bluuebunny/crossref_metadata_2025 huggingface dataset:
IMPLANTATION OF MICRO-CIRCUITS FOR MYO-ELECTRIC CONTROL OF PROSTHESES
Authors: Herberts P. , Kadefors R. , Kaiser E. , Petersén I.
Published: February 2018

1. Experience with a refined type of implantable electrode for the myo-electric control of externally powered prostheses is reported.

2. The electrodes are externally energised by electromagnetic induction and therefore do not contain any battery cells. The myo-potentials are transmitted in frequency-modulated form and detected by a receiver placed on the skin. The implantable electrode, measuring 5x11x4 millimetres, is encapsulated in epoxy resin.

3. Six electrodes have been implanted in the forearms of two normal subjects and two below-elbow amputees. The time of implantation ranged from three to fifteen months. Macroscopically, a fibrous capsule developed around the electrodes. Histological examination showed a capsule of granulation tissue of varying thickness with slight inflammatory reaction and foreign-body giant cells.

4. In all cases except one the signals received have been of high quality as ascertained by conventional electromyography and frequency analysis. There has been no significant deterioration in signal quality during the follow-up periods.

5. The major source of failure was fatigue fracture of the gold wires making contact with the body tissues. In one case, however, the electrode was still functioning normally at the time of removal fifteen months after insertion.

6. The patients have not been inconvenienced either by the operative procedures or by the presence of the electrodes in the tissues.
PERIPHERAL COMPRESSION LESIONS OF THE ULNAR NERVE
Authors: Vanderpool D. W. , Chalmers J. , Lamb D. W. , Whiston T. B.
Published: February 2018

1. Sixty-one cases of compression of the ulnar nerve are reported, forty at the elbow and twenty-one at the wrist. Although contributory factors may include deformity, osteoarthritis, injury, ganglia and other tumours, the narrow anatomical confines of the nerve at these two levels are noteworthy and alone may produce nerve compression.

2. Careful clinical examination will usually determine the level of involvement if not the exact pathology. Surgical exploration is indicated both as a diagnostic and therapeutic procedure in most cases.

3. Following removal of the compressing agent rapid recovery occurred in most cases.
SYMPHALANGISM AND TARSAL COALITIONS: A HEREDITARY SYNDROME
Authors: Neel James V. , Geelhoed Glenn W. , Davidson Ruth T.
Published: February 2018

It has been known for well over a century that the corresponding ossification centres of the hand tend to appear before those of the foot (Mall 1906), although even now the range of variability remains poorly defined. Presumably a similar asynchrony also obtains for chondrification, although precise timing is more difficult here than for ossification. Accordingly, it is tempting with respect to this syndrome to relate fusions restricted to the phalanges of the hand and to the tarsal bones to the action of a gene which during a very limited period of development exerts an effect on those small bones of the hand and foot which are in a very specific stage of development. But since there are other inherited abnormalities of the skeleton, such as brachydactyly, where homologous bones are involved, it is clear that at the descriptive level gene action can either appear to be "stage-specific" or "homologue-specific." There are also mutations affecting the axial skeleton such as the type of polydactyly of the foot described by Neel and Rusk (1963) which appear to be neither "stage" nor "homologue" specific, involving only the foot. Finally then, there are syndromes, such as Lawrence-Moon-Biedl-Bardot, in which involvement of the hands and feet (polydactyly) is associated with such other apparently completely unrelated defects as retinitis pigmentosa and hypogonadism. While it is tempting to try to construct theoretical patterns and systems of developmental processes on the basis of results such as these, it is clear that the ultimate understanding of how genes can appear to act in so many ways almost certainly depends on the identification of a genetically controlled, qualitative or quantitative biochemical lesion. With the current parallel developments in biochemical and developmental genetics, new insights into these enigmas will surely be forthcoming in the relatively near future.
MAJOR ARTERIAL INJURY IN CLOSED FRACTURE OF THE NECK OF THE HUMERUS
Authors: Smyth E. H. J.
Published: February 2018

A case of injury of the axillary artery complicating a closed fracture of the neck of the humerus in a woman of eighty-six is reported. Spasm was not relieved despite repeated instillation of papaverine. Gangrene developed and amputation above the elbow was required.
POSTERIOR CERVICAL ELECTROMYOGRAPHY IN THE DIAGNOSIS AND PROGNOSIS OF BRACHIAL PLEXUS INJURIES
Authors: Bufalini C. , Pescatori G.
Published: February 2018

1. The deep posterior muscles of the neck are innervated by the posterior branches of spinal nerves, which branch off immediately after the root emerges from the intervertebral foramen. Electromyographic examination of these muscles permits a differential diagnosis to be made between intraforaminal and extraforaminal brachial plexus lesions.

2. The earlier diagnosis and prognosis thus achieved permit definitive treatment, in particular suture of the torn nerve trunks in recent extraforaminal cases.
REVERSAL OF THE RADIAL HEAD DURING REDUCTION OF FRACTURE OF THE NECK OF THE RADIUS IN CHILDREN
Authors: Wood S. K.
Published: February 2018

Two cases of an unusual injury to the proximal end of the radius in children are reported illustrating a pitfall of closed manipulation. A review of the literature suggests that this injury is comparatively rare and is likely to be followed by permanent restriction of rotation of the forearm.
THE LAURENCE-MOON-BIEDL-BARDET SYNDROME
Authors: Levy M. , Lotem M. , Fried A.
Published: February 2018

1. Three cases of the Laurence-Moon-Biedl-Bardet syndrome occurring in a Yemenite family are presented. The parents were first cousins.

2. In two of the patients the complete syndrome, which comprises retinitis pigmentosa, polydactyly, obesity, genital hypoplasia and mental retardation, was found. The patients also had abnormalities of the hips.
HAEMANGIOMATOSIS WITH MASSIVE OSTEOLYSIS
Authors: Fornasier V. L.
Published: February 2018

1. An unusual case of haemangiomatosis in an adult is presented. The association of angiomatosis with massive osteolysis and With extensive soft-tissue destruction is discussed.

2. The extensive vascular involvement of skin, soft tissues and bone strengthens the idea that massive osteolysis results from vascular proliferation or angiomatosis.
THE DISTRIBUTION OF COLLAGEN IN HUMAN ARTICULAR CARTILAGE WITH SOME OF ITS PHYSIOLOGICAL IMPLICATIONS
Authors: Muir Helen , Bullough Peter , Maroudas Alice
Published: February 2018

1. Serial slices of articular cartilage obtained at necropsy from apparently normal femoral condyles of individuals between the ages of twenty-six and sixty were examined chemically, by electron microscopy and for permeability.

2. The most superficial layer was shown by chemical analysis and electron microscopy to have the highest collagen content, which fell sharply with distance from the articular surface. On the other hand the glycosaminoglycan content was very low in the superficial layers but increased with depth. This variation was found in all specimens tested but the absolute levels of collagen and of glycosaminoglycans were widely different. There was no correlation of chemical composition with age.

3. Collagen fibrils in the superficial layer were of much smaller diameter than in the deeper zones.

4. Hydraulic permeability was shown to depend more on glycosaminoglycan than on collagen content, although it varied inversely with both these factors.

5. The results obtained demonstrate clearly the close relation between the physical properties of cartilage and its chemical composition.
OCHRONOTIC ARTHROPATHY
Authors: Laskar F. H. , Sargison K. D.
Published: February 2018

1. Four cases of ochronotic arthropathy have been studied and the related literature has been reviewed.

2. Ochronotic arthropathy is a rare condition resulting from an inborn error of metabolism occurring as a Mendelian recessive characteristic. Its incidence, however, may have been underestimated.

3. Problems of differential diagnosis are discussed and it is suggested that more widespread screening should be undertaken in order to assess the true incidence of the condition.
SYPHILITIC DISORDERS OF THE SPINE
Authors: Johns David
Published: February 2018

1. Two cases of syphilitic involvement of the spinal column are described, illustrating the presentation and pathology of the disease.

2. The possibility of increased incidence of syphilitic disorders of bone and joint is considered in the light of recent statistics, and the need for awareness of the disease in its various forms is emphasised.

3. The problems of diagnosis are discussed.
OSTEOCHONDRITIS DISSECANS OF THE KNEE
Authors: Aichroth Paul
Published: February 2018

1. One hundred patients with osteochondritis dissecans of the knee have been reviewed. Sixty-eight were male. Unilateral lesions were found in seventy-four. The average age at onset of symptoms was eighteen years.

2. The outstanding etiological feature was found to be direct injury to the joint surface (46 percent), repeated injuries sustained in first class athletics and field sports, and mechanical abnormalities of the knee.

3. Osteochondral fracture was found in seven cases.

4. The results of various types of treatment are described and a plan of management outlined.
POTT'S PARAPLEGIA
Authors: Martin N. S.
Published: February 2018

1. In 120 of 740 European patients found to be suffering from spinal tuberculosis the disease was complicated by paraplegia. These 120 patients have been studied.

2. The patients could be divided into two groups: those receiving chemotherapy and those not receiving specific drugs. Chemotherapy improves the patient's general condition and makes operation safer, but does not have any significant effect in preventing paraplegia or in promoting recovery from it.

3. Only twenty-four of the fifty patients treated by closed method made full recovery.

4. The recovery rate after decompression was only 60 per cent. The reasons for this relatively low rate are discussed and the advantages of the postero-lateral approach to the cord, combined with focal operation on the lesion, are stressed.

5. Experience has shown that a policy of early and adequate focal operation can eliminate the risk of this serious complication of spinal tuberculosis.

6. The behaviour of spinal tuberculosis in the European is contrasted with that in the African and Asian.
PAGET'S DISEASE INVOLVING THE HIP JOINT
Authors: Graham James , Harris William H.
Published: February 2018

1. The early signs of Paget's disease of the acetabulum and femur are described.

2. The pattern of arthritis is presented in 199 hips in which Paget's disease of bone occurred in either the femur, the acetabulum or both bones. Distinct patterns of disease occur with different bone involvement.

3. Selective narrowing of the medial segment of the joint is common and is particularly associated with pelvic disease. Why the narrowing occurs here preferentially is unexplained.

4. Protrusio acetabuli occurred in only 25 per cent of hips and usually when both the femur and the acetabulum were involved. This may be due to the presence simultaneously of weakened bone and coxa vara, the latter leading to an alteration in the direction of the resultant force across the hip joint.

5. Degenerative arthritis was present with Paget's disease in 14 per cent of hips but it may be a chance relationship in half of these hips.
GIANT-CELL TUMOUR OF BONE
Authors: McGrath P. J.
Published: February 2018

1. Fifty-five giant-cell tumours of bone are described in fifty-two patients of whom thirty-five were women. The highest incidence was in the third and fourth decades.

2. The tumours were characteristic radiologically: they all occurred in skeletally mature patients, and chiefly in the expanded extremities of long bones.

3. Histological grading was not done, the tumours being designated typical or malignant.

4. Curettage and graft, resection, radiotherapy and amputation were the basic forms of treatment. Amputation has an occasional place in primary treatment and radiotherapy should be confined to tumours in surgically inaccessible sites.

5. Resection is the method of choice for tumours in suitable sites, such as the upper end of the fibula ; careful curettage and grafting should be used to preserve the function of a large joint.

6. Recurrences within two years should be treated by limited resection without preliminary biopsy. Late recurrences must have a biopsy taken to establish the diagnosis before planning treatment.
ARTERIAL INJURIES COMPLICATING ORTHOPAEDIC SURGERY
Authors: Horton R. E.
Published: February 2018

1. Three new cases of injury to main arteries at orthopaedic operations are described, and a follow-up of two previously described cases is given. The rarity of these accidents is a credit to those engaged in orthopaedic surgery, for many orthopaedic operations are done very close to great vessels, and often under the bloodless conditions of a tourniquet. Nevertheless, it is well to have the risk of great vessel injury in mind because such an accident, although rare, may be a serious threat to life or limb.

2. It is important to repair the damaged artery rather than ligate it because the risk to the growth or viability of the limb is lessened.

3. The aim should be a return to full function with as near normal a vascular anatomy as possible.
INTRACELLULAR COLLAGEN IN EXPERIMENTAL ARTHRITIS IN RATS
Authors: Cullen J. C.
Published: February 2018

1. Experimental arthritis was induced in rats by the intradermal injection of modified Freund's adjuvant.

2. The granulation tissue occurring in and around the joints was examined with the electron microscope.

3. Intracellular collagen was demonstrated in many of the cells.

4. Collagen formation by these cells was studied by autoradiographic techniques using tritiated proline as a label.

5. The proline turnover was rapid, as most of the labelled proline had become extracellular one hour after its injection.

6. It was concluded that the collagen was present within the cells as a result of phagocytosis despite the fact that the cells had the electron microscopic features of fibroblasts.
EXPERIMENTAL BRIDGING OF OSSEOUS DEFECTS IN RATS BY THE IMPLANTATION OF KIEL BONE CONTAINING FRESH AUTOLOGOUS MARROW
Authors: Plenk Hanns , Hollmann Karl , Wilfert Karl-Heinz
Published: February 2018

1. Into osseous defects cut in the pelvis of rats, Kiel bone grafts were implanted after impregnation with the animals' own fresh bone marrow, obtained by femoral puncture. Unimpregnated Kiel bone grafts and Kiel bone grafts impregnated with an antibiotic solution were implanted as controls.

2. Histological examination of the implant area showed that in the marrow-impregnated grafts new bone formation could be observed after twelve days, and that during an observation period of 135 days after implantation bone formation occurred in thirteen out of nineteen rats. In four of these cases a continuous bony bridge developed over the defect.

3. In the unimpregnated grafts no more than a small amount of new bone was seen in only one of seven rats. In the antibiotic-impregnated grafts no bone formation was found in six rats during the same period of observation.
TREATMENT OF THE POPLITEAL CYST IN THE RHEUMATOID KNEE
Authors: Pinder I. M.
Published: February 2018

1. Anterior synovectomy was undertaken in sixteen knees of fourteen patients with rheumatoid arthritis associated with popliteal or calf cysts. Subsequent changes in the knees and cysts were observed clinically and by arthrography.

2. In all instances there was alleviation of symptoms and in fourteen cases the cysts disappeared.

3. It is suggested that anterior synovectomy is the logical treatment of a posterior cyst associated with rheumatoid arthritis of the knee.
THE EXTENSOR DIVERSION GRAFT OPERATION FOR CORRECTION OF INTRINSIC MINUS FINGERS IN LEPROSY
Authors: Srinivasan H.
Published: February 2018

1. A new procedure, called "the extensor diversion graft operation", has been devised for correcting the deformity and reducing the disability of the intrinsic minus fingers so commonly seen in leprosy.

2. The procedure consists of the insertion of a free tendon graft which spans the metacarpophalangeal joint along its volar aspect and is attached at both ends to the extensor mechanism, to the extensor tendon proximally and to the lateral band distally.

3. The procedure reduces extensor dominance at the metacarpo-phalangeal joint and improves the balance of forces, allowing the assumption of a straight posture by use of the extrinsic muscles.

4. The assessment of function of ninety-seven fingers on average eight months after operation has shown that in addition to correction of deformity, this procedure in the majority of cases also restores partial independence of movement at the metacarpo-phalangeal and proximal interphalangeal joints, to such an extent that the finger can reach and hold a functionally useful position.

5. One advantage of the procedure is that it obviates the need for re-education of muscles.
ANTERIOR SACRAL MENINGOCELE OCCURRING IN A FAMILY
Authors: Klenerman Leslie , Merrick M. V.
Published: February 2018

1. A case of anterior sacral meningocele is described in members of a family consisting of a woman, her father and his brother.

2. This is the first recorded case of this anomaly in members of the same family of different sex, and only the second recorded case of occurrence in the same family.
EOSINOPHILIC GRANULOMA OF BONE AND ITS RELATIONSHIP TO HAND-SCHÜLLER-CHRISTIAN AND LETTERER-SIWE SYNDROMES
Authors: Schajowicz Fritz , Slullitel Jorge
Published: February 2018

1. The clinical, radiological and pathological features of 106 cases of eosinophilic granuloma of bone (solitary and multiple) are reported.

2. Our findings support strongly the concept that eosinophilic granuloma, Hand-Schüller-Christian and Letterer-Siwe syndrome are closely related manifestations of a single pathological disorder, characterised fundamentally by the proliferation of non-neoplastic histiocytes, intermingled with a variable amount of eosinophilic leucocytes and other inflammatory elements.

3. Lipid-bearing histiocytes (xanthoma cells) may be found in variable amounts in solitary and multiple lesions but are more abundant in the more extensive or chronic lesions of Hand-Schüller-Christian syndrome.

4. These entities may perhaps represent some type of immuno-allergic (hypersensitive) reaction to a still unknown infection, possibly viral.
LABORATORY TESTS ON TOTAL JOINT REPLACEMENT PROSTHESES
Authors: Swanson S. A. V. , Freeman M. A. R. , Heath J. C.
Published: February 2018

1. Currently available total replacement hip and knee prostheses were tested in a machine enabling flexion-extension movements to be applied whilst the prostheses were surrounded with Ringer's solution or other liquid and loaded within the physiological range.

2. Prostheses of which both components were made in cobalt-chromium-molybdenum alloy produced visible quantities of alloy particles, whose sizes ranged down to about 0·1 microns, and cobalt and molybdenum ions in solution.

3. No metallic or plastic particles were detected during tests on a hip prosthesis made of stainless steel and high density polyethylene.

4. The frictional moments in cobalt-chromium-molybdenum hip prostheses were higher than in stainless steel-polyethylene hip prostheses, by a factor of at least 2 to 1.

5. It is accepted that the conditions of these tests were probably more severe than in life, but the difference is held to be one of degree and not one of kind.

6. The particulate alloy debris, when injected in massive doses into the muscles of rats, gave an incidence of malignant tumours which was comparable to that already established for pure cobalt powder, whereas particles of several other metals, tested in the same way, gave no tumours.

7. It is argued that the particles which are known to be produced in at least some patients using cobalt-chromium-molybdenum total replacement joint prostheses constitute a risk of tumour formation which is certainly small, possibly negligible, but not accurately calculable at present.

8. The results of these tests, particularly the differences in frictional moment and in the production of particulate debris, suggest a preference for high density polyethylene as one component of a total joint replacement prosthesis.
CHANGES IN SHAPE OF THE HUMAN HIP JOINT DURING ITS DEVELOPMENT AND THEIR RELATION TO ITS STABILITY
Authors: Ráliš Z. , McKibbin B.
Published: February 2018

1. Dissection of forty-four developing human hip joints has shown that while the embryonic acetabulum is a deeply set cavity which almost totally encloses the head it gradually becomes more shallow as birth approaches. During the same period the femoral head becomes less globular and at the end of foetal life is almost hemispherical. The cover afforded to the femoral head by the acetabulum also becomes decreased.

2. After birth these trends reverse: the acetabulum becomes deeper again and the femoral head more globular. This process continues throughout childhood.

3. The findings provide a possible explanation for the increased liability to dislocation of the infantile hip.
DISTURBED PATTERNS OF VENOUS DRAINAGE OF THE FEMORAL NECK IN PERTHES' DISEASE
Authors: Suramo I. , Puranen J. , Heikkinen E. , Vuorinen P.
Published: February 2018

1. Intra-osseous venographs have been obtained in twenty-eight hips affected by Perthes disease and in twenty normal hips after the injection of opaque medium into the femoral neck.

2. In the normal hips the contrast medium drained rapidly into the local veins; none flowed distally into the diaphysis.

3. In the initial and in the fragmentation stages of Perthes' disease some contrast medium always flowed into the diaphysis and the flow into the local veins was greatly reduced.

4. In the restitution stage the venographs approached normal.

5. The implications of these findings are discussed.
CORRECTION OF DISORDERS OF THE DISTAL RADIO-ULNAR JOINT BY ARTIFICIAL PSEUDARTHROSIS OF THE ULNA
Authors: Goncalves Danilo
Published: February 2018

Dysfunction of the distal radio-ulnar joint caused by traumatic, congenital and inflammatory onditions is usually treated by excision of the head of the ulna. This operation can induce ulnar carpal shift, with complications such as instability with poor grip, pain and clumsiness of the wrist, if the lower articular surface of the radius is normally inclined, or overinclined towards the ulna.

These complications can be avoided by use of an operation producing pseudarthrosis of the distal part of the ulna, with fusion of the radio-ulnar joint (Lauenstein) if there is dislocation, radio-ulnar discrepancy or arthritis, or without fusion (Baldwin) if the joint, in spite of keeping normal articular surfaces, has its movement blocked by malunion of a radial fracture.
A LONG-TERM FOLLOW-UP OF SYNOVIAL SARCOMA
Authors: Cameron H. U. , Kostuik J. P.
Published: February 2018

1. Thirty-nine patients with synovial sarcoma have been reviewed.

2. The average rate of five-year survival was 45 per cent; of ten-year survival, 30 per cent; and of survival for more than ten years, 10 per cent.

3. The only important factor influencing the long-term results was the method of treatment; primary amputation was by far the best.
THE REPAIR POTENTIAL OF DIGITAL FLEXOR TENDONS
Authors: Matthews Phillip , Richards Harold
Published: February 2018

1. Tendon possesses an active potential for repair and remodelling.

2. Large defects made in the flexor tendons of rabbits showed tenoblastic activity and repair without the formation of adhesions.

3. The failure to show this intrinsic ability for repair in previous studies may have been influenced by adverse factors introduced in order to hold the cut tendon ends together.
SPINA BIFIDA IN AFRICAN AND INDIAN BABIES
Authors: Henry A. P. J. , Wood Harlow , Mickel R. E.
Published: February 2018

1. A review of 193 African and Indian children suffering from spina bifida has been made. Forty-three were seen on the first day of life and the remainder during subsequent weeks of life.

2. For the baby with mild or moderate paralysis and an open spinal lesion early closure was of value in preventing progressive neural damage.

3. For the baby with severe paralysis and an open myelomeningocele early operation was not of value in preventing further neural damage, and all remained severely paralysed. immediate operation to close the spinal lesion is not justified in babies with severe paralysis: survivors may be treated by later operation to prevent recurrent meningitis.
THE TRANSARTICULAR GRAFT FOR INFANTILE PSEUDARTHROSIS OF THE TIBIA
Authors: Baw San
Published: February 2018

Fourteen cases of pseudarthrosis of the tibia in childhood presented at a hospital in Burma over a period of eight years. The ages of the patients ranged from one month to seventeen years. Nine were treated by a pointed graft driven into the medullary cavity of the distal tibia, and usually across the ankle joint into the body of the talus, before fixation to the proximal tibia. In six of the nine union was secured, but one case required a second grafting. Transarticular segments of graft showed a marked tendency to undergo absorption. No significant deformity was observed to follow central penetration of the growth plate and epiphysis of the lower tibia.
AN OPERATION FOR PARTIAL CLOSURE OF AN EPIPHYSIAL PLATE IN CHILDREN, AND ITS EXPERIMENTAL BASIS
Authors: Langenskiöld A.
Published: February 2018

In two cases of partial closure of an epiphysial plate causing angular deformity, one of a finger and one of the lower end of a femur, the deformities were corrected by growth after resection of a small peripheral bone bridge and its replacement with a free transplant of fat. This procedure has a firm basis on experimental work. Thus, when part of a growth plate in the rabbit is destroyed but the formation of a bone bridge uniting epiphysis and metaphysis is prevented, the destroyed part is replaced by regeneration of cartilage from the adjacent parts of the plate. Moreover, it has been proved in rabbits that when a bone bridge is induced and later resected and replaced with fat, recurrence of the bridge can be prevented and subsequent growth may correct the deformity.
LESIONS OF BONE IN DISSEMINATED INFECTION DUE TO THE MYCOBACTERIUM AVIUM–INTRACELLULARE GROUP
Authors: Jenkin D. J. M. , Dall George
Published: February 2018

A white child with a long history of illness from the age of six was thought at first to have Hodgkin's disease. There followed an acute illness with lesions involving glands, lungs, bone and skin. Mycobacterium avium-intracellulare group (Battey) was isolated from various lesions at the age of thirteen. After six years of continuous treatment the patient, now eighteen, is living a normal life.
Protection from stress in bone and its effects. Experiments with stainless steel and plastic plates in dogs
Authors: Tonino AJ , Davidson CL , Klopper PJ , Linclau LA
Published: February 2018

In a preliminary experiment the paired radii and femora of dogs were tested for bone mineral mass and mechanical properties including the load at break, the ultimate bending strength and the modulus of elasticity; symmetry was observed for most of the parameters determined. The influence of the elasticity of materials used for the internal splintage of bone and its relationship to bone remodeling were then investigated for stainless steel and plastic plates applied to the femora of dogs. A significant decrease in bone mineral mass per centimetre length of bone and in mechanical properties was demonstrated for the femora plated with steel, and microradiography showed that this was due to massive endosteal resorption. A model for determining the influence of protection from stress in bone is presented.
Subcapital fractures of the femur. A prospective review
Authors: Barnes R , Brown JT , Garden RS , Nicoll EA
Published: February 2018

This abridged account of a report to the British Medical Research Council describes a long-term investigation of 1,503 subcapital fractures of the femur, almost all of which were treated by reduction and internal fixation. With three exceptions, union occurred in all Garden Stage I and Stage II fractures and in 67% of Stage III and Stage IV fractures, of which only 14-5% were united at six months. In women, late segmental collapse was seen after union had occurred in 16% of Stage I and in 27-6% of Stage III and Stage IV fractures. Delay of up to one week before operation had no significant effect on the incidence of non-union or of late segmental collapse. The incidence of union followed by late segmental collapse was higher in women with normal bone density than in those with osteoporosis. Smith-Petersen nailing was found to be the least effective form of fixation in displaced fractures. The age and physical state of the patient, the accuracy of reduction, and the security of fixation had the greatest influence on union.
Late open reduction of traumatic dislocation of the hip. Report of three cases
Authors: Nixon
Published: February 2018

Three patients were reviewed seven, eight and fourteen years after delayed open reduction of traumatic posterior dislocation of the hip. The delay between injury and operation varied from twenty-eight to ninety-three days. At the time of review symptoms were minimal or absent, and in all cases the injured hip was clinically normal. Radiological examination showed loss of articular cartilage in one hip and trabecular changes in the bone of all three. On the basis of these three results the traditional pessimism about prognosis in such cases may not be justified.
The rib hump in idiopathic scoliosis. Measurement, analysis and response to treatment
Authors: Thulbourne T , Gillespie R
Published: February 2018

This paper describes a simple method for the recording of rib deformity in idiopathic scoliosis. The relationships have been recorded between the measured rib hump and rib depression deformities and 1) the rotation of the vertebral bodies (as measured by the method of Nash and Moe on the standing radiograph); 2) the degree of lateral curvature (as measured by the method of Cobb on the standing radiograph); and 3) the rib-vertebra angles and their differences (as described by Mehta). No clear linear relationships were found. Many examples of irregular relationship were recorded, for example, marked spinal rotation with minimal rib hump. The response of the rib deformities to treatment by Milwaukee brace in fifty-two patients is described; the hump is little changed but the depression on the opposite side may be considerably reduced. Harrington instrumentation may have a similar effect.
Patterns of osteoarthritis of the hip
Authors: Solomon L
Published: February 2018

The division of osteoarthritis into primary and secondary varieties implies that these are aetiologically distinct entities, the former being due to some intrinsic defect of cartilage and the latter resulting from previous articular damage. This traditional concept is questioned and the hypothesis is advanced that osteoarthritis is always secondary to some underlying abnormality of the joint. A detailed clinical, radiographic and morbid anatomical study of 327 cases of osteoarthritis of the hip is presented. In all but twenty-seven some predisposing abnormality of the joint was diagnosed: 107 (33%) were associated with major pathology such as Perthes' disease or epiphysiolysis; minor acetabular dysplasia was present in sixty-seven (20%), with a male: female ratio of 1:10; minimal femoral head tilt was demonstrated in fifty-nine (18%), the male: female ratio being 14:1; and in forty-three (13%) there were features suggesting an underlying inflammatory arthritis. On the basis of this study a new classification is proposed and osteoarthritis of the hip is divided into three pathogenetic groups: 1) failure of essentially normal cartilage subjected to abnormal or incongruous loading for long periods; 2) damaged or defective cartilage failing under normal conditions of loading; 3) break-up of articular cartilage due to defective subchondral bone.
Parastremmatic dwarfism
Authors: Horan F , Beighton P
Published: February 2018

A girl aged ten, of Cape Coloured stock, with typical features of parastremmatic dwarfism has been investigated. The clinical manifestations included disproportionate dwarfism, limb deformity, a short stiff neck, and marked thoracic kyphosis. The radiographic changes were dramatic, the skeleton having a "flocky" appearance due to patches of radiolucency in an irregular lattice of sclerosis. The metaphyses and epiphyses of the long bones were grossly expanded, and the vertebrae were flattened and distorted. The clinical and radiographic features of five other previously reported individuals with parastremmatic dwarfism were very similar to those of our patient. The differential diagnosis of this condition includes metatrophic dwarfism, diatrophic dwarfism and the spondylo-epiphysial dysplasias. However, the unique "flocky" radiographic appearance of the bones permits diagnostic precision. There is some evidence to indicate that parastremmatic dwarfism might be transmitted as an autosomal dominant, although this is by no means certain. The fact that our patient had seven normal siblings and unaffected parents would be compatible woth autosomal recessive inheritance.
Excision of the head of the radius in rheumatoid arthritis
Authors: Taylor AR , Mukerjea SK , Rana NA
Published: February 2018

The results of excision of the head of the radius in forty-four elbows affected by rheumatoid arthritis are presented. Relief of pain was obtained in 90 per cent and an increase in the range of flexion and extension was seen in 70 per cent. Involvement of the humero-ulnar joint seen radiologically is no contra-indication to the operation; simple excision of the radial head often gives gratifying results; In our experience the relief of pain and increased range of movement have greatly reduced the need for total replacement arthroplasty.
The correction of genu valgum by epiphysial stapling
Authors: Pistevos G , Duckworth T
Published: February 2018

Forty-nine patients treated by epiphysial stapling for idiopathic genu valgum are reviewed. The children were aged from eleven to fourteen and a half years. The severity of the condition and subsequent correction were assessed by measuring the inter-malleolar distance. Results show that femoral stapling is the treatment of choice for most patients with inter-malleolar separation of up to 12-5 centimetres. The optimum age for stapling for both boys and girls is eleven and a half years. Stapling of both epiphyses is advised for those patients presenting late, for example, between thirteen and fourteen and a half years, or where the deformity is greater than 12-5 centimetres of separation. Correction rarely takes more than one year, and was cosmetically satisfactory in all cases. The operation is virtually free from complication except for a tendency for the scars to be broad and conspicuous. Stapling has proved to be a safe, effective and predicatable operation for idiopathic genu valgum.
Aseptic necrosis of bone in a compressed air worker
Authors: Weatherley CR , Gregg PJ , Walder DN , Rannie I
Published: February 2018

This paper reports a detailed examination of three lesions of aseptic necrosis of bone occurring in a man who had worked in compressed air eleven years previously. Although two of the lesions were juxta-articular, in neither had the bone collapsed. Histology of only one similar lesion is reported in the literature (McCallum et al. 1966). Necropsy material is considered, together with radiographs and bone scans of the same lesions taken four years earlier. Similar changes have been shown to occur in commercial divers. On the evidence of this case it becomes clear that radiography is limited in its use and that bone scans as an indicator of repair may be open to misinterpretation. There may be a place for operation before the onset of symptoms in these cases of aseptic bone necrosis.
The painful arc syndrome. Clinical classification as a guide to management
Authors: Kessel L , Watson M
Published: February 2018

Ninety-seven patients suffering from painful arc syndrome of the shoulder were studied. Local anaesthetic and radiographic contrast investigations were carried out. One-third of the patients had lesions in the posterior part of the rotator cuff which resolved after injections of local anaesthetic and steroid. One-third had anterior lesions in the subscapularis tendon: almost all resolved under the same regime but two required division of the coraco-acromial ligament. The remaining third had lesions of the supraspinatus tendon, usually associated with degeneration of the acromio-clavicular joint: most of these failed to gain relief from the local anaesthetic and steroid. Twenty-two operations were performed either by a transcromial or by a deltoid splitting approach. Excision of the outer end of the clavicle and division of the coraco-acromial ligament abolished the pain in most cases.
Crawling patterns in neglected poliomyelitis in the Solomon Islands
Authors: Cross AB
Published: February 2018

Two hundred and twenty-two adult crawling poliomyelitic cripples were investigated. Analysis showed that bilateral lower limb paralysis with or without trunk involvement was the most common residual lesion. Remarkably paralysis was confined to a single lower limb in six cases. The various crawling patterns can be classified into six broad groups which are described and illustrated. It is suggested that in a developing country this classification has a practical application in the assessment of patients for rehabilitation to crutch walking. Subjects in the "true quandruped progression" and "squatting gait" categories generally have an excellent potential for rehabilitation, as often do those in the "infant-like crawl" group. Caution should be exercised in attempting crutch walking for those in the "body-dragging" group, and there seems little indication for attempting to establish upright walking for those in the "buttock pivoting" and "minimal movement" groups.
Bacterial infection and acrylic cement in the rat
Authors: Elson RA , Jephcott AE , McGechie DB , Verettas D
Published: February 2018

In thirty-one rat tibiae, plugs of plain acrylic cement were inoculated with Staphylococcus aureus; these all remained contaminated at the end of two weeks when the animals were killed. Inoculation with known strains of Pseudomonas, Proteus and Gp. G Streptococcus resulted in 70 to 93 per cent persisting contamination. Gentamicin, to which the organisms were fully sensitive, was efficacious in controlling the infection (90 per cent plugs proving sterile after two weeks). Fucidin was less successful against Staphylococcus aureus although effective in vitro. Intravenous inoculation with a suspension of Staphylococcus aureus succeeded in contaminanting 70 per cent of sixty plain cement plugs when injected into the tail vein half an hour after closure of the leg wounds. Only 11 per cent of sixty-four plugs were so contaminanted when the injection was delayed for two weeks. This animal model is submitted as a possible future means of testing different antibiotic-cement combinations against infection.
Partial amputation of the foot for diabetic or arteriosclerotic gangrene. Results and factors of prognostic value
Authors: Larsson U , Andersson GB
Published: February 2018

One hundred and eighty-three conservative amputations of some part of the foot in 161 patients with gangrene from diabetes or arteriosclerosis have been studied retrospectively. They constituted 48 per cent of all amputations in one orthopaedic service over a period of twelve years, during which the minimal feasible procedure was always chosen. Sixty per cent healed soundly, but in over a third of these cases at least one revision to a higher level on the foot had been required. Factors that significantly influenced the outcome of the initial operation were the level of amputation, the age of the patient, the interval between the onset of gangrene and operation, anaemia and pyrexia.
The problems associated with flail feet in children and their treatment with orthoses
Authors: Fulford GE , Cairns TP
Published: February 2018

Children with flail feet who have control of their hips and knees are able to walk but are unable to stand still and find it difficult to walk slowly. These problems have been overcome in fifty-three children with flail feet due to myelomeningocele by fitting them with below-knee orthoses which provide maximum stability and yet allow normal walking. The biomechanical principles and the development of the orthoses are discussed.
Is chondromalacia patellae a separate clinical entity?
Authors: Abernethy PJ , Townsend PR , Rose RM , Radin EL
Published: February 2018

The articular cartilage of the patella was studied in 100 knees at necropsy. In twenty-one of these knees the cartilage changes were related to the trabecular architecture of the underlying bone. It would appear that the initiation and location of cartilage damage and its rate and degree of progression are related to the relative stiffness of the underlying cancellous bone. On the basis of our observations we suggest that the diagnosis "chondromalacia of the patella" should be reserved for patients with asymptomatic or transiently symptomatic fibrillation of the articular cartilage of the central medial patellar facet. Those patients with persistent patellofemoral pain should be considered to have some other syndrome.
Congenital spinal extradural cyst (lateral meningocele) simulating acute transverse myelitis. Report of a case
Authors: Dickson RA , Arabi K , Goodfellow J
Published: February 2018

Congenital spinal extradural cysts are rare and may be the cause of acute paraplegia. In their clinical features they closely resemble acute transverse myelitis. Immediate decompression of the spinal cord and removal of the cyst may lead to restoration of normal function. Myelography differentiates these two conditions by showing a cyst in communication with the spinal canal. This investigation must be mandatory.
Clinical application study of multifunctional prosthetic hands
Authors: Herberts P , Almstrom C , Caine K
Published: February 2018

A control system for a multifunctional hand prosthesis, which requires a minimum of training for the amputee, has been developed. The great advantage of the pattern recognition technique in making it possible to control as many as six prosthetic movements has prompted this study. The development of a complete miniaturised system has allowed a clinical trial on four patients. Two different tests have been employed to evaluate this system: an objective computer test and a test representing activities of daily living (ADL test). The computer test shows that a high rate of correct recognition is obtained immediately after the prosthesis is applied to the amputee. The ADL test shows that forearm rotation, and flexion and extension of the wrist are used in most activities, indicating that few compensatory movements are performed. It is suggested that this control system is feasible and that long periods of training are unnecessary.
Biochemical disturbances associated with total hip replacement
Authors: Alexander JP , Barron DW
Published: February 2018

A prospective study on 227 patients undergoing arthroplasty of the hip was carried out with reference to the effects on the cardiovascular and respiratory systems. Investigations revealed that the placing of acrylic bone cement and the prosthesis in the femoral shaft produced clinical and biochemical disturbances which were consistent with pulmonary microembolism. A fall in arterial oxygen tension during the procedure and hypoxaemia extending into the postoperative period with elevation of serum lipase and a fall in triglycerides supported the idea that embolisation with marrow fat occurred. The method of venting (by catheter or proximal hole) did not influence the biochemical disturbances. The implications of these findings are discussed.
A histological study of idiopathic avascular necrosis of the head of the femur
Authors: Inoue A , Ono K
Published: February 2018

We have studied the histological appearances of forty femoral heads with idiopathic avascular necrosis. The characteristic histopathological changes of recurrent necrosis were present in 83 per cent. Recurrent necrosis occurred widely after revascularisation had progressed as far as the subchondral zone. The aetiology of idiopathic avascular necrosis of the femoral head may be a chronic condition which produces repeated infarction. The deformation and incomplete revascularisation of the femoral head may be due to repeated episodes of infarction as well as to mechanical factors related to weight-bearing.
Free vascularised fibular transplant for replacement of the lower radius
Authors: Pho RW
Published: February 2018

An operation is described in which a microvascular technique was used to transfer a living fibula, with its vascular pedicle intact, to replace the lower end of the radius after massive resection for giant-cell tumour. Angiography carried out six weeks later showed that the grafted bone was viable. Six months after operation the transplanted fibula showed no osteoporosis or bone resorption and bony union at the junction of host and graft.
On splitting plasters. A useful analogy
Authors: Bingold AC
Published: February 2018

An inner tube was inflated and then surrounded with plaster wool and plaster-of-Paris bandages. The plaster and the wool were next progressively divided. There was no significant reduction of the pressure inside the tube until both the plaster and the wool had been divided and separated from the inner tube along the entire circumference. These findings demonstrated that wool and plaster applied to limbs likely to swell should be split right down to skin and widely separated immediately after their application. A plaster slab is safer still, but the wool must be cut before the crepe bandage is applied.
The correction of angular deformities of long bones by osteotomy-osteoclasis
Authors: Smith DN , Harrison MH
Published: February 2018

The correction of angular deformities of long bones by incomplete osteotomy, followed three weeks later by manual osteoclasis, overcomes the problem of secondary displacement sometimes seen after correction by complete osteotomy and makes internal fixation unnecessary. This paper presents an experience of twenty-six operations in eighteen patients. In all cases the deformity was corrected with excellent cosmetic and functional results. Complete bony union was achieved and there were no problems with displacement at the osteotomy site. Four cases are described in detail to illustrate use of the technique in different clinical situations.
The importance of femoral rotation in chondromalacia patellae as shown by serial radiography
Authors: Sikorski JM , Peters J , Watt I
Published: February 2018

A new radiological technique is presented in which serial axial radiographs of the patellofemoral joints are taken under conditions in which the muscles about the knee and hip are contracted in a manner similar to that during weight-bearing. A form of analysis has been developed whereby patellar rotation can be measured in two planes and femoral rotation about its long axis inferred. A population of asymptomatic adults and children was investigated in this way and their results (regarded as normal) compared with those in fifteen children with idiopathic chondromalacia patellae. In the normal child the femur rotates medially with the onset of muscle activity; by contrast the children with chondromalacia show a reversal of this mechanism.