bluuebunny/crossref_metadata_2025 huggingface dataset:
RECURRENT DISLOCATION OF THE PATELLA
Authors: Heywood A. W. B.
Published: February 2018

1. A study has been made of the treatment of recurrent dislocation of the patella in 106 knees in seventy-six patients.

2. In young adults in whom degenerative changes in the knee were not severe at the time of operation transplant of the tibial tubercle gave the best results.

3. In older patients and in those in whom osteoarthritic changes were present in the knee transplant of the tibial tubercle was unsatisfactory, but patellectomy with rerouting of the quadriceps mechanism gave fair results.

4. Tibial tubercle transplant is contra-indicated in children because it may give a recurvatum deformity.

5. When the dislocation is permanent, operation may be unnecessary, but if it becomes inevitable simple patellectomy is the best procedure.

6. The results of plastic operations on the quadriceps expansion and of supracondylar femoral osteotomy are bad.

7. No operation can give consistently good results because the knee is usually congenitally weak, often as part of generalised ligamentous laxity.
EROSION OF THE EPIPHYSIS OF THE RAT TIBIA BY CAPILLARIES
Authors: Cameron D. A.
Published: February 2018

Calcified matrix that is being absorbed has a characteristic appearance. At the junction of the epiphysis and metaphysis in the rat tibia this appearance can be seen near capillary endothelium as well as under osteoclasts. It is concluded that absorption can take place under the walls of capillaries without the presence of osteoclasts.
SUBCHONDRAL BONE CYSTS
Authors: Woods C. G.
Published: February 2018

1. The clinical, radiological and pathological features in seven cases of subchondral bone cyst are described.

2. Various hypotheses on the etiology of the lesion are discussed.

3. Although the hypothesis of vascular disturbance is thought to be the most attractive one, it is concluded that study of material from much earlier lesions than that hitherto available is essential if any justifiable theory is to be propounded.
STUDIES IN THE TRANSPLANTATION OF BONE
Authors: Burwell R. Geoffrey , Gowland G.
Published: February 2018

1. The effects of the insertion of pieces of fresh cancellous bone into the subcutaneous tissues of the ear upon lymph nodes and spleens have been investigated in seventy rabbits.

2. The main immunological response is found to occur in the first regional nodes draining the sites of insertion of homografts of bone, which show a considerable increase in weight compared with nodes draining autografts of bone.

3. An increased number of large and medium lymphoid cells occurs principally in the first regional node of the homografted animals, as Scothorne and McGregor (1955) observed using skin as the homografted tissue.

4. The large and medium lymphoid cell response is found in both the cortex and the medulla of the lymph nodes. In the cortex a sectoral distribution of the cellular response is observed and the name reactive cortex is given to these sectors. Evidence is presented to show that the sectoral pattern of reactivity is probably determined by the localised entry into the node of iso-antigens through lymphatic vessels draining the bed of the graft.

5. We have made a quantitative analysis of the large and medium lymphoid cell response in the reactive parts of the diffuse lymphoid tissue of the cortex. The mean maximal large and medium lymphoid cell response occurs five days after the insertion of bone homografts.

6. The origin and fate of the large and medium lymphoid cells and their role in the production of antibodies is reviewed in the light of recent work.

7. A correlation is made between the maximal production of large and medium lymphoid cells in the first regional lymph node, the invasion of the graft bed with small lymphocytes and the inhibition of new bone formation in the homografts.
DISORDERS OF TEMPERATURE REGULATION IN ACUTE TRAUMATIC TETRAPLEGIA
Authors: Pledger H. G.
Published: February 2018

1. A patient is described who developed hypothermia shortly after being rendered tetraplegic by a fracture of the cervical spine.

2. The causes and prevention of hypothermia or hyperpyrexia in tetraplegia are discussed.
MINOR REACTIONS DUE TO MODERN METAL
Authors: Hicks J. H. , Cater W. H.
Published: February 2018

1. Two of the three metals at present in use in orthopaedic surgery have been studied to assess their tendency to cause wound reactions.

2. Cobalt-chrome alloy proved to be the better, the incidence of obligatory plate removal being at most 3 per cent. Visible corrosion in this metal never occurred.

3. 18/8 Mo stainless steel proved to be the poorer, the incidence of obligatory plate removal being 20 per cent. Visible corrosion of the metal is estimated to have occurred in about 5 per cent of screws inserted.

4. Regardless of such accelerating factors as metallic transfer, 18/8 Mo steel may have to be accepted as inherently more susceptible to corrosion than is cobalt-chrome alloy.

5. The qualities of two other stainless steels also became evident. Previous work describing the very bad situation arising from the use of EMS was confirmed. By contrast, a steel that was in use before 1951 gave little trouble. This steel was probably FSL.
THE GROWTH OF TRANSPLANTED FOETAL BONES IN DIFFERENT IMMUNOLOGICAL ENVIRONMENTS
Authors: Chalmers J. , Ray R. D.
Published: February 2018

1. Homografts of eighteen-day-old foetal femora in pure strains of mice showed no fundamental difference in behaviour from grafts of more mature bone and cartilage.

2. Growth of bone was limited to a short period after transplantation and was abolished by previous immunisation. Cartilage growth alone was responsible for the increase in size of these transplants and did not appear to be influenced by the presence of immunity.

3. There is no reason to suppose that bone from an immature source is likely to behave more favourably than more mature bone homografts in clinical use.

4. The limited growth of cartilage and the total failure of bone survival in the heterografts indicate an immune reaction ofa different order from that which develops against the homograft.

5. The different effect of the homograft immune reaction on cartilage and bone enabled certain conclusions to be drawn concerning the part played by these two tissues in determining the form of a bone. Cartilage growth and development is shown to be regulated in large part by intrinsic factors. Bone growth and form on the other hand is shown to be dependent largely upon extrinsic influences.
MALIGNANT ANGIOBLASTOMA OF LONG BONE
Authors: Elliott G. B.
Published: February 2018

Two cases of malignant angioblastoma of tibia are described, one finally treated by amputation and the other by segmental resection and grafting. They have remained free from signs of local recurrence or distant metastasis for five and a half and ten and a half years respectively. Both showed prominent areas of neoplastic mesenchymal angioblastic tissue which closely imitates solitary fibrous dysplasia.

The natural history and radiological characteristics of these little-known tumours, long thought to be "adamantinoma" of bone, are described.
CHONDROMYXOID FIBROMA OF BONE
Authors: Ralph Leslie L.
Published: February 2018

In 1948 Jaffe and Lichtenstein published a series of bone tumours as chondromyxoid fibromata, stressing that this newly recognised entity was likely to be mistaken for chondrosarcoma but was a benign growth. The accumulated experience of thirty-seven cases, which are all that have been recorded in detail, is briefly reviewed. A further series of nine similar cases is reported here and comparisons are made which show general agreement with the experiences and conclusions of earlier authors. It is however suggested that the tendency to recur may have been underestimated, particularly in younger patients.
NEW APPROACHES TO THE PROBLEM OF OSTEOPOROSIS
Authors: Urist Marshall R. , Zaccalini Patrick S. , MacDonald Norman S. , Skoog William A.
Published: February 2018

1. Individuals who are normal and not osteoporotic seem to show retention of cortical bone at successive decades of life in proportion to the total lean body-mass. In patients with osteoporosis the weight of the skeleton decreases at a rate exceeding the physiological rate of atrophy of muscle, tendon and bone tissue that occurs with the time-dependent process of ageing.

2. Six patients representing the typical forms of osteoporosis commonly found in orthopaedic practice were investigated intensively over a period of three years and compared with individuals in whom there was no osteoporosis by studies of metabolic balance, Sr85 osteograms, and tetracycline deposition.

3. Studies of metabolic balance in patients with osteoporosis showed normal or negative calcium balances, but an equilibrium for the metabolism of nitrogen and phosphorus. Increased intake of calcium in the diet produced retention of calcium but not sufficient phosphorus, nitrogen or gain in weight to prove that the patient had made new bone and healed the osteoporosis.

4. Radio-isotope osteograms showed high, normal or low rates of change of uptake of Sr85 and the accretion rate was calculated to be normal or low in individuals with osteoporosis. High uptake of tetracycline by a small mass of bone tissue and by a relatively small percentage of the total number of osteons suggested that in an adult human being the calcium reserve in the skeleton is enormous. Thirty to 50 per cent of the total bone mass was sufficient to turn over 0·5 to 1·0 gramme, the amount of calcium utilised in twenty-four hours by the human adult. This was accomplished by structural or old bone throughout the entire skeleton, and by labile or newer bone located in approximately 10 per cent of the total number of Haversian cylinders or osteons.

5. Some of the unclosed or half-closed osteons were hyperactive in osteoporotic bones. In the process of remodelling of cortical bone a significant quantity of bone tissue was incompletely restored and there were, presumably as a result, intermittently large or small negative calcium balances. Osteoporosis may have been the cause, rather than the result, of the negative calcium balance.

6. The experimental and clinical literature of the past ten years, and studies on patients described in this critical review, were interpreted to indicate that prolonged calcium deficiency, castration, hyperadrenal corticoidism or a sedentary life may precipitate, accentuate and accelerate osteoporosis in individuals who are genetically predisposed to develop it. Sometimes high calcium intake or sex hormones, or both, may have slowed the rate of resorption but did not replace the deficit in cortical bone.

7. Further research is necessary to find the chief etiological factor and to produce the cure for this increasingly common disorder of the skeleton.
OSTEOCHONDRITIS DISSECANS FOLLOWING LEGG-CALVÉ-PERTHES' DISEASE
Authors: Morris Martin L. , McGibbon Kenneth C.
Published: February 2018

A case of osteochondritis dissecans complicating Legg-Calvé-Perthes' disease is reported. Despite four years of conservative treatment in an ischial-bearing caliper a part of the fragmented femoral head failed to unite with the rest of the epiphysis and has persisted as an intra-articular loose body.

Freehafer (1960) listed the indications for surgical removal of this fragment in such cases: 1) persisting symptoms; 2) dislocation of the loose fragment into the joint with secondary arthritic changes inevitable; 3) a mechanical block to movement of the hip.

Since our patient had a relatively symptomless hip with a full range of movement, surgical removal of the loose body was not advised. The prognosis for this hip is nevertheless guarded, and surgery can be reserved for the above indications or for reconstructive procedures should they be required in the future.
POSTERIOR SPINAL FUSION IN SPONDYLOLISTHESIS
Authors: Klenerman L.
Published: February 2018

1. Four out of five patients with spondylolisthesis, four-fifths of whom were seen at least five years after operation, had their symptoms relieved after posterior spinal fusion.

2. In a small series of patients treated by anterior spinal fusion, the results were less successful.
OBSERVATIONS OF THE INFLUENCE OF CHONDROITIN SULPHATE ON THE RATE OF BONE REPAIR
Authors: Burger Martin , Sherman Burton S. , Sobel Albert E.
Published: February 2018

1. A study has been made of the repair of bony defects in the calvaria of albino rats.

2. An accelerated rate of bone repair was observed in experimental defects into which chondroitin sulphate-treated demineralised bone was implanted.

3. Acid-soluble collagen reconstituted with chondroitin sulphate was also more effective as an implant than was acid-soluble collagen reconstituted with sodium chloride.

4. It is concluded from these studies that chondroitin sulphate treatment accelerated the rate of new bone formation induced by demineralised bone, by reconstituted acid-soluble collagen, and to a lesser extent by Gelfoam. It was also found that demineralised bone and fresh homogenous bone promoted bone repair, but that chondroitin sulphate-treated demineralised bone promoted the most rapid rate of bone repair among the substances tested.

5. The possible role of chondroitin sulphate in bone formation is discussed.
THE RESPONSE OF MUSCLE TO STRENUOUS EXERCISE
Authors: Van Linge B.
Published: February 2018

1. The effects of heavy training on a skeletal muscle have been studied in the rat. After denervation of the triceps surae muscle the tendon of the plantaris muscle was implanted into the tuberosity of the calcaneum. It was then possible to demand an unusual performance of the plantaris, the weight of which is only 18 per cent of the weight of the triceps surae.

2. Formation of new muscle fibres was observed after prolonged heavy training. This is incontrast to the opinion of most investigators, who have seen no new fibres formed after training. Degenerative changes followed by regeneration were also seen.

3. The trained muscle could almost double its weight, and treble its force. Paradoxically, the supposedly non-contractile sarcoplasm was seen to have increased after training.

4. Training induced a strong protein synthesis in muscle. In normal muscle protein synthesis can hardly be demonstrated.

5. Connective tissue grew between single muscle fibres in the heavily trained muscle. Its distribution was unequal.

6. Heavy exercise caused marked swelling of an untrained muscle.

7. Functional recovery was satisfactory after the operation. This showed that a muscle can be replaced by one only one-fifth its weight, provided the latter is trained adequately.

8. Not even the most arduous training could inflict permanent damage on the muscle.
A PRELIMINARY REPORT OF VASCULAR ASSAY IN PROGNOSIS OF THE FRACTURED FEMORAL NECK
Authors: Harrison M. H.M.
Published: February 2018

1. A method is described for determining the presence or absence of a circulation within the femoral head after fracture of the neck of the femur.

2. An account is given of the fate of nineteen femoral heads in patients who had sustained high femoral neck fracture and in whom these tests had been carried out.

3. A favourable prognosis as regards fracture union and viability of the head was found to be correct in twelve of fifteen patients.

4. Non-union and major collapse of the head occurred in four patients in whom a diagnosis of an anaemic head had been made.

5. The morbidity of the method is described.

6. An explanation is given why vascular assay has been carried out as a secondary procedure, and possible clinical applications are indicated.
CERVICAL VERTEBRAL DEFORMITY IN VON RECKLINGHAUSEN'S DISEASE OF THE NERVOUS SYSTEM
Authors: Heard G. E. , Holt J. F. , Naylor B.
Published: February 2018

1 . The bone changes in von Recklinghausen's disease of the nervous system are reviewed and the gross deformities that are sometimes encountered in the cervical region are illustrated.

2. A case is described in which, at necropsy, histological study of affected vertebrae revealed actual neurofibromatous erosion and infiltration.
INTRA-ARTICULAR AND PERI-ARTICULAR FRACTURES OF THE PHALANGES
Authors: Lee M. L. H.
Published: February 2018

1. A review of intra-articular and peri-articular fractures of the phalanges has been carried out, and the late results of such injuries have been examined.

2. These fractures usually unite by bone.

3. The results of conservative treatment by immobilisation are satisfactory in the case of mallet fractures, hyperextension sprain fractures and collateral avulsion fractures of the proximal phalanges.

4. The less satisfactory results after collateral avulsion fractures of the interphalangeal joints and avulsion fractures complicating dislocations are discussed.
AVASCULAR NECROSIS OF THE LUNATE BONE TREATED BY EXCISION AND PROSTHETIC REPLACEMENT
Authors: Agerholm J. C. , Goodfellow J. W.
Published: February 2018

Of fifteen patients treated by excision of the lunate bone and prosthetic replacement twelve had no pain at all or slight discomfort after exceptionally heavy work. All these were able to return to and continue at heavy manual jobs. Two patients continued to experience pain with vigorous use of the wrist but were none the less satisfied with their improvement. In one patient the operation failed and pain persisted unrelieved.

We believe that the radiographs show that the prosthesis greatly minimises the distortion of the carpus after excision of the lunate bone and that the maintenance of a normal carpal architecture is important in the avoidance of osteoarthritis of the remaining joints. The results suggest that when the operation is technically successful degenerative changes do not occur despite prolonged and heavy use. The presence of osteoarthritis in the wrist before operation is not a contra-indication to prosthetic replacement because the degenerative process may remain stationary for several years after removal of the damaged lunate bone.

The prosthesis has proved durable over many years and none of our patients having attained a good wrist has suffered a relapse. The operation entails a month off work for a heavy labourer and as little as a fortnight for those who do lighter jobs. These considerations prompt us to suggest its wider use in the treatment of Kienböck's disease.
THE EFFECT OF SCARIFICATION ON ARTICULAR CARTILAGE IN THE RABBIT
Authors: Meachim G.
Published: February 2018

1. The changes resulting from superficial scarification of articular cartilage have been observed in the knee joint of adult rabbits. A reduction in the amount of stainable matrix ground substance occurred at the sites of damage. Particular attention was therefore paid to sulphated mucopolysaccharide synthesis by cartilage cells in or near the traumatised areas.

2. The femoral groove cartilage one week after scarification showed evidence of increased mucopolysaccharide synthesis, especially by the more superficial chondrocytes near the cuts, but three or four weeks later the enhanced chondrocyte activity tended to diminish, and after six weeks the superficial cells near the cuts were found to be inactive. From six to thirty-four weeks the loss of stainable ground substance extended more deeply, but cell degeneration in these deeper areas of matrix depletion was preceded by a period in which many of the deeper chondrocytes still showed evidence of active mucopolysaccharide synthesis. Cellular activity in tags of depleted cartilage was usually lost before the tags finally disintegrated. Chondrocyte clusters were often seen in the scarified areas, especially in the deeper zones. They seemed to be a reactive rather than degenerative phenomenon.

3. In the scarified cartilages of the patella examined after one week a reactive response by superficial chondrocytes was less evident than in the femoral cartilage from the same joint, and after six weeks areas of deeply extending matrix loss were exceptional.

4. The structural and functional changes in the rabbits' femoral articular cartilage after its scarification resembled those which have been observed in the developing cartilage lesion of human osteoarthritis–namely, loss of interstitial matrix and superficial fibrillation, a stimulated synthesis of chondroitin sulphate by the chondrocytes, and the appearance of cell clusters in the deeper zones. Within the period of the experiment, up to thirty-four weeks, the joint lesions remained strictly localised to the traumatised areas ofcartilage, and exposure of bone and joint remodelling, which are features of advanced osteoarthritis in man, were not seen.
THE ETIOLOGY OF SPONDYLOLISTHESIS
Authors: Newman P. H. , Stone K. H.
Published: February 2018

1. During a fifteen-year period a clinical, radiological and in some cases a surgical study has been made of 319 patients suffering from spondylolisthesis–that is, forward slipping of one lumbar vertebra on another or forward sagging of the whole lumbar spine in relation to the sacrum.

2. The five etiological factors are described, and the cases are assigned to five groups according to the factor responsible for the slip. In every case slipping is permitted by a lesion of the apparatus which normally resists the forward thrust of the lower lumbar spine–that is, the hook of the neural arch composed of the pedicle, the pars interarticularis and the inferior articular facet engaging caudally over the superior articular facet of the vertebra below.

3. In Group I (congenital spondylolisthesis–sixty-six cases) the lesion is a congenital defect of the facets. In Group II (spondylolytic spondylolisthesis–164 cases) the lesion occurs in the region of the pars interarticularis and is either an elongation of the bone or a break in continuity. There are reasons for thinking that the lesion is caused by stress over a long period rather than by acute injury or by a congenital anomaly of ossification. In Group IV (degenerative spondylolisthesis–eighty cases) the lesion of the facets is degenerative. There are no good grounds for thinking that an abnormality of the angle between the facets and the pedicles is the primary lesion behind the degenerative change.

4. Group III and V comprise few cases. In the former (traumatic spondylolisthesis–three cases) the lesion–a fracture of the neural arch–is caused by a single severe injury. In Group V (pathological spondylolisthesis–six cases) the slipping is caused by weakness of bone from various causes.

5. A full description is given of the etiological and biomechanical features of each group. A special investigation has been made into the etiological factors in degenerative spondylolisthesis.

6. The incidence of involvement of nerve tissues is highest in degenerative spondylolisthesis; the most severe degrees of slip are found in congenital spondylolisthesis.
TREATMENT OF INTRACAPSULAR FRACTURES OF THE FEMORAL NECK WITH THE CHARNLEY COMPRESSION SCREW
Authors: Hargadon E. J. , Pearson J. R.
Published: February 2018

1. A series of 100 intracapsular fractures of the femoral neck treated with the Charnley compression screw is reported.

2. There were six deaths, and in patients reviewed long enough (seventy-five) there were eleven undisplaced fractures, with successful union in 8l·8 per cent, and sixty-four displaced fractures, with a union rate of 59·6 per cent.

3. If we exclude six failures of operative technique, there remain fifty-eight patients in whom the fracture was judged radiologically to have united in 65·5 per cent.

4. The Charnley compression screw is an effective method of internal fixation in such fractures, and non-union with this method is usually due to causes other than mechanical failure.
CONGENITAL PSEUDARTHROSIS OF THE CLAVICLE
Authors: Alldred A. J.
Published: February 2018

1. Congenital pseudarthrosis of the clavicle is described.

2. The distinction from cranio-cleido-dysostosis and from birth fracture is stressed.

3. Details are given of two patients reported in the literature and a further nine patients are described.

4. The embryology, natural history and treatment of the condition are discussed.
RADIO-ULNAR FUSION FOR DEFECTS IN THE FOREARM BONES
Authors: Lowe H. G.
Published: February 2018

1. The problem of gap defects in the forearm bones and its solution by radio-ulnar fusion is discussed.

2. Seven patients with radio-ulnar fusions are presented. In four patients the operation was done for defects in the ulna, in two for defects in the radius, and in one for non-union of the radius and ulna after fracture.

3. The good cosmetic and functional result after radio-ulnar fusion is emphasised.
CONTRACTURE OF THE VASTUS INTERMEDIUS IN CHILDREN
Authors: Gammie W. F. P. , Taylor J. Hermon , Urich H.
Published: February 2018

1. Two patients are reported with progressive fibrosis of the vastus intermedius muscle causing limitation of flexion of the knee. The first patient, a girl of ten years who was one of binovular twins, noticed difficulty in walking at the age of five, the disability increasing with age. The other girl, aged three, was one of uniovular twins and displayed the abnormality as soon as she started walking.

2. The nature of the condition remains obscure.

3. Surgery is effective, and simple division of the affected muscle segment is recommended. A good range of passive flexion is obtained at once; the active range can be obtained thereafter by physiotherapy. Because this requires the patient's cooperation it is suggested that the best age for surgery is about five or six years.
QUADRICEPSPLASTY
Authors: Nicoll E. A.
Published: February 2018

1. Thirty cases of stiff knee treated by the operation of quadricepsplasty are reviewed.

2. The causes and morbid anatomy are analysed. The operative technique is based on an appreciation of the latter.

3. The after-care must be meticulous and prolonged. Manipulation under anaesthesia was used after operation in over half the cases.

4. The results were most gratifying. There were two technical failures but in the remaining twenty-eight cases the average gain of fiexion was 68 degrees. In twenty-one of these active extension was full and it was only 5 degrees short in another three. Permanent loss of active extension occurred when the rectus femoris tendon had to be divided or lengthened.
SPONTANEOUS RUPTURE OF THE EXTENSOR POLLICIS LONGUS
Authors: Riddell D. M.
Published: February 2018

1. Forty-eight patients with spontaneous rupture of the tendon of the extensor pollicis longus have been studied and the results of forty-four operations by tendon transfer are reported.

2. The etiology and the pathology of the condition are discussed.

3. Transfer of the extensor indicis in general gives a better result than transfer of the extensor carpi radialis longus, but each method has its advantages and disadvantages.

4. The best results are obtained when the suture is done so as to leave the tendon in the fullest degree of tension obtainable.
TYPHOID SPINE IN A NIGERIAN WITH SICKLE HAEMOGLOBIN
Authors: Walker Geoffrey F.
Published: February 2018

1. A proven case of typhoid spine in a patient with sickle cell trait (AS) is recorded. It responded well to conservative treatment with chloramphenicol.

2. The literature on typhoid spine is briefly reviewed and the relationship between salmonella osteomyelitis and sickle cell disease is discussed.
OSTEOMYELITIS VARIOLOSA
Authors: Davidson James C. , Palmer P. E. S.
Published: February 2018

The purpose of this report is not to describe a new condition but to remind those who seldom see smallpox of one of its most important and easily recognised complications. Bone infection can be late, almost silent and often most unexpected. It is usually symmetrical and almost always multiple. It does not affect the spine, pelvis and ribs, but does affect the arms, hands, legs and feet. It is destructive, unpreventable and untreatable. It ends with deformity but not with loss of life. The recognition of its etiology will prevent a great deal of unnecessary and unrewarding interference with a self-limiting disease.
BENNETT'S FRACTURE
Authors: Spêngberg Olle , Thorén Lars
Published: February 2018

A method of treatment of Bennett's fracture is described. A Kirschner wire is drilled obliquely through the base of the first metacarpal bone and traction is applied in a distal, ulnar and palmar direction in order to counteract the dislocating action of abductor pollicis longus and the flexor muscles.

The advantages of the method are: 1) It is technically easy and practically without complications. No important structures are liable to be damaged. 2) It can be used in those cases where the palmar fragment is very small. 3) It can be used for comminuted fractures. 4) It can be used in neglected cases where malunion has occurred. 5) It can be used when there are other fractures of the first metacarpal or adjacent bones. 6) It allows exercises of all the finger joints during the whole period of treatment.
REPEATED REGENERATION OF A MENISCUS IN THE KNEE
Authors: Evans David K.
Published: February 2018

1. The characteristics of the regenerated knee meniscus are reviewed.

2. A case is reported in which a meniscus twice regenerated and was twice torn.
DISCITIS
Authors: Menelaus M. B.
Published: February 2018

1. Thirty-five children suffering from a mild illness with narrowing of an intervertebral disc have been studied.

2. Backache was the presenting symptom in only a small proportion of children, vague aching in the legs being almost as common at the onset.

3. Stiffness of the affected part of the spine is often present, but there may be no abnormal signs in the back.

4. Radiographs reveal a narrowed disc space with adjacent bony changes. There is usually progressive narrowing of the disc space which may go on to fusion of the affected vertebrae. Less commonly there is reconstitution of the affected disc.

5. The symptoms and signs quickly subside with immobilisation in recumbency and this treatment should be continued until the blood sedimentation rate returns to normal.

6. Adults who have suffered from discitis in childhood are probably more prone to develop backache.

7. The etiology remains uncertain.
THE RESULTS OF EARLY AND DELAYED INTERNAL FIXATION OF FRACTURES OF THE SHAFT OF THE FEMUR
Authors: Smith J. E. M.
Published: February 2018

1. The results in 211 fractures of the shaft of the femur in adults treated by internal fixation have been reviewed.

2. A comparison has been made between the effects of early internal fixation within the first six days of injury and delayed fixation.

3. Eighty-five fractures treated by early fixation gave a rate of non-union of 23 per cent; in 126 fractures treated by delayed fixation the rate was 0·8 per cent.

4. Delayed operation is therefore advocated for the majority of femoral shaft fractures for which internal fixation is indicated.
EARLY WEIGHT BEARING AFTER INTERNAL FIXATION OF TRANSCERVICAL FRACTURE OF THE FEMUR
Authors: Abrami George , Stevens Jack
Published: February 2018

1 . A preliminary report is presented of a clinical trial to compare the results of early and late weight bearing in randomly selected patients of comparable age groups whose displaced femoral neck fractures were treated by internal fixation with a sliding nail-plate.

2. When 124 patients were assessed at three months and 107 at six months after operation there was no significant difference between those who started unguarded weight bearing two weeks after operation and those who avoided weight bearing for three months.

3. Early weight bearing appears to have no harmful effect on the early post-operative stability of this fracture when a sliding nail-plate is used for fixation.

4. Further information is necessary before any conclusion can be reached about the effect of early weight bearing on the ultimate fate of the fracture and of the femoral head. For this reason, and also to increase the numbers of patients in the series, the trial is continuing and the patients are being followed up for a three-year period.
POST-TRAUMATIC OSTEOCHONDRITIS OF THE LOWER TIBIAL EPIPHYSIS
Authors: Robertson D. E.
Published: February 2018

1 . This case of post-traumatic osteochondritis of the lower tibial epiphysis is important because the condition is rare.

2. The similarity to osteochondritis in other sites dating from a single injury is noted.

3. The ankle joint bears more body weight per surface area of articular cartilage than other weight-bearing joint surfaces. It is of interest that regeneration took place in spite of the fact that the child continued to bear weight and that the joint was immobilised for only two months, beginning four months after the original injury.
CHRONIC PROGRESSIVE DISLOCATION OF THE TALO-NAVICULAR JOINT
Authors: Jacobs Philip
Published: February 2018

1 . Two cases of chronic progressive dislocation of the talo-navicular joints are discussed.

2. Radiographs are presented showing the development of the lesions over a period of eighteen years.

3. It is thought that the lesion is caused by laxity of ligaments and subsequent osteoarthritic changes.
DUPUYTREN'S DIATHESIS
Authors: Lettin Alan W.F.
Published: February 2018

1 . An epileptic patient with Dupuytren's contracture of the palms, severe plantar fibromatosis, prominent knuckle pads, periarthritis of the shoulders and hyperplasia of the gums is described.

2. The plantar lesions recurred despite radical excision. The knuckle pads on one hand disappeared after radiotherapy.

3. The association of each of these conditions with epilepsy and with Dupuytren's contracture is reviewed, and it is suggested that the hyperplasia of the gums may be a hitherto unrecognised feature.

4. The characteristic histological appearances of the plantar lesions are described and the risk of confusion with fibrosarcoma is emphasised.
THE PATHOLOGICAL CHANGES IN RATS'S NERVES SUBJECT TO MODERATE COMPRESSION
Authors: Weisl H. , Osborne G. V.
Published: February 2018

1. A method of constricting sciatic nerves of rats was devised which produced lesions resembling macroscopically and electromyographically those of carpal tunnel and related syndromes.

2. The nerves became swollen and hyperaemic proximal and distal to the constriction. The swellings were largely caused by an accumulation of fluid between the axons, but the axons themselves were also increased in size.

3. This accumulation of fluid was an oedema secondary to a partial obstruction of the vasa nervorum.
AMPUTATION IN FRACTURES OF THE TIBIA
Authors: Hicks J. H.
Published: February 2018

1. The conservative school of treatment of fractures of the tibia, which bases part of its criticism of internal fixation on the ultimate risk of amputation, does not often publish its own rates of amputation.

2. Statistics from a hospital that treats one-third of closed fractured tibiae and two-thirds of compound fractures by internal fixation are therefore put up as a basis for criticism.

3. Comparisons are made with the few available statistics in the literature of conservative treatment.

4. Almost all of the causes for secondary amputation are now curable and in recent years the number of limbs being saved is increasing.
THE PLACE OF DELAYED INTERNAL FIXATION IN THE TREATMENT OF FRACTURES OF THE LONG BONES
Authors: Lam S. J.
Published: February 2018

It seems right to draw the following conclusions from this study of the relative merits of early and delayed fixation for fractures of the femoral and tibial shafts.

1. In patients under the age of sixty years with femoral shaft fractures there seems to be a significant improvement in the speed and quality of union when internal fixation is delayed. In patients over the age of sixty years the results of delayed fixation are worse than those of early fixation, and in any case the dangers of prolonged recumbency make the latter method preferable.

2. Delaying fixation for tibial shaft fractures does not affect speed of union or functional result. However, the incidence of non-union in these fractures is reduced by over 50 per cent by delaying fixation. This is a good reason for delaying fixation of this fracture too.

Some possible reasons for the improved results after delayed fixation have been discussed.
MIXED SCLEROSING BONE DYSTROPHIES
Authors: Walker Geoffrey F.
Published: February 2018

1. A Nigerian patient with radiographic features of osteopathia striata, osteopoikilosis and melorheostosis is reported. Also radiographs of a patient from the Radiographic Museum of the Institute of Orthopaedics at the Royal National Orthopaedic Hospital are reproduced because they show a similar mixture of these conditions.

2. lt is probable that a common factor is present at some stage in the development of melorheostosis, osteopathia striata, osteopoikilosis and possibly osteopetrosis.
COMPRESSION ARTHRODESIS OF THE SHOULDER
Authors: Charnley John , Houston James Kirk
Published: February 2018

1. A series of twenty-three compression arthrodeses of the shoulder are reviewed.

2. The review demonstrates compression arthrodesis to be an excellent method of obtaining bony fusion of the shoulder.

3. The consistent success in achieving arthrodesis, in what is to be considered a difficult joint to fuse, is significant in the theory of compression arthrodesis, because the shoulder offers a more perfect example of compression arthrodesis than the knee in that the element of absolute fixation is less obvious.
DISLOCATIONS OF THE METATARSAL BONE AND ADJACENT TOE
Authors: English T. A.
Published: February 2018

1. Two cases of an unusual forefoot injury are recorded in which dislocation of the base of a metatarsal bone is associated with, and tends to perpetuate, dislocation of the metatarsophalangeal joint of the adjacent toe.

2. The anatomical and mechanical relationships between these linked dislocations are discussed, as are the principles of treatment.

3. The concept of segmental injuries to the forefoot is introduced.
ON THE QUESTION OF RECURRENCE OF OSTEOCHONDROMA
Authors: Morton K. S.
Published: February 2018

1. Two cases are reported in which reappearance of an osteochondroma after excision was shown to represent a second independent lesion and not a true recurrence.

2. The significance of this observation is discussed in relation to the pathogenesis and prognosis of this lesion.

3. A plea is made for greater discrimination in using the ominous description "recurrence," because the rare true recurrence must strongly favour a diagnosis of malignancy.
VULNERABILITY OF THE SCIATIC NERVE IN CLOSED ISCHIO-FEMORAL ARTHRODESIS BY NAIL AND GRAFT
Authors: Adams J. Crawford
Published: February 2018

1. The risk of injury to the sciatic nerve during closed ischio-femoral arthrodesis by nail and graft has been assessed on the basis of clinical evidence and of anatomical studies in the living and in cadavers.

2. The margin of safety for the nerve is nearly always small.

3. The risk of injury to the nerve is prohibitive when there is marked deformity or hypoplasia of the pelvis. The risk is also increased when the buttock is compressed against the table and, because of the technical difficulties that are entailed, when the hip is in marked flexion. The risk is probably greater in children than in adults.

4. In properly selected cases in which none of these adverse factors is present it is submitted that the risk of nerve injury can be eliminated by proper attention to surgical technique and by the observance of certain definite precautions.

5. When there is doubt in the surgeon's mind about his ability to complete the operation without injuring the nerve the closed technique should be abandoned in favour of the open posterior approach.
FRAGMENTATION AND RODDING IN OSTEOGENESIS IMPERFECTA
Authors: Williams Peter F.
Published: February 2018

1. Fifty operations of fragmentation and rodding in the long bones of patients with osteogenesis imperfecta are reported.

2. The technique of the operation is described and a modification of Sofield's original method is suggested.

3. The results and complications of treatment are described.
HYPERSENSITIVITY TO PARA-AMINOSALICYLIC ACID
Authors: Griffiths H. E. D. , Watts C.
Published: February 2018

1. Attention is drawn to the incidence of hypersensitivity to para-aminosalicylic acid in the course of antituberculous treatment.

2. The clinical features are described with particular reference to hepatic complications.

3. Three cases are presented to illustrate the salient features of the condition.

4. The importance of early detection of the reaction, the giving of test doses and the technique of desensitisation of the patient to para-aminosalicylic acid are discussed.
A DIRECT APPROACH TO TRIMALLEOLAR FRACTURES
Authors: Patrick James
Published: February 2018

1. A direct approach to trimalleolar fractures is described.

2. It is considered that a direct view of the fractured joint surface is essential in operations on all trimalleolar fractures and that access must be planned accordingly.

3. Failure to get a perfectly congruous surface is likely to be followed by osteoarthritis.
TREATMENT AND PREVENTION OF CHRONIC HAEMORRHAGIC ARTHROPATHY AND CONTRACTURES IN HAEMOPHILIA
Authors: France W. G. , Wolf P.
Published: February 2018

1. Orthopaedic treatment of joint deformities in thirteen patients with haemophilia is reviewed over a period of seven years.

2. Forms of treatment discussed include open operation, manipulation under general anaesthesia, continuous traction, splintage and physiotherapy. The amount of intravenous therapy required for each form of treatment is indicated.

3. In discussing prevention of joint deformity the histories of a further eighteen patients have been taken into account. It is concluded that initially painless haemarthroses provide the main threat to joint deformity in haemophilia.

4. The best preventive treatment is early immobilisation followed by prolonged splintage and physiotherapy; intravenous therapy with antihaemophilic factor plays a less important role here than in other forms of haemorrhage.

5. Evidence is presented that joint deformity in severe haemophilia can often be entirely avoided.
RESECTION OF THE SHOULDER WITH HUMERAL SUSPENSION FOR SARCOMA INVOLVING THE SCAPULA
Authors: Burwell H. Nevile
Published: February 2018

1. Resection of the shoulder for a malignant tumour involving the scapula which was too extensive for treatment by excision of the bone is described.

2. The procedure is suggested as an alternative to forequarter amputation in suitable instances.
MYO-ELECTRIC CONTROL OF POWERED PROSTHESES
Authors: Bottomley A. H.
Published: February 2018

1. A prosthesis under myo-electric control is described.

2. An advanced technique of proportional control of such a prosthesis is outlined.
ON THE USE OF ELECTRICITY IN UPPER EXTREMITY PROSTHESES
Authors: McLaurin Colin A.
Published: February 2018

1. The working of an electrically powered prosthesis is described.

2. The advantages of this method are discussed.
A CLINICAL SYNDROME ASSOCIATED WITH SEVERE LUMBO-SACRAL SUBLUXATION
Authors: Newman P. H.
Published: February 2018

1. Thirty-four patients with severe lumbo-sacral subluxation have been studied. Twenty-nine of these came for advice between the ages of nine and nineteen, and of these, twenty-five developed symptoms and signs of a characteristic syndrome.

2. The details of the syndrome are described: the essential features are spinal stiffness, a lordotic gait, resistance to straight leg raising, and in some cases evidence of interference with cauda equina or nerve root.

3. The danger of attempted reduction by traction is stressed, as well as the difficulties to be encountered during posterior lumbo-sacral fusion.

4. The reasons for operating are given; the results of spinal fusion were satisfactory.

5. The traditional apprehension concerning the effect of severe subluxation on childbirth has probably been over-stressed.

6. The tendency to slip was almost completely arrested by spinal fusion.
SYNOVECTOMY FOR RHEUMATOID ARTHRITIS
Authors: Wilkinson M. C. , Lowry J. H.
Published: February 2018

1. The follow-up reports of ninety-one joints affected by rheumatoid arthritis and treated by synovectomy showed that seventy-three joints remained free of pain. Forty-nine out of ninety-one joints retained useful function after a period averaging three and a half years.

2. The average duration of the disease before admission was eight and a half years.

3. The joints causing most distress were selected for operation. Better results might have been obtained if these patients had received constitutional treatment, splintage and synovectomy earlier. Many of these patients had advanced disease which was continuing to advance at the time of their admission, in spite of previous treatment. Many accepted a trial of treatment in a long stay hospital as a last hope.

4. The return of forty-eight out of sixty-two patients to unassisted or nearly unassisted activity and the maintenance of this state in thirty-nine out of fifty-four shows that the success of the pilot scheme conducted in cooperation with Dr W. S. Tegner and Dr R. M. Mason of the London Hospital has been confirmed by further experience.
TIBIO-FIBULAR RELATIONSHIP IN PARALYSED LIMBS
Authors: Makin Myer
Published: February 2018

1. A survey of 112 cases of residual poliomyelitis with leg shortening of 2·5 centimetres or more is reported.

2. In eighty-seven patients paralysed in early infancy the fibular shortening was greater than the tibial shortening.

3. The absence of the normal "to and fro" motion of the fibula causes delay in the appearance of the fibular epiphyses and retards fibular development.

4. The shortening of the fibula in infancy causes deformity at the ankle, in the tibia itself and at the knee.

5. At the ankle the poorly developed lateral malleolus causes wedging of the lower tibial epiphysis and valgus at the ankle, which is often unstable.

6. At the knee progressive genu valgum is produced and in the tibia lateral torsion occurs.

7. The clinical significance of these deformities in relation to reconstructive procedures is stressed.
PRIMARY SUBACUTE PYOGENIC OSTEOMYELITIS
Authors: Harris N. H. , Kirkaldy-Willis W. H.
Published: February 2018

1. A primary subacute type of staphylococcal osteomyelitis has been described. It is the commonest form of osteomyelitis seen in East Africa, and the incidence appears to be increasing in Great Britain.

2. A review of the literature indicates that this is not a new disease but that in the past there has been some confusion in terminology.

3. The causative organism is a coagulase positive staphylococcus, but in a few instances a coagulase negative one has been isolated. The staphylococcus is thought to be of reduced virulence and in East Africa it is likely that the population has acquired an increased resistance to the staphylococcus.

4. Two radiologically distinct groups are recognised, depending on whether a bone abscess is present or not. In the first group there are two types of localised abscesses: the familiar Brodie's lesion and the less well recognised large bone abscess that occurs in the metaphysis of a long bone. While the pathology of the two types is similar, the radiological features are quite distinct. The lesions in the second group are characterised by extensive diaphysial changes, with or without metaphysial involvement, and an obvious abscess cannot usually be demonstrated.

5. The main clinical features are the long history, often weeks or months, before diagnosis; insignificant or absent general reaction to the infection and minimum physical signs.

6. Vertebral body osteomyelitis in adults is included because it generally presents as a subacute infection; the difficulties in distinguishing it from a tuberculous infection are outlined.

7. The most useful diagnostic aids are the staphylococcal antibody titres (especially in vertebral infections) and the erythrocyte sedimentation rate. A limited surgical exposure is usually required if the causative organism is to be isolated and empirical antibiotic therapy is to be avoided. The total and differential white blood count are so often normal in these patients that they are considered to be of no diagnostic value.

8. Curettage and local antibiotics together will cure the localised bone abscess. Other lesions may be effectively treated by systemic antibiotics alone, but in the later stages removal of sequestra and infected granulation tissue may be necessary. In this instance it is essential to make a planned incision and to cut a window in the bone large enough to expose the whole of the lesion; primary suture of the wound is advocated.