHAGE IN PATIENTS WITHOUT HAEMOPHILIA
Authors: Gertzbein S. D. , Evans D. C.
Published: February 2018

1. Paralysis of the femoral nerve secondary to haemorrhage of the iliopsoas muscle is described.

2. Four cases are presented. None of the patients had haemophilia, but one was receiving anticoagulant treatment–the second reported case in the literature. Only one case in a non-haemophiliac not receiving anticoagulants has been described previously. We have added three more such cases.

3. This condition can usually be managed conservatively because recovery can be expected. We believe that operation is indicated only if the lesion progresses and the symptoms and signs increase.

4. These cases underline the importance of assessing the femoral nerve in patients with hip symptoms after trauma. Iliopsoas haemorrhage should be suspected as the cause of femoral nerve neuropathy in cases of trauma to the back in adolescents or in those receiving anticoagulants.
OSTEOTOMY-EXCISION OF THE SPINE FOR LUMBAR KYPHOSIS IN OLDER CHILDREN WITH MYELOMENINGOCELE
Authors: Sharrard W. J. W. , Drennan J. C.
Published: February 2018

1. The etiology and natural progress of lumbar kyphosis in children from three to twelve years of age with myelomeningocele are reviewed.

2. The indications for operation have included intractable or recurrent skin ulceration, inability to wear calipers for walking, inability to sit in a wheel-chair and inability to perform ileal conduit operations.

3. The technique of osteotomy-excision of lumbar vertebrae used in eighteen cases is described.

4. The results in fourteen children are described. The primary aims of operation have been achieved in all patients.

5. A comparison is made with the results of neonatal osteotomy-excision of the spine in the newborn. Recurrence of deformity, but at a much reduced rate, must be anticipated after either operation.
THE LONG-TERM RESULTS OF LOW-FRICTION ARTHROPLASTY OF THE HIP PERFORMED AS A PRIMARY INTERVENTION
Authors: Charnley John
Published: February 2018

1. The results have been reported of total hip replacement by a low-friction technique using high-density polyethylene for the acetabular component in 379 primary interventions, performed between November 1962 and December 1965 and followed for between four and seven years.

2. Apart from failures due to infection, the rate of which in the era under review was 3·8 per cent, late failures from mechanical causes were unusual after total hip replacement by this technique. When the socket was cemented in position, which is now routine, the late mechanical failure from all causes was only 1·3 per cent in 210 cases.

3. As regards the quality of the results and their maintenance over the years, the results were so good (Table X) that it was unnecessary to distinguish an intermediate class of "improvement" between success and failure.

4. As regards relief of pain and ability to walk, the average final rating, on a scale numbered 1 to 6, was 5·9 for both, indicating 90 per cent of patients in Grade 6 (excellent) and only 10 per cent in Grade 5 (good).

5. The average recovery of movement was not as spectacular and was influenced considerably by the pre-operative range, but in all cases that range was improved on. Even starting with the stiffest of hips about one patient in four regained a right angle of flexion movement. There was no tendency to lose movement with the passage of time.

6. As regards late infection (2·2 per cent out of a total of 3·8 per cent), the various findings tend to exonerate cement as a cause.

7. The mechanical details of the technique became stabilised in the period 1959 to 1962 in the Teflon era, and with the exception of improved methods of reattachment of the greater trochanter, they are identical with our current practice in 1971.
THE MACINTOSH TIBIAL PLATEAU HEMIPROSTHESIS FOR THE RHEUMATOID KNEE
Authors: Kay Neville R. M. , Martins H. Delgado
Published: February 2018

1. Thirty-nine patients with rheumatoid arthritis who had had a MacIntosh tibial plateau hemiarthroplasty are reviewed.

2. From the clinical findings it is possible to suggest a basis for the selection of suitable patients for the procedure.

3. Eighty-five per cent of the patients obtained relief of pain with good function of the knee.

4. The complications were infection and instability of the prosthesis.