bluuebunny/crossref_metadata_2025 huggingface dataset:
TRAUMATIC URAEMIA
Authors: Darmady E. M.
Published: February 2018

Traumatic uraemia is of particular significance to orthopaedic surgeons in so far as this complication is responsible for high mortality in cases of severe injury, crushing injury, traumatic shock, gun-shot wounds, incompatible blood transfusions, and the misuse of tourniquets. In this contribution the association between muscle injury and renal failure is reviewed.

The syndrome of the "crush kidney," which at first was thought to be the result of deposition of myohaemoglobin in the renal tubules, is almost certainly due to the association of many factors, all of which lead to alteration of the renal circulation and renal ischaemia.

Certainly the combination of ischaemia of the kidney with deposition of pigment and haemolysis of blood causes a high mortality in animals, and it is believed that this may account for the serious prognosis in human cases where there is both shock and haemolysis.

Disturbance of water balance, allergic phenomena, and chemical nephrotoxic action are also discussed. The pathology is considered together with significant changes in the blood chemistry.

A plea is made for early recognition of this clinical syndrome with its characteristic features. Important aspects of treatment are discussed. The dangers of excessive intravenous infusion are emphasised.

Closer investigation and further research promise to throw light on the more accurate localisation of function in the nephron, to add to our knowledge of traumatic arterial spasm, and to explain many orthopaedic problems which hitherto appeared insoluble.
INFECTIONS OF THE HAND
Authors: Loudon J. B. , Miniero J. D. , Scott J. C.
Published: February 2018

1. A report is presented of the method and results of treatment of sixty-nine consecutive cases of infection of the hand.

2. Excision and primary suture, combined with chemotherapy and immobilisation in plaster, was the method of treatment.

3. The results, from the point of view of rapidity and completeness of recovery, justify consideration of the method for further use.
FRACTURE-SUBLUXATIONS OF THE SHOULDER
Authors: Fairbank T. J.
Published: February 2018

1 . Attention is drawn to the not infrequent occurrence of downward subluxation of the shoulder joint accompanying fractures of the upper end of the humerus.

2. Such cases fall into early or late groups according to the time of onset of the subluxation.

3. The subluxation often disappears spontaneously, but it may persist and cause disability. It cannot safely be disregarded.

4. The etiology is discussed and experiments are described which lead to the conclusion that the subluxation is due chiefly to lack of tone in the scapulo-humeral muscles supporting the weight of the limb.

5. It is suggested that the use of a collar and cuff sling as a method of treatment for fractures of the shoulder is not without danger. A triangular sling usually prevents or cures the displacement.
CAUSALGIA
Authors: Cullen C. H.
Published: February 2018

1 . Twenty-four patients complaining of severe pain after nerve injuries have been considered from a diagnostic and therapeutic point of view.

2. The typical syndrome of causalgia develops only when the median or internal popliteal nerves are injured. It is doubtful whether pain associated with injury in the peripheral part of the limb, or of the brachial plexus, should be classed as causalgia.

3. The importance of novocaine block of the sympathetic ganglia as a diagnostic test is stressed, and its usefulness as a therapeutic measure is considered.

4. Sympathectomy is shown to be a reliable method of treatment in suitable cases.

5. The limited field of application of radiotherapy is also indicated.
ISCHIO-FEMORAL ARTHRODESIS
Authors: Brittain H. A.
Published: February 2018

It will be seen that the proportion of successful fusions in this series of ninety-five patients treated by ischio-femoral arthrodesis of the hip was over 80 per cent. Similar percentages of successful fusion have been reported by Knight (1945), Freiberg (1946), Langston (1947), and Nisbet, who was resident surgical officer at the Robert Jones and Agnes Hunt Orthopaedic Hospital, and informed me in a personal communication that he had carried out twenty-six operations with an approximate fusion rate of 80 per cent. He stated: "It is the only operation which gives a reasonable chance of a successful arthrodesis in children. Up till now at Oswestry the chances of a fusion by the other methods in children have proved so disappointing that the operation had been abandoned. Dame Agnes Hunt, with her vast experience of the condition, was always very annoyed when she found a surgeon trying to fuse a child's hip. All this has been changed."
AN OPERATIVE APPROACH TO SUPRACLAVICULAR PLEXUS INJURIES
Authors: Bateman James E.
Published: February 2018

The use of the upright position of the patient, and a vertical incision for exposure of the brachial plexus, has been attended by no complications or serious hazards. The aid of skilled anaesthetists is acknowledged. The structures are visible and accessible; the operative field is steady; bleeding is controlled easily; and dissection is facilitated. By this technique it has been possible to explore a larger field from above, and division of the clavicle has seldom been necessary. Finally, and of importance, the operative area at shoulder level enables the surgeon to continue tedious dissection for some hours comfortably, and to escape postoperative postural complications in his own back.
THE TREATMENT OF RESIDUAL PARALYSIS AFTER BRACHIAL PLEXUS INJURIES
Authors: Hendry A. M.
Published: February 2018

After brachial plexus injuries, and other forms of paralysis of the upper limb, even when residual paralysis is very grave indeed, and even when the limb is almost flailâa forearm which can project forwards by the construction of a bone-block behind the elbow, with arthrodesis of the shoulder when necessary; a hand with fingers in the form of a claw and a thumb which opposes them; and a wrist which may perhaps be arthrodesed, but which still better can flex or extend when the forearm is pronated or supinated; together with the wise use of such muscles as are likely to gain function; may enable a patient to do very much more than he can with an artificial limb.
ADDENDUM
Authors: Perry Walter L. M.
Published: February 2018

1. Three groups of one month old rats were fed for a period of four to five weeks on a rachitogenic diet (group R), the same rachitogenic diet with vitamin D (group N), and a complete diet (group S).

2. Young's modulus of elasticity E for bone can be derived from measurements of the deflexion of the centre of a femur loaded at the centre and supported at its ends.

3. The three different diets produced significant differences in breaking stress SB, Young's modulus E, and percentage ash in the bones. It has not been shown conclusively that higher ash content alone is responsible for the greater SB and E values of bones produced on the better diets.

4. The value of E in group R was 0Â·6 x 106 lb./in.2; in group N 1Â·0 x 106 lb./in.2; and in group S (which can be taken as normal) 1Â·6 x 106 lb./in.2.

5. There is a high correlation between SB and E even when the effect of diet is eliminated.

6. Although the bones produced on the good diet (group S) were much stronger than those of groups N or R, the strain at the elastic limit was the same (about 1Â·5 per cent.). The strain at rupture tended to be higher in groups N and R than in group S.

7. The properties of bone as a structural material are discussed.
VARIATION IN EXTENSION OF THE METACARPO-PHALANGEAL AND INTERPHALANGEAL JOINTS OF THE THUMB
Authors: Harris H. , Joseph J.
Published: February 2018

1. The range of variation in full extension at the interphalangeal and metacarpo-phalangeal joints of the thumbs of 133 male and 100 female Europeans, and of 31 male Indians and 30 male Africans, has been investigated.

2. There is considerable variation between individuals in the maximum extension of both joints of the right and left thumbs in all groups studied.

3. The distribution for each joint in both thumbs in all groups is fairly symmetrical.

4. There is a high correlation between the right and left thumbs for both joints in all groups

5. The mean angle of extension at the right and left metacarpo-phalangeal joints in all groups is similar. Female Europeans, however, show a significantly greater mean angle than male Europeans.

6. The mean interphalangeal angle of extension in male Europeans is significantly greater than that in female Europeans and the mean in the Indian and African groups is significantly greater than in the male European group.

7. There is slight negative correlation between the metacarpo-phalangeal angle and interphalangeal angle in each thumb in the European groups.

8. Many subjects in all groups can increase extension at the metacarpo-phalangeal joint after flexing the carpo-metacarpal joint. Marked hyperextension (over 40Â°) is more frequent in the left than in the right thumb, in females than in males, and in male Indians than in male Europeans and Africans.

9. Maximum extension at the interphalangeal joints is not related to the presence of a sesamoid bone in the anterior part of the capsule of the joint.

10. The surfaces of the metacarpo-phalangeal joints vary considerably in shape. Those which are flat form about 10 per cent. of the sample and do not show hyperextension.

11. The factors influencing the amount of extension at the interphalangeal joint is the degree of laxity of the anterior capsule. The problem at the metacarpo-phalangeal joint is more complex; both the capsule and the shape of the joint surfaces play important roles.
EXCISION OF THE CARPAL SCAPHOID FOR UNUNITED FRACTURE
Authors: Dwyer F. C.
Published: February 2018

1. The late results in nineteen cases of total excision of the carpal scaphoid bone for ununited fracture have been reviewed.

2. The results are least satisfactory when there is clinical evidence of arthritis on the dorsal aspect of the wrist, or subluxation of the os magnum and semilunar. In other cases good results usually can be expected.

3. The operation must be done carefully without injury to the neighbouring bones and ligaments. Total excision is preferable to excision of the proximal pole alone.
PRONATION INJURIES OF THE FOREARM
Authors: Evans E. Mervyn
Published: February 2018

1 . Anterior dislocation of the head of the radius with or without fracture of the ulna is a forced pronation injury.

2. Full supination is essential for reduction, and immobilisation in full supination is the surest safeguard against recurrence of the deformity.
THE USE OF RADIOACTIVE PHOSPHORUS IN THE DIAGNOSIS OF AVASCULAR NECROSIS OF THE FEMORAL HEAD
Authors: Tucker F. R.
Published: February 2018

1. The pathology of avascular necrosis of bone and its relationship to the radiographic changes are considered briefly.

2. The inadequacy of radiographic examination in the early diagnosis of avascular necrosis is stressed.

3. Methods of early assessment of the residual vascularity of a bone mass are discussed.

4. Details of the principles, methods, and results of using radioactive phosphorus in the diagnosis of avascularity of bone are described.

5. The dangers and technical difficulties of using radioactive substances are discussed.

6. The possibility is envisaged that surgeons may soon be able to determine at the time of emergency operation whether the femoral head is dead or alive.
FRACTURE-SEPARATION OF THE PROXIMAL EPIPHYSIS OF THE HUMERUS
Authors: Bourdillon J. F.
Published: February 2018

Five cases of fracture-separation of the proximal epiphysis of the humerus are recorded. A method of reduction and immobilisation is described, and the literature is reviewed.
THE SENSITIVITY AND INNERVATION OF THE ARTICULAR CAPSULE
Authors: Kellgren J. H. , Samuel E. P.
Published: February 2018

1. Pain and pressure sensibility has been studied in the fibrous articular ligament and synovial membrane of the knee joint in normal human subjects and in patients subjected to arthrotomy under local anaesthesia.

2. The fibrous ligament was found to be a highly sensitive structure, containing many spots which give rise to sensations of pain or pressure when stimulated mechanically or chemically. Synovial membrane was found to be a relatively insensitive structure which only occasionally contains pain-sensitive spots.

3. Histological examination of articular capsule from the knee joints of normal and sympathectomised cats shows that articular ligaments have a rich nerve plexus and a variety of specialised and unspecialised nerve endings, most of which are somatic in origin. Synovial membrane contains a more delicate nerve network and also a variety of nerve endings, the majority of which are autonomic in origin. But a substantial number of somatic nerves enter the synovial membrane, some of which terminate in nerve loops, globular endings or simple unspecialised endings.

4. Histological examination of normal human articular capsule shows that its innervation closely resembles that of the cat, but no sympathectomised human material was examined.

5. The bearing of these findings on the symptomatology of joint disease is discussed briefly.
PSEUDARTHROSIS OF THE HIP JOINT
Authors: Taylor R. G.
Published: February 2018

1. The operation of pseudarthrosis of the hip joint is described and the results are assessed in ninety-three patients.

2. The result was good in eighty-three cases and poor in seven cases. Three patients died as a result of the operation.

3. Pseudarthrosis is the most satisfactory and the most reliable operation: 1) in ankvlosing spondylitis, and 2) in patients over sixty years of age with disabling osteoarthritis.

4. The more formidable operation of cup arthoplasty may prove to be superior in younger patients with osteoarthritis.
THE TREATMENT OF QUIESCENT TUBERCULOSIS OF THE HIP JOINT BY EXCISION AND "DYNAMIC" OSTEOTOMY
Authors: Gruca Adam
Published: February 2018

1. The operation of "dynamic" osteotomy is designed to secure a stable and freely mobile pseudarthrosis in cases of quiescent tuberculosis of the hip joint.

2. The principles and technique of the operation are described and illustrated.

3. The results of 224 operations are presented.
FRACTURES OF THE HEAD OF THE RADIUS IN CHILDREN
Authors: Jeffery C. C.
Published: February 2018

1. Full recovery after fracture of the head of the radius in children may be expected in cases with tilting of the radial head from 30 to 60 degrees, whether treated by early manipulative or by operative reduction.

2. Manipulative reduction is facilitated by knowledge of the direction of displacement and tilting of the radial head, which can be determined by the study of appropriate radiographs.

3. When the upper radial epiphysis is completely displaced from the shaft, some permanent loss of movement is to be anticipated even when accurate reduction has been secured by operation. Early fusion and some deformity of the radial head are also to be expected. This is not surprising in view of the risk to the blood supply of the displaced head, particularly in those cases treated by operative reduction.
AMPUTATION ABOVE OR BELOW THE KNEE FOR PRIMARY PERIPHERAL VASCULAR DISEASE
Authors: Smith H. G.
Published: February 2018

1. An attempt has been made to rationalise the selection of the site of amputation for gangrene in primary peripheral vascular disease.

2. There is a good chance of the survival of a below-knee stump if the circulation in the skin of the proposed flaps appears adequate clinically, and if the blood supply to the muscles is obviously good at amputation.

3. If the popliteal pulse is present before operation, below-knee amputation should succeed. The absence of a popliteal pulse, however, does not exclude below-knee amputation.

4. Below-knee stumps should be about four inches long in amputations for peripheral vascular disease.

5. Tests for determining the state of the circulation are also necessary before choosing the level for above-knee amputations.
INTRATHORACIC MENINGOCELE, SPINAL DEFORMITY, AND MULTIPLE NEUROFIBROMATOSIS
Authors: Kessel A. W. Lipmann
Published: February 2018

Two cases of lateral meningocele and spinal deformity in von Recklinghausen's disease are reported. Of the ten known cases of lateral meningocele, seven have occurred in patients with neurofibromatosis. The relation of spinal deformity and neurofibromatosis is briefly discussed.
EXPERIENCE WITH THE USE OF REFRIGERATED HOMOGENOUS BONE
Authors: Wilson Philip D.
Published: February 2018

1. Experimental evidence suggests that the autogenous graft exhibits some advantage over refrigerated homogenous grafts in that healing takes place more rapidly but that in the end the results are the same.

2. Histological study of fragments of healing grafts, both autogenous and refrigerated, that have been removed from human hosts shows no significant difference in the rate or method of repair.

3. Study of the clinical results of the use of homogenous transplants in 307 operations shows the bone to be well tolerated. The rate of infection in clean cases was 2Â·6 per cent; loss of bone occurred in only two cases.

4. Follow-up studies of 248 cases showed successful results obtained in 210, or 85 per cent. These are comparable with the results obtained with autogenous grafts. The healing of cancellous transplants takes place more rapidly than with cortical grafts. Transplants that have been preserved for more than one year do not heal as well as those that have been preserved for a shorter period and the failure rate is higher.

5. The operation of a bone bank is safe and practical. It offers great advantages to the patient and the surgeon from the standpoint of availability, abundance and the elimination of the necessity of secondary operations to obtain bone. When a bone bank is available the number of operations in which bone transplants are used will show a sharp increase.
VOLKMANN'S ISCHAEMIC CONTRACTURE AND ITS RELATIONSHIP TO FRACTURE OF THE FEMUR
Authors: Thomson Stuart A. , Mahoney Leo J.
Published: February 2018

1. Volkmannâs ischaemia is a real and threatening complication of fracture of the femur, and it is more common than reports in the literature would suggest.

2. The early signs and symptoms in the calf are ominous whereas the early vascular signs of a good tibial pulse, colour and temperature are often misleading.

3. Muscle decompression with or without arterial exploration has proved to be of no value.

4. Early recognition and radical treatment are imperative. Temporary paralysis of the lumbar sympathetic outflow has been shown to be an effective measure.

5. Transfixion of the calcaneum with a Kirschner wire for traction has the advantage of eliminating all bandages, suspending the tender calf and preventing an equinovarus deformity.

6. The only essential difference between the histological appearance of muscle which recovers and that which does not appears to be degeneration of muscle nuclei. The significance of engorged blood vessels remains in doubt.

7. Histological studies suggest that despite the typical gross appearance of an infarct some regeneration of muscle may occur.
INTERNAL FIXATION OF THE McMURRAY OSTEOTOMY WITH A TRIFIN NAIL
Authors: Roaf Robert
Published: February 2018

Internal fixation with a trifin nail after displacement osteotomy of the femur permits reduction of external splintage to a degree that any patient can tolerate with ease; it also eliminates the problem of the stiff knee.

The method has been used successfully for recent and old fractures of the femoral neck, for post-irradiation fractures, for failed nailing operations or arthroplastics, for osteoarthritis, for rheumatoid arthritis, for old congenital dislocations and subluxations, and to stabilise the hip after excision of the head and neck to create a pseudarthrosis.
THE LATE RESULTS OF ARTHRODESIS OF THE FOOT
Authors: Drew A. J.
Published: February 2018

Our investigations have shown that the late results of tarsal arthrodesis are good. We have endeavoured to find the disadvantages and to stress residual symptoms, but the general mpression after seeing these patients is that they were all well satisfied with the result. We think it should be added that these patients were selected in so far as they were all operated upon by masters of operative technique who were acknowledged authorities in this particular subject. Without the careful attention to detail and to the points discussed, these operations can be dismal failures and a burden to the patients concerned.
TREATMENT OF TROCHANTERIC FRACTURES
Authors: Scott J. C.
Published: February 2018

1. Published comparisons of the results of conservative and operative treatment of trochanteric fractures have been fallacious because the groups have not been strictly comparable and because all deaths during convalescence have not been included.

2. In a series of cases studied at Oxford, comparable groups have been secured by allotting alternate cases to each group. All deaths within three months of injury have been included, whether occurring in hospital or elsewhere.

3. There was no great difference in mortality or in functional results between the two groups. One type of trochanteric fracture gives poor results whatever the method of treatment.

4. The series is too small for statistical conclusions, but the results suggest that the only advantages of operative treatment are greater economy of hospital beds, and increased comfort and mobility for the patient. The latter factor is important in frail patients, who are believed to be less prone to develop non-fatal complications if treated by operation than if treated conservatively.
TROCHANTERIC FRACTURES OF THE FEMUR
Authors: Hafner R. H. V.
Published: February 2018

1. The advantages of internal fixation of trochanteric fractures of the femur are discussed.

2. It is suggested that a long oblique trifin nail driven across the fracture affords more rigid fixation than a nail-plate and facilitates earlier weight-bearing.
ON CONGENITAL DISLOCATION OF THE HIP
Authors: Burke Gerald L.
Published: February 2018

A new concept of the etiology of congenital dislocation of the hip, which states that the process is simply an accident, is presented. It is observed that the diagnosis should be made at birth. The importance of obtaining movement of the hip, after the reduction has been stabilised, is stressed. Contact and function are mandatory for the natural production of a normal hip. A mobile brace is described which allows a wide range of movement while safely maintaining reduction. The success of this method of treatment supports the conception of the etiology on which it is based.
SUPRAGLENOIDAL PSEUDARTHROSIS
Authors: Belton A. A. , Davies F.
Published: February 2018

Supraglenoidal dislocation of the humerus is uncommon. The anatomical findings in a bilateral example in which efficient pseudarthrosis had developed are described, and the probable evolution of the lesion is discussed.
JOINT CHANGES IN NEUROFIBROMATOSIS
Authors: Bingold A. C.
Published: February 2018

1 . Two patients with monomelic bone and joint changes in neurofibromatosis have been described.

2. The joint changes in neurofibromatosis include dysplasias, sclerosis of the articulating bone ends and secondary osteoarthritis.
VOLKMANN'S ISCHAEMIC CONTRACTURE BENEFITED BY MUSCLE SLIDE OPERATION
Authors: Nisbet N. W.
Published: February 2018

1. A case of Volkmann's ischaemic contracture, in which function was greatly improved by a muscle slide operation, is described.

2. The possibility of regeneration of muscle after ischaemia is reviewed in the light of recent research.

3. Injection experiments suggest that the forearm flexors, like the gastroenemius,are supplied by end arteries.
HALLUX VALGUS AND HALLUX RIGIDUS
Authors: Bonney George , Macnab Ian
Published: February 2018

1. A survey has been made of 518 operations for hallux valgus and hallux rigidus.

2. The methods of critical examination used in this survey are described.

3. The results obtained have led to the formulation of certain views on etiology and modes of treatment.

4. In hallux valgus in the adolescent, operations aimed at correcting the primary deformity are justifiable when correctly performed, though the exact form such operations should take still requires further study.

5. In hallux valgus in the adult, arthroplasty offers a reasonably good solution in the well chosen case, though no one should consider that the results are so good as to make unnecessary any further research in this field. Metatarsal osteotomy has in the adult only a limited sphere of application.

6. In hallux rigidus arthroplasty alone has no place in the treatment of the adult cases showing metatarsus primus elevatus, nor in the adolescent case. The possibilities of other methods of operative treatment, notably osteotomy, are discussed.
CARPAL GANGLION AS A CAUSE OF PARALYSIS OF THE DEEP BRANCH OF THE ULNAR NERVE
Authors: Seddon H. J.
Published: February 2018

Traumatic neuritis of the deep branch of the ulnar nerve may be caused by compression of the nerve by a ganglion originating in a carpal joint, and removal of the protrusion is followed by a prompt recovery. This lesion was found in four out of five explorations.
THE BLOOD SUPPLY OF THE FLEXOR AND EXTENSOR TENDONS OF THE FINGERS IN MAN
Authors: Brockis J. G.
Published: February 2018

The blood supply of the flexor and extensor tendons of the fingers is described. The blood-vascular system consists of main feeding channels which supply a longitudinal network of vessels. These lie in the interfascicular connective tissue.

A variation of the typical intratendinous vascular pattern in relation to the proximal interphalangeal joint is described.
ACUTE OSTEOMYELITIS OF THE MAXILLA IN INFANCY
Authors: McCash C. R. , Rowe N. L.
Published: February 2018

1. The literature on acute osteomyelitis of the maxilla in infants is reviewed and the improvement in the prognosis since the introduction of chemotherapy is noted.

2. The clinical features, diagnosis, surgical anatomy, pathology, and bacteriology are discussed and the constant pathogenicity of the staphylococcus aureus stressed. It is suggested that the first deciduous molar tooth is the centre of the early bone infection, and that the infection begins in the mucosa overlying this tooth.

3. Two cases are reported. Both were caused by a penicillin-resistant staphylococcus aureus.

4. The early use of aureomycin in an attempt to abort the infection is advocated.
COMPLICATIONS AND DIFFICULTIES OF THE JUDET ARTHROPLASTY
Authors: Buxton St J. D. , Waugh W.
Published: February 2018

1 . Complications of the Judet arthroplasty are few.

2. The antero-lateral approach provides good access to the joint for insertion of the prosthesis.

3. Details of treatment before and after operation are described and their importance in limiting complications is emphasised.

4. The complications that have been encounteredâincluding dislocation and fracture of the stemâare described and factors in their causation are discussed.

5. Study of the mechanical state of the new joint and the diagnosis of complications are aided by radio-opaque markers in the prosthesis.
POSTERIOR INTERVERTEBRAL FUSION OF THE LUMBAR SPINE
Authors: James Anthony , Nisbet Norman W.
Published: February 2018

1. A new operation of body-to-body intervertebral fusion by grafts introduced through a posterior approach is described. This is a preliminary report of early results, with follow-up to two years, which seems to be encouraging.

2. In spondylolisthesis, abnormal mobility of the loose posterior neural arch is believed in itself to cause nerve root pressure, and excision of the arch is an important part of the operation.

3. In the few cases where spinal fusion is needed after removal of a prolapsed intervertebral discâand the proportion is now very lowâposterior intervertebral fusion has proved very satisfactory.
THE TRUMBLE GRAFT
Authors: Stratford Bryan
Published: February 2018

1. Thirty-six cases of tuberculous hip disease treated by the Trumble type of extra-articular arthrodesis are reviewed.

2. The size and position of the graft, and the results and complications, are tabulated.

3. It is concluded that a short wide graft, placed almost horizontally between femur and ischium, gives the best results, and that a long obliquely placed graft is less satisfactory, and more liable to fracture or non-union.
HYPERPLASTIC CALLUS FORMATION IN OSTEOGENESIS IMPERFECTA
Authors: Strach E. H.
Published: February 2018

A case of hyperplastic callus formation is reported in a girl of eleven; several bones were affected. There were no associated fractures. She is believed to be suffering from a mild non-familial type of osteogenesis imperfecta without blue sclerotics and presents multiple bony excrescences unassociated with injury. The relevant literature is reviewed. The effect of a trial of treatment with A.C.T.H. and with deep x-ray is reported.
EXPERIMENTAL ARTERIAL SPASM IN THE LOWER EXTREMITIES PRODUCED BY TRACTION
Authors: Mustard W. T. , Simmons E. H.
Published: February 2018

1. Arterial spasm may be expected in any injury resulting in stretch of the arterial system.

2. Excessive traction in the treatment of fractures may well initiate diffuse arterial spasm.

3. In fractures that have permitted shortening of the vascular system for a considerable period, spasm may be initiated when a return to normal length is made.
A LATERAL INTERMUSCULAR APPROACH TO THE HIP JOINT FOR REPLACEMENT OF THE FEMORAL HEAD BY A PROSTHESIS
Authors: Burwell H. N. , Scott Dan
Published: February 2018

1. A lateral intermuscular approach to the hip joint is described for replacement of the head of the femur by a prosthesis.

2. Advantages claimed for it are that it is attended by little or no shock, because the operation is rapid and relatively bloodless; that adequate exposure can be gained without dividing muscle or tendon; and that muscle function is unimpaired and so walking can be allowed early. The exposure is easily extended if unexpected difficulty is encountered.

3. Prosthetic replacement of the femoral head through this incision is advocated as a primary measure for elderly or unfit patients with fractured femoral neck.
ALBERS-SCHOÌNBERG DISEASE (MARBLE BONES)
Authors: Enticknap J. B.
Published: February 2018

1. A case is described of the marble bone disease of Albers-SchoÌnberg in a woman of forty-one who died from subarachnoid haemorrhage. Several congenital abnormalities were present.

2. No significant abnormality of the chemical composition of the bones was discovered.

3. The long bones were more resilient, stronger, softer and of higher specific gravity than normal and the abnormal compact bone of the skull was less resilient, weaker, harder and of about the same density as normal bones.

4. The simple investigation of determining the breaking strength of cortical bone yielded results similar to the more complex investigations and if applied to a larger series of cases could provide sound data on which to base speculations about this condition.
CONCEALED DAMAGE FROM A RUN-OVER ACCIDENT
Authors: Farrow Raymond
Published: February 2018

A case of concealed run-over injury of the lower limb, complicated by delayed local gangrene and peripheral vascular involvement, is described and the mechanism of the lesion discussed.
TISSUE CHANGES IN HUMAN FEMURS CONTAINING PLASTIC APPLIANCES
Authors: Collins Douglas H.
Published: February 2018

1. A pathological study has been made of eight femurs containing acrylic Judet type prostheses, in patients who had died two to thirteen weeks after arthroplasty.

2. Haemorrhage occurs into the tunnel and into a limited zone of the spongy bone around the tunnel. Organisation of the blood clot is evident at two weeks and new bone formation appears shortly afterwards. At eight weeks the tunnel is lined by a fibrous membrane. Further fibrosis and new bone growth tend to establish a new surface, healing the wound in the bone and sequestrating the foreign body.

3. There is no evidence that the intact methyl-methacrylate appliance had exerted any toxic action on the tissues.
BERYLLIUM-INDUCED OSTEOGENIC SARCOMA IN RABBITS
Authors: Janes Joseph M. , Higgins George M. , Herrick J. F.
Published: February 2018

The method of producing osteogenic sarcoma in rabbits by the injection of beryllium in the form of "zinc beryllium silicate" is presented. In five of ten animals which had such injections, osteogenic sarcomas developed several months later. There was new bone formation in the medullary cavities of the long bones before malignant changes were apparent. It is of particular interest to note that there was atrophy of the spleen in those animals in which bone tumours developed, whereas the spleen seemed to be quite normal in the rabbits which did not develop bone tumours. The tumours usually developed in the metaphysial regions. More than one tumour often developed in the same animal.
ARTHROPLASTY OF THE KNEE
Authors: Shiers L. G. P.
Published: February 2018

If conclusions are to be of any value they must be definite and one cannot draw definite conclusions from less than, say, fifty cases followed up for at least five years. However, few surgeons will ever see fifty patients requiring arthroplasty of the knee, let alone operate of them, even in five years. Accordingly, this account of a new approach to the problem of knee arthroplasty is submitted in the hope that other surgeons may care to try it and thereby learn, and thus be able to teach, tile modifications and improvements that all new techniques seem so surely to need.
SPRAIN OF THE PISIFORM-TRIQUETRAL JOINT
Authors: Smith A. McEwen
Published: February 2018

Sprain of the pisiform triquetral joint is a definite clinical entity. It presents as a "tenosynovitis" of the flexor carpi ulnaris muscle from which it can be distinguished by the tests described. The disability in most cases is such that operation is justifiable. Fusion of the pisiform-triquetral joint is preferred to excision of the pisiform because it restores stability to the wrist with the least disturbance to related structures.
MULTIPLE PSEUDO-CYSTIC TUBERCULOSIS OF BONE
Authors: De Pape A. J.
Published: February 2018

1. A case of multiple pseudo-cystic tuberculosis in an American Indian infant is described.

2. The extensive lesions in the skull of this infant are considered to be of particular interest.

3. The possible significance of a bony lesion present at birth is discussed.
BIOPHYSICAL STUDIES OF THE BONE TISSUE IN OSTEOGENESIS IMPERFECTA
Authors: Engfeldt B. , EngstroÌm A. , ZetterstroÌm R.
Published: February 2018

Results are given of a study of four cases of osteogenesis imperfecta using biophysical methods comprising microradiography, microscopy using polarised light, and x-ray diffraction. Rebuilding of bone tissue was infrequent in the material studied and has been shown to occur in an abnormal manner. The mineralisation of the bone is more uniform than is found in normal bone. The collagen has an abnormal organisation and is sparse. The ultrastructure of bone salts and their orientation are as in normal bone.
FAMILIAL OSTEOCHONDRITIS DISSECANS
Authors: Pick M. Pickering
Published: February 2018

Osteochondritis dissecans occurring bilaterally in either the knees or the elbows is recorded in four members of one family. The suggestion is supported that the underlying pathology may be developmental, resulting in a form of localised osteochondrodystrophy.
SYNOVECTOMY OF THE KNEE IN RHEUMATOID ARTHRITIS
Authors: London P. S.
Published: February 2018

1. Synovectomy was carried out in thirty-four knees, of which thirty-one were certainly or probably afflicted by rheumatoid arthritis.

2. Synovectomy was considered only when adequate medical and physical treatment had failed to afford relief. Its purpose is to preserve useful function, and one of the principal factors influencing the decision to operate was the retention of a normal or good radiographic joint space in a persistently painful, warm and swollen knee.

3. Radiographic appearances constituted a useful but not infallible guide to the true state of the articular surfaces.

4. The method of operation, findings and subsequent care are described.

5. Up to two years after operation it appeared that improvement might be related to the state of the articular surfaces, but after two years this relationship was not evident and an attempt to explain this difference has been made.

6. It seems clear that the longer-term results are determined mainly by the course taken by the rheumatoid process. An unfavourable course was associated with considerably less satisfactory results than was a favourable course.

7. It is concluded that in rheumatoid arthritis which has resisted rest and medical treatment synovectomy of the knee is most likely to be successful when the radiographic joint space is good or normal, and when the rheumatoid process follows a favourable course. To undertake the operation at an early stage in the disease is to leave in doubt the outcome, as this is dependent upon the as yet undeclared general course of the disease. Even so, early synovectomy is worth considering when nothing else has given relief. The fact that arthrodesis has only once been necessary after synovectomy appears to justify the policy of salvage described.
THE NATURAL HISTORY AND PROGNOSIS OF INFANTILE IDIOPATHIC SCOLIOSIS
Authors: Scott J. C. , Morgan T. H.
Published: February 2018

1. The natural history and prognosis of progressive infantile idiopathic scoliosis are reviewed and twenty-eight cases are reported.

2. Resolving infantile idiopathic scoliosis is described and seven cases are reported.

3. The length of the curve, the degree of rotation, the age of onset of deterioration, and the rate of progression are the important factors in determining the type and severity of the deformity.

4. Infantile idiopathic scoliosis is briefly compared with congenital scoliosis.
KYPHOSCOLIOSIS
Authors: James J. I. P.
Published: February 2018

1. The true deformity of kyphoscoliosis has received little attention. Twenty-one deformities of congenital origin, ten idiopathic, and two secondary to neurofibromatosis, are discussed. The diagnosis is established and usually first suspected by radiography.

2. The deformity was severe and progressive except in three cases; paraplegia occurred in five congenital cases.

3. Early correction and fusion are advocated in the hope of preventing paraplegia and because correction of the old-established deformity is difficult or impossible.
A CHONDROMATOUS TUMOUR OF THE CALCANEUM
Authors: Durbin F. C. , Smith G. Stewart
Published: February 2018

The characteristics of enchondromata of long bones are mentioned and the special features of a malignant chondroma of the calcaneum are described. The management of such a case is discussed.
MULTIPLE PSEUDO-CYSTIC TUBERCULOSIS OF BONE
Authors: Clinton-Thomas C. L. , Young W. B.
Published: February 2018

1. A case of multiple pseudo-cystic tuberculosis of bone presenting as a generalised disease of the skeleton in a child is reported.

2. The response to streptomycin and para-amino-salicylic acid is shown.

3. A possible explanation of the etiology of this rare disease is suggested.
EXPERIMENTAL PLASTER BANDAGES
Authors: Sayle-Creer W.
Published: February 2018

Clinical trials and experiments with a new plaster-of-Paris bandage which can be used in the normal manner are described. Only about two-thirds of the usual number of bandages are required to produce a plaster case of equivalent strength.
ARTHRODESIS OF THE OSTEOARTHRITIC HIP JOINT
Authors: Watson-Jones Reginald , Robinson Walter C.
Published: February 2018

1. This is a simple clinical study of the end-results of arthrodesis of the hip joint in patients followed up and re-examined five to twenty-five years after operation.

2. The study was stimulated by our astonishment at recent reports which suggested that arthrodesis of the hip caused serious operative mortality, a high rate of wound infection, and failure of sound fusion in one of every two cases; and that even when sound fusion was gained there was always pain in the back and usually stiffness of the knee. To say that we were astonished puts it mildly.

3. This review includes 120 patients aged from ten to seventy years, treated for osteoarthritis of the hip joint by intra-articular arthrodesis with the internal fixation of a nail, usually with an iliac graft, and with immobilisation in plaster for not less than four months.

4. Of these 120 patients there was sound fusion of the joint, proved radiographically, in 94 per cent; a mortality of nil; and recovery of free movement of the knee joint to the right angle or far beyond in 91Â·5 per cent. Almost half of the patients regained normal movement, the heel touching the buttock. Only in eight patients was there less than right-angled flexion.

5. There was no pain in the backânone whateverâin 64 per cent of the patients. In 36 per cent there was some pain or discomfort. One alone said that the low back pain was worse than before the operation. Many others said that pain in the back had been relieved by the operation.

6. It is emphasised that these results were gained only from sound fixation of the joint in the mid-position with neutral rotation, no more abduction than is needed to correct true shortening, and no more flexion of the joint than that with which the patient lies on the table. The limb was immobilised in plaster for at least four months after operation. The stiff knee was mobilised by the patient's own exercise without passive stretching, force or manipulation.

7. Two other groups of patients are considered. There are fourteen treated by fixation of the joint with nail alone, an operation that was never intended to arthrodese the joint and which has long since been abandoned. The other small group is that of patients with old unreduced traumatic dislocation of the hip, a procedure in which the risks of operation are so great and the number of successful results so small as to dissuade us from attempting operative reduction.

8. After successful arthrodesis of the hip joint patients can return to every household activity and every recreation including ski-ing, mountaineering, rock climbing, or whatever else they want.
MULTIPLE EPIPHYSIAL DYSPLASIA
Authors: Shephard Edmund
Published: February 2018

Three cases of multiple epiphysial dysplasia in three generations of one family are described. The history indicates that three further members, one in a fourth generation. have been affected.
WEAR AND TEAR IN JOINTS
Authors: Barnett C. H.
Published: February 2018

1. By reducing the viscosity of the synovial fluid within the ankle joints of rabbits and then subjecting these to prolonged exercise, wear and tear of articular cartilage can be consistently produced.

2. This finding is an indirect confirmation of the view that fluid film lubrication is an important factor in the mechanical efficiency of joints.

3. The special properties of synovial fluid and articular cartilage that allow fluid film lubrication to exist within joints that are, in effect, slowly moving, heavily loaded, reciprocating bearings are discussed. They account for the remarkable resistance to wear and tear exhibited by synovial joints under physiological conditions.
SYME'S AMPUTATION
Authors: Harris R. I.
Published: February 2018

The details in technique which are most essential to ensure a perfect Syme's stump are the provision of a broad area of support for the heel flap by transecting the tibia and fibula as low as possible; the maintaining intact of the specialised weight-bearing qualities of the heel flap; and the proper placement of the heel flap under the cut ends of the tibia and fibula. If these aims are achieved a good and useful stump is assured; if they are neglected the stump will be imperfect and may be unsatisfactory and no further operation can restore the qualities of the heel flap which are lacking.

It must be recorded, however, that Syme's stumps which are not technically perfect often function so well that there has been no need to consider re-amputation. A loose heel pad can be held beneath the end of the bone by firm lacing of the corset of the prosthesis.If its area of bony support is reasonably large it may serve well, though not perfectly, as an end-bearing stump. Syme's stumps so completely unsatisfactory as to necessitate re-amputation have been those in which the plane of transection of the tibia is so high that the area supporting the heel flap is too small; or the weight-bearing qualities of the heel flap have been damaged; or there is instability of the heel flap which cannot be controlled; or there is impairment of nutrition of the heel flap.
MEASUREMENT OF THE VARIATIONS IN CALCIFICATION IN NORMAL RABBIT BONE
Authors: Owen Maureen
Published: February 2018

1. Measurements have been made of the relative calcification of different types of bone in tibia of the rabbit at the ages of six weeks, three and a half months and seven months by comparing their absorption of x-rays.

2. Calcified cartilage is between 8 and 10 per cet more highly calcified than periosteal and endosteal bone and about 20 per cent more highly calcified than bone formed immediately adjacent to cartilage.

3. Young and adult bones have a framework of approximately the same strength; that is, calcified cartilage, bone adjacent to cartilage and the interstitial areas of periosteal and endosteal bone have each approximately the same degree of calcification at all ages.

4. Adult rabbit bone approaches uniform calcification throughout, equal to the calcification of the interstitial areas of periosteal and endosteal bone. Evidence for this is the replacement of the lowly calcified epiphysial bone by osteones of higher calcification.
INDUCED HYPOTENSION IN ORTHOPAEDIC SURGERY
Authors: Holmes Frank
Published: February 2018

1. Figures relating to blood loss and post-anaesthetic progress during and after 407 orthopaedic operations performed with the aid of hexamethonium bromide are presented.

2. Two deaths from circulatory failure are examined in detail.

3. The criteria that must be observed to ensure safety are discussed.

4. Measures designed to avoid reactionary haemorrhage are enumerated.

5. Observations regarding contra-indications are presented.
TUBERCULOMA OF STRIATED MUSCLE
Authors: Griffiths Evan
Published: February 2018

1. An example of haematogenous tuberculous lesion of striated muscle is described.

2. Its rarity is stressed and pathological details described.

3. Some of the theories for the refractory reaction of muscle tissue to tuberculous infection are discussed, and experimental work is reviewed.

4. The prognosis, treatment, and the relationship of the disease to trauma are considered.
HISTOLOGICAL CHANGES IN EXPERIMENTALLY DISPLACED UPPER FEMORAL EPIPHYSES IN RABBITS
Authors: Harris W. Robert , Hobson K. W.
Published: February 2018

An experimental method is described which permits observations on the early stages of repair after acute displacement of the upper femoral epiphysis. Because the epiphysis is intra-articular, displacement brings about avascular necrosis which is slowly repaired by ingrowth of callus and blood vessels from the stump of the neck. As the bulk of the epiphysial plate remainsattached to the epiphysis, it acts as a barrier to successful revascularisation. Deliberate removal of the epiphysial cartilage allows earlier revascularisation. It is suggested that in clinical cases reduction be done through the epiphysial plate rather than through the neck, and that it be accompanied by curettage of the remaining part of the epiphysial plate from the under surface of the head.
A SWEAT GLAND TUMOUR OF THE HAND
Authors: Potter C. M. C.
Published: February 2018

1. The clinical appearance and histological structure of a myo-epithelial tumour of a sweat gland of the hand is described.

2. A review of previously published papers is given.

3. It is suggested that trauma may play a part in the causation of these tumours.
PSEUDOHYPOPARATHYROIDISM
Authors: Howat T. W. , Ashurst G. M.
Published: February 2018

A case of pseudohypoparathyroidism is reported. The clinical, biochemical and radiological findings are described. There was a satisfactory response to large doses of Calciferol.