bluuebunny/crossref_metadata_2025 huggingface dataset:
METALLIC REPLACEMENT OF THE FEMORAL HEAD
Authors: Martin N. S.
Published: February 2018

1. After almost seventeen years the three metal prostheses remain in approximately the original position in which they were inserted.

2. All three patients are ambulatory and two of them pleased with the result.

3. The youngest patient, now fifty-six, has a solid ankylosis of the hip and leads an active life free of pain.

4. In view of the attritional changes which have been seen to occur as a result of the reaction of bone to metal, it is suggested that resection replacement operations should be reserved for the primary treatment of certain fractures in the elderly and in those patients who are expected to be mostly inactive for the rest of their life. As a rough guide, it is considered that the operation should not be carried out under the age of seventy.
THE ETIOLOGY AND PREVENTION OF FUNCTIONAL INSTABILITY OF THE FOOT
Authors: Freeman M. A. R. , Dean M. R. E. , Hanham I. W. F.
Published: February 2018

1. Eighty-five patients have been studied soon after a ligamentous injury at the foot or ankle. These patients were treated in one of three ways, and in fifty-six patients the results were evaluated six to fifteen months after injury.

2. It is concluded: a) that ligamentous injuries at the foot and ankle frequently produce a proprioceptive deficit affecting the muscles of the injured leg; b) that such a deficit is responsible for the symptom of "giving way" of the foot; and c) that the incidence of both the proprioceptive deficit and the symptom of "giving way" can substantially be reduced by treatment after injury with the coordination exercises described in this study.

3. The mechanism of production of the proprioceptive defect is discussed.
DISLOCATION OF THE HIP IN YOUNG RATS PRODUCED EXPERIMENTALLY BY PROLONGED EXTENSION
Authors: Sijbrandij S.
Published: February 2018

1. Dislocation and subluxation of the hip has been produced in young rats by application of splints reaching from the hip to the foot, bringing the hip into extension.

2. Progressive acetabular dysplasia and anatomical abnormalities of the head and neck of the femur occurred.

3. Results of the experiments suggest that post-natal extension of the hip is of importance in the pathogenesis of congenital dislocation of the hip in man.
INTRACAPSULAR FRACTURES OF THE NECK OF THE FEMUR
Authors: Frangakis E. K.
Published: February 2018

This study attempts to establish the factors on which the prognosis of an intracapsular fracture of the femoral neck depends, and to draw attention to certain causes of non-union and ischaemic necrosis. These factors are of two kinds: those inherent in the fracture, and those produced by the surgeon.

The prognosis depends largely on the nature of the fracture. Original displacement and comminution are the factors which have most influence. Fractures of Type IV with severe comminution have mainly contributed to the bad reputation of intracapsular fractures. Accurate reduction and firm fixation are necessary if the best results for the type of fracture are to be expected. Accurate reduction does not mean merely accurate apposition of the fragments. Fixation of the fracture in certain rotational malpositions such as valgus of over 20 degrees and rotation round the long axis of the neck may occlude the only remaining source of blood supply, the vessels of the ligamentum teres. If these vessels remain open they may produce revascularisation in a femoral head deprived of its blood supply. The degree of valgus can easily be measured but it is impossible to detect rotation round the long axis of the neck.

In this analysis only two methods of fixation were studied. It is clear that rigid fixation is of great significance, and a nail-plate, though it may not be the ideal method of fixation, is greatly superior to a Smith-Petersen nail introduced in the usual way. From the results of this survey there is no justification for continuing the use of this method except perhaps in Type II fractures.

The greater the risk of non-union the more important is the fixation, and this is true of all fractures.

This study also has a bearing on the indications for primary prosthetic replacement. If the nature of the fracture and the result of the reduction make it likely that replacement by a prosthesis is going to be the ultimate solution, and if the patient is over seventy years old, it is wiser to do it as a primary measure.

Finally it was shown that condensation and collapse of the femoral head are not the only radiological signs of ischaemic necrosis. An earlier sign is flattening of the weight-bearing area, which appears on an average six and a half months after injury, as compared to condensation, which may not be apparent until eighteen months after injury.
SEVERE CONGENITAL TALIPES EQUINOVARUS
Authors: Attenborough C. G.
Published: February 2018

1. The movements of the talus are described with particular reference to the anatomy of congenital talipes equinovarus.

2. It is suggested that the fundamental deformity in severe club foot is the fixed plantar-flexion of the talus.

3. Early operation is advised whenever serial stretching fails to bring the heel quickly into its normal position.
BENIGN CHONDROBLASTOMA
Authors: Sundaram T. K. Shanmuga
Published: February 2018

1. Benign chondroblastoma is a rare primary neoplasm of bone with excellent prognosis. It is believed that instances of it are still being missed.

2. Six cases are described with special emphasis on diagnostic pitfalls.

3. A critical survey of the literature and a discussion on nomenclature and histogenesis are included.
USE OF THE AUSTIN MOORE PROSTHESIS FOR ADVANCED OSTEOARTHRITIS OF THE HIP
Authors: Heywood-Waddington M. B.
Published: February 2018

1. The early results of thirty Austin Moore arthroplasty operations with acetabular reaming in twenty-five patients with advanced osteoarthritis of the hip have been investigated.

2. The radiological changes after insertion of a prosthesis have been studied.

3. There was a variable degree of improvement in all patients. There was a worth-while improvement in function and relief of pain. Stability, however, was disappointing in more than half (and in all the bilateral cases). An average of three-quarters of an inch of shortening was found in the unilateral cases.

4. In such advanced cases the results of Austin Moore arthroplasty are probably of the same order as for cup arthroplasty, and in many cases they show no more than marginal improvement over pseudarthrosis.

5. It is concluded that at the present stage of progress in the development of arthroplasty the use of the Austin Moore prosthesis with acetabular reaming has very limited indications.
SEPTIC ARTHRITIS OF THE HIP IN ADULTS
Authors: Bulmer J. H.
Published: February 2018

1. Septic arthritis of the hip in adults is not common and the diagnosis can be difficult. The value of diagnostic aspiration is emphasised.

2. Predisposing causes in fifty patients are analysed and the possible relationship to pelvic infection is discussed.

3. Loss of joint space is occasionally seen within one week of the onset of the infection.

4. A method of treatment is suggested and the value of decompression by arthrotomy is discussed.
TREATMENT OF METACARPAL ENCHONDROMATA
Authors: Giannikas Anastasios C.
Published: February 2018

1. Three patients with enchondromata of the metacarpal bones are described.

2. The nature of the enchondromata in all three patients was confirmed by histological examination.

3. Treatment was by radical excision and bridging of the gap by a cortical bone graft.

4. There has been no impairment of function in the hands. No patient complained of pain after the operation.

5. Radiographs taken one year after operation in two patients showed that the flat bone grafts had become cylindrical and that medullary canals had appeared.
SALMONELLA OSTEOMYELITIS IN INFANTS
Authors: Ebrahim G. J. , Grech Paul
Published: February 2018

1. Five cases of Salmonella osteomyelitis in infants without red-cell sickling are reported.

2. All these cases occurred in children under eighteen months of age and within a period of five months of time, suggesting a seasonal incidence.

3. Only one strain of Salmonella was isolated–Salmonella typhimurium.

4. There was complete healing in four of the cases.

5. In one case there was destruction and complete absorption ofthe upper humeral epiphysis.
INGROWING TOENAIL AND ONYCHOGRYPOSIS
Authors: Townsend A. C. , Scott P. J.
Published: February 2018

We conclude that conservative excision of the nail bed gives satisfactory results–89 per cent in this series. Recurrence is common but rarely causes symptoms. No patient had symptoms without recurrence. We think that recurrence is related to technique and to infection. Syme's terminal amputation is recommended for troublesome recurrence because repetition of Zadik's operation proved unsatisfactory.
CONGENITAL MACRODACTYLY
Authors: Ben-Bassat M. , Casper J. , Kaplan I. , Laron Z.
Published: February 2018

1. A patient with macrodactyly of the middle finger of the left hand was followed up from birth until the finger was amputated at the age of three.

2. The affected finger, besides showing gigantism at birth, grew at a faster rate than the normal fingers. The degree of bone maturation (as judged from the appearance and size of the phalangeal ossification centres) proceeded at a faster rate than the normal fingers. No vascular abnormality which could account for the gigantism was detected either radiologically or microscopically. The affected finger showed histological abnormalities of both bone and soft tissues.
CERVICAL SPONDYLOSIS AND NERVE ROOT LESIONS
Authors: Holt Shirley , Yates Peter O.
Published: February 2018

1. One hundred and twenty cervical spines removed at routine necropsy from elderly patients dying in a general hospital have been examined.

2. There was some degree of degeneration of intervertebral discs in 110 cases–in forty-six this was severe.

3. Degenerative disc disease was found at an earlier age in men; mild damage preceded severe degeneration and collapse by about a decade.

4. Discs of the lower spine were most frequently and most severely affected.

5. Alterations of the normal cervical lordosis were produced by disc disease in thirty-two cases.

6. Osteoarthritis of the apophysial joints was found in seventy-eight, and by contrast to disc degeneration was commonest in the mid-cervical and upper cervical regions. In eighteen it was severe.

7. Degeneration and scarring of nerve roots was frequently associated with diseased discs; apophysial joint arthritis was found to be an important additional factor when it occurred in the lower cervical region.

8. No nerve root changes could be attributed to ischaemia resulting from narrowing or distortion of the vertebral arteries.

9. Cystic arachnoidal diverticula which excavate the posterior root ganglia were found in thirty-six cases.
BENIGN OSTEOBLASTIC CHANGE RESEMBLING OSTEOID OSTEOMA
Authors: Morton K. S. , Bartletf L. H.
Published: February 2018

1. Three cases of a benign osteoblastic lesion of bone are described. An outstanding feature of each was the hyperostosis of adjacent bones or synovitis in an adjacent joint.

2. The clinical, radiological and histological features resembled osteoid osteomata more than benign osteoblastoma in each case.

3. The significance of this observation is questioned in relation to the pathogenesis of osteoid osteoma.
VOLKMANN'S ISCHAEMIA IN THE LOWER LIMB
Authors: Seddon H. J.
Published: February 2018

1. Volkmann's ischaemia of the lower limb is more common in adults than in children and occurs with sufficient frequency after injuries of the femur, knee and leg to warrant a more determined effort to prevent it.

2. The first and most essential step is to recognise the early signs of ischaemic damage. Incision of the deep fascia may then save the threatened underlying muscle, though it may also be necessary to seek for and evacuate a haematoma beneath the muscle. When the femoral or popliteal artery is injured, exploration and repair may be imperative.

3. The treatment of established ischaemic contracture is by whatever measures are necessary to correct the deformity. These are lengthening of shortened tendons, or excision of them if they are involved in dense fibrosis at the periphery of the ischaemic mass; and excision of all totally destroyed muscle. Amputation may be necessary.
THE VULNERABILITY OF THE POSTERIOR INTEROSSEOUS NERVE OF THE FOREARM
Authors: Capener Norman
Published: February 2018

1. The posterior interosseous nerve of the forearm is vulnerable to constriction in an aponeurotic cleft in the supinator muscle.

2. A case is presented of paresis of the nerve by an intramuscular lipoma which extended into this cleft.

3. A discussion is given of the possible relation of this feature to certain cases of occupational stress–"tennis elbow."

4. An approach is described for decompressing the nerve in the rare cases which do not respond to conservative treatment.
EPIPHYSIAL INFARCTION IN A GROWING LONG BONE
Authors: Young M. H.
Published: February 2018

1. Experiments are described in which total infarction of the epiphysis was produced in the metatarsal bones of growing rabbits.

2. After operation both proliferation and normal maturation of the cells of the growth plate were slowed or stopped. Cartilage destruction on the metaphysial side of the growth cartilage continued with consequent thinning of the cartilage. Localised areas of cell death appeared in the growth cartilage as early as the second day after operation. These increased in size and led to revascularisation of the epiphysis by metaphysial vessels which grew through the growth cartilage, reaching the epiphysis seven days after operation. The main, central part of the growth cartilage survived intact and its normal structure was restored after epiphysial revascularisation took place. Vessels growing into the bone from outside also contributed to revascularisation of the epiphysis. After revascularisation occurred, new bone formation led to increased radiographic density of the epiphysis.
A HAEMANGIOMA INVOLVING TENDONS
Authors: Waddell George F.
Published: February 2018

1 . A case of haemangioma arising in the tendons of the extensor pollicis longus and extensor pollicis brevis muscles of a twenty-seven-year-old woman is described.

2. The etiology of the lesion is discussed, together with a brief review of the literature.
OCCIPITO-CERVICAL FUSION
Authors: Hamblen D. L.
Published: February 2018

1. Thirteen cases of occipito-cervical fusion performed in the past fifteen years at the London Hospital are described.

2. Seven of the patients had congenital anomalies in the region of the foramen magnum, six had spontaneous atlanto-axial dislocations, and in one case the operation was performed prophylactically to stabilise a severely disorganised cervical spine.

3. Nine of the patients had evidence of neurological involvement before operation due to pressure on the spinal cord or nerve roots.

4. Operative fusion was successful in all cases and there was no operative mortality.

5. The clinical results were good in eight cases and four patients were improved. The condition of one patient, in whom progressive disseminated sclerosis was also present, deteriorated.

6. The technique of operation is described, and it is recommended that it should always be performed as a combined orthopaedic and neurosurgical procedure.
MADELUNG'S DEFORMITY
Authors: Henry Adrian , Thorburn Marigold J.
Published: February 2018

1 . A classification of Madelung's deformity on an etiological basis is suggested.

2. Seven patients with "idiopathic" Madelung's deformity and one occurring in association with Turner's syndrome are discussed.

3. Cytogenetic studies of five patients are recorded and their significance discussed.

4. Arthrodesis of the radio-carpal joint by the "wedge" technique is preferred for those patients whose symptoms warrant treatment.
THE DUAL NATURE OF EPIPHYSIAL CARTILAGE
Authors: McKibbin B. , Holdsworth F. W.
Published: February 2018

1. The hypothesis is put forward that the cartilage of a developing epiphysis consists of two separate moieties. There is a superficial zone which from the first is destined to become articular cartilage and is incapable of ossification, whereas the deeper layers are concerned with the actual growth of the epiphysis and will eventually be converted totally to bone.

2. The results of an experiment which support this theory are described. A piece of developing joint cartilage was excised and replaced in its bed upside down. It was found that although the cartilage continued to proliferate at its normal rate, ossification of the original articular layer did not occur, so that there was a considerable increase in the thickness of the excised cartilage.

3. The supporting evidence for the hypothesis is discussed.
AN EXPERIMENTAL MULTIPLE BARBED SUTURE FOR THE LONG FLEXOR TENDONS OF THE PALM AND FINGERS
Authors: McKenzie A. R.
Published: February 2018

1. Multiple barbed sutures made from nylon are described and the theoretical advantages with the use of the nylon are outlined.

2. Methods of joining tendon stumps using the multiple barbed sutures are illustrated and in vitro tests show that the anchorage of this suture in cadaveric and canine flexor tendons is of the same order.

3. Preliminary in vivo tests where the flexor digitorum profundus tendon of dogs have been repaired with multiple barbed sutures show that it maintains apposition of the tendon stump as effectively as the Bunnell "buried core" technique using G 40 stainless steel wire.

4. The multiple barbed suture is an experimental suture for certain compact tendons capable of giving a neat and relatively atraumatic junction. It requires further study and development. It does not appear to make tendon repair technically easier, nor does it alter the indications for operation or management.
THE LATE RESULTS OF NAVICULO-CUNEIFORM FUSION
Authors: Seymour N.
Published: February 2018

1. The long-term results of thirty-two naviculo-cuneiform fusions for flat foot have been reviewed sixteen to nineteen years after operation.

2. The initial encouraging results of the operation have not been maintained.
RADICAL SURGICAL APPROACH TO SPINAL TUBERCULOSIS
Authors: Kohli S. B.
Published: February 2018

1. The results are recorded of radical excisional surgery for spinal tuberculosis in eighty-five patients.

2. Clinically satisfactory results were obtained in 97 per cent of seventy-one patients followed up. Radiologically the disease was deemed to be cured in 71 per cent of cases.

3. The average period of rest after operation was three and a half months, and the average hospital stay was five and a half months.

4. Total recovery from paraplegia occurred in 84 per cent of patients so affected.
SPINAL TUBERCULOSIS IN NIGERIAN CHILDREN
Authors: Dickson J. A. S.
Published: February 2018

1. The long-term results in thirty-one cases of spinal tuberculosis treated by the ambulant method are reviewed. The method has been shown to be successful in early cases.
CONGENITAL INDIFFERENCE TO PAIN
Authors: Ingwersen O. S.
Published: February 2018

1. A case of congenital indifference to pain in a boy aged fifteen years is described. The boy's sister was similarly affected.

2. Clinical features and treatment are described, and the features are compared with those in previously reported cases.

3. Causation is discussed in the light of the negative findings at necropsy on the patient's sister.
ILIACUS HAEMATOMA
Authors: Goodfellow John , Fearn C. B. d'A. , Matthews J. M.
Published: February 2018

1. Haemorrhage into the fascial compartment which contains the iliacus muscle and the femoral nerve is a common complication of haemophilia.

2. The iliacus haematoma syndrome is described and illustrated from the authors' study of thirty episodes occurring in twenty-four patients.

3. The anatomy of the iliopsoas fascia is described and the mechanism of femoral nerve compression explained.

4. Differential diagnosis, prognosis and treatment are discussed and the necropsy findings in one patient are presented.

5. An instance of iliacus haematoma occurring as a complication of anticoagulant therapy is recorded.
THE PERMEABILITY OF ARTICULAR CARTILAGE
Authors: Maroudas A. , Bullough P. , Swanson S. A. V. , Freeman M. A. R.
Published: February 2018

1. We have shown that the permeability of cartilage is the same in necropsy specimens as in the living animal. We have concluded that studies of material transport into cartilage carried out on necropsy specimens validly reflect in vivo conditions.

2. We have studied the effect of agitation of the fluid in which cartilage is immersed upon the rate of diffusion of substances into cartilage and have found that agitation increases the rate of penetration up to three or four fold. We believe that it may be inferred from this fact that the nutrition of cartilage is partly dependent on joint movement.

3. We have examined the permeability of the bone-cartilage interface to water and solutes and have found that in the adult no detectable material transfer occurs across this zone. In the child on the other hand the bone-cartilage interface appears to be permeable to water and solutes.

4. We have measured the diffusion coefficient of glucose in cartilage and have hence estimated the depth of cartilage which can be adequately supplied with glucose from the synovial fluid in the presence and absence of agitation.

5. We have examined both experimentally and theoretically the possible effect of intermittent loading on the rate of penetration of substances into cartilage. We have concluded that at low pressures intermittent loading contributes little to the material transfer into cartilage. At high pressures intermittent loading does lead to the transport of solutes into cartilage but it cannot significantly increase the rate of transfer above that attributable to normal diffusion. Loading cartilage surfaces for prolonged periods of time without allowing intermittent relaxation would be expected to lead to decreased diffusion, without any absorption of fresh fluid attributable to the action of a pump, and would thus result in an overall decrease in the rate of penetration of substances into cartilage.
NON-TRAUMATIC DISPLACEMENT OF THE ATLANTO-AXIAL JOINT
Authors: Hunter G. A.
Published: February 2018

1. Seven cases of non-traumatic anterior atlanto-axial displacement in young people are recorded.

2. Four of the seven patients showed evidence of neurological compression. All cases improved symptomatically with treatment, but five still show persistent radiological displacement.

3. The mechanism of the displacement is thought to be due to acquired insufficiency of the transverse ligament.

4. The distance between the anterior arch of the atlas and the dens in children measured on lateral radiographs of the cervical spine, varies from two to more than three millimetres.

5. Skull traction followed by immobilisation in a collar or Minerva plaster is advised.

6. The place of cervical fusion is discussed.
PIGMENTED VILLONODULAR SYNOVITIS OF THE WRIST WITH PENETRATION INTO BONE
Authors: Schajowicz Fritz , Blumenfeld Isidoro
Published: February 2018

A case of unusually extensive pigmented villonodular synovitis of the wrist with involvement of bone, particularly of the distal end of the radius, is reported. The clinical and radiographic evidence suggested a diagnosis of primary bone tumour, possibly a giant-cell tumour with sarcomatous transformation.
RUPTURE OF THE POSTERIOR CRUCIATE LIGAMENT OF THE KNEE
Authors: Trickey E. L.
Published: February 2018

1. Seventeen cases of knee injury are described in which the predominant lesion was rupture of the posterior cruciate ligament. Seven were treated conservatively and ten by surgical repair.

2. Most cases occurred in motor cyclists.

3. The extent of the rupture should be determined by examination under anaesthesia.

4. Early surgical repair is indicated for complete rupture.

5. An effective method of repair is described.
BONE GRAFTING WITH BOPLANT
Authors: Pieron A. P. , Bigelow D. , Hamonic M.
Published: February 2018

The results of using Boplant in a series of thirty-three operations have been very disappointing. Pyrexia of over 100 degrees Fahrenheit followed operation in more than one-third of cases. There was an incidence of at least 36 per cent of failure to achieve the object of operation. Radiographic evidence of failure of incorporation was seen even in a number of clinically successful cases. As a result of this experience and of the experience of other surgeons in Winnipeg the use of Boplant has now largely been abandoned.
OCCULT FRACTURE-SUBLUXATION OF THE MIDTARSAL JOINT
Authors: Dewar F. P. , Evans Dennis C.
Published: February 2018

1. Occult fracture-subluxation of the midtarsal joint is described and illustrated by a typical case.

2. Comments are made on the mechanism of injury, diagnostic features and treatment.
SPINAL OSTEOTOMY FOR CONGENITAL KYPHOSIS IN MYELOMENINGOCELE
Authors: Sharrard W. J. W.
Published: February 2018

1. The management of severe kyphosis of the lumbar spine in association with myelomeningocele is discussed.

2. Neonatal spinal osteotomy-resection has been performed in six patients with partial correction of the deformity and a greatly improved ease of closure and healing of the skin defect. The severity of lower limb paralysis has been diminished compared with the complete paraplegia that almost always results from conservative management of closure of the defect without osteotomy.

3. In an older child who has not had the benefit of neonatal osteotomy and who has complete lower limb paralysis, transverse spinal osteotomy or excision of the prominent laminae and pedicles on each side of the midline makes possible the fitting of apparatus for walking and diminishes the liability to recurrent ulceration of the skin.
TWO-TAILED TRANSFER OF TIBIALIS POSTERIOR FOR CORRECTION OF DROP-FOOT IN LEPROSY
Authors: Srinivasan H. , Mukherjee S. M. , Subramaniam R. A.
Published: February 2018

1. The results of thirty-nine operations for correction of drop-foot in thirty-three patients with leprosy are discussed.

2. The procedure used was circumtibial, subcutaneous, two-tailed, tendon-to-tendon transfer of the tibialis posterior to extensor hallucis longus and to extensor digitorum longus and peroneus tertius. The motor slips were inserted into the recipient tendons on the dorsum of the foot.

3. Analysis of the results showed some correlation between the angle of active dorsiflexion and the range ofactive movement ofthe ankle. The angle ofdorsiflexion seemed to determine the range of movement.

4. When contracture of the tendo calcaneus was present, simultaneous lengthening improved the angle of dorsiflexion more than the range of active movement.

5. The causes of failure were sepsis, failure of re-education and unrecognised tightness of the tendo calcaneus.

6. The advantages of the present procedure are mentioned.
PRIMARY OSTEO-LIPOSARCOMA OF BONE (MALIGNANT MESENCHYMOMA)
Authors: Ross C. F. , Hadfield G.
Published: February 2018

1. A case of primary intraosseous liposarcoma is described which was producing tumour bone (osteo-liposarcoma: malignant mesenchymoma) in the right fibula of a boy of fifteen.

2. Death occurred from pulmonary metastases nine months after excision and cobalt teletherapy.

3. Only one similar case has been reported.
THE MECHANISM OF CLAW FINGER
Authors: Mulder J. D. , Landsmeer J. M. F.
Published: February 2018

1. The claw position of a finger with intrinsic paralysis is caused by the blocking effect of the transverse lamina on the long extensor. This starts as soon as the metacarpo-phalangeal joint is hyperextended, and increases with further hyperextension. Thus the long extensor loses its pull on the interphalangeal joints and allows them to flex. Therefore, in intrinsic paralysis the claw position can be prevented or cured by keeping the metacarpo-phalangeal joint in flexion, however slight, which can be done by splinting, by tenodesis or by capsulorrhaphy.

2. Replacement of the intrinsics by some active element, although it may improve the action of the fingers, is not necessary for the correction of claw finger. The function of the intrinsics in the prevention of claw finger is not to be found in their extending effect on the interphalangeal joints, but in the flexion effect on the metacarpo-phalangeal joint, or at least in preventing its hyperextension. This is in accordance with the fact that loss of intrinsic function is disastrous only in supple fingers, in which the metacarpo-phalangeal joints tend to assume extreme degrees of hyperextension (Riordan 1953, Brand 1958). In such fingers, the wide range of hyperextension available at the metacarpo-phalangeal joints is, of course, part of a generalised laxity of the soft parts of the fingers. These soft parts generally tend to counteract the tendency to clawing; the less their resistance, the more the human finger as a whole will tend to behave like a musculo-articular model, and such a model without intrinsics will always immediately assume the claw position.
HEREDITARY PSEUDO-VITAMIN D DEFICIENCY RICKETS
Authors: Dent C. E. , Friedman M. , Watson Lyal
Published: February 2018

1. A child is described who presented with very severe rickets and gross myopathy. The clinical, biochemical and radiological signs were identical with those to be expected of a very chronic and severe vitamin D deficiency. The child's diet, however, had been normal.

2. All the pathological signs, except for residual dwarfism and leg bowing, disappeared on treatment with very large doses of vitamin D2. Ordinary anti-rachitic doses had no effect.

3. We suggest that this child demonstrates a true resistance to the action of vitamin D and that the defect is permanent. The findings in two similar patients that we have seen suggest that the condition is inherited as an autosomal recessive gene, and that it may be the same disease as that described in the continental literature as "hereditäre pseudo-mangelrachitis" and by other names.

4. The disease seems distinct clinically and biochemically from the disease originally described under the name "vitamin resistant rickets," which does not respond so well to massive vitamin D therapy and which is usually inherited as a sex-linked dominant gene.
ANTERIOR INTEROSSEOUS NEURITIS
Authors: Sharrard W. J. W.
Published: February 2018

A case of anterior interosseous neuritis due to compression of the nerve over an abnormally large tendon of origin of the flexor digitorum profundus is described. Excision of the band relieved the paralysis.
POST-TRAUMATIC AVASCULAR NECROSIS OF THE FEMORAL HEAD IN CHILDREN
Authors: Stougêard Jörgen
Published: February 2018

Two cases of post-traumatic avascular necrosis of the head of the femur without evident dislocation of the head or fracture of the head or neck are recorded.
SPINAL DYSRAPHISM
Authors: Till Kenneth
Published: February 2018

1. A group of children with congenital malformations of the lower back involving the spinal cord or nerve roots is described. The malformations have little or no resemblance to spinal rachischisis, either embryologically or clinically. The lesions found are often complex.

2. It is considered from clinical and operative findings that the malformations are, in many patients, responsible for increasing neural damage in childhood and even in later life.

3. Early investigation and operative treatment are recommended.
OCCIPITO-CERVICAL FUSION
Authors: Newman Philip , Sweetnam Rodney
Published: February 2018

1. A relatively simple method of occipito-cervical fusion using autogenous bone chips without internal fixation is described.

2. In patients with atlanto-axial subluxation posterior fusion from the occiput to the axis rather than from the atlas to the axis is more reliable and is preferred. Inclusion of the occiput adds no more than a few degrees to the restriction of movement that follows C. 1-2 fusion.

3. The indications for occipito-cervical fusion are discussed, particularly in relation to C. 1-2 instability in rheumatoid arthritis.
AVULSION FRACTURES OF THE CALCANEUS
Authors: Lowy Martin
Published: February 2018

1. The literature on fractures of the postero-superior aspect of the calcaneus is reviewed.

2. The mechanical distinction between "beak" fractures and avulsion fractures is questioned, and the dangers of a purely radiological diagnosis are stressed.

3. When a complete avulsion is suspected on clinical grounds, open reduction should be done.
THE STRUCTURE OF THE VERTEBRAL SPONGIOSA
Authors: Amstutz H. C. , Sissons H. A.
Published: February 2018

1. The structure ofthe cancellous bone ofthe third lumbarvertebral body from a twenty-year-old woman who died from head injuries was studied, using serial section reconstruction techniques.

2. In addition to the construction of enlarged models from different regions of the vertebral body, measurements were made of the bone area, the surface area, and the thickness and spacing of the bony structures.

3. The vertebral spongiosa consists of a complex network of bony plates perforated by rounded openings of varying size. The plates show preferential orientation in the vertical and horizontal planes, and the amount of bone is greatest towards the upper and lower surfaces of the vertebral body.

4. The mechanical significance of the structure of the vertebral spongiosa is discussed.
RECURRENT POST-TRAUMATIC DISLOCATION OF THE HIP
Authors: Liebenberg F. , Dommisse G. F.
Published: February 2018

1. Two cases of recurrent post-traumatic dislocation of the hip are reported.

2. The literature is reviewed and the rarity of the condition is emphasised. Only twenty-two cases have been previously reported, eleven in adults and eleven in children.

3. The sequence of events leading to recurrent dislocation is not understood but the following important facts emerge. The initial incident could not be distinguished from that causing uncomplicated dislocations. There was a significant delay in reduction in a number of cases. Subsequent dislocations followed minor injury. A large defect in the posterior capsule with a large synovial-lined pouch or false joint was found at operation in both our cases. The ligamentum teres was not seen at operation. The surgeon was unable to redislocate the hips during the operation.

4. In both cases reported here treatment was by excision of the posterior pouch and repair of the capsular defect.

5. Based on the above facts some tentative deductions are made.
A FOLLOW-UP STUDY OF MOORE'S ARTHROPLASTY IN THE TREATMENT OF OSTEOARTHRITIS OF THE HIP
Authors: Apley A. Graham , Millner W. F. , Porter D. S.
Published: February 2018

1. A total of 120 Moore's arthroplasties in 111 patients were reviewed one to nine years after operation.

2. There was striking reduction in the severity of pain in 105 out of the 120 hips reviewed. Range of movement was improved in most patients but the degree of independence was improved less often. The reasons for this are discussed.

3. We draw the following conclusions regarding the place of Moore's arthroplasty. Firstly, it was a natural step in the evolution towards total hip replacement, an operation which promises to give more complete relief of symptoms and which seems likely to replace Moore's arthroplasty as the treatment of choice in osteoarthritis of the hip in the elderly. Secondly, Moore's arthroplasty is still a rational procedure for the treatment of degeneration if the acetabulum is not involved—for instance, in idiopathic avascular necrosis of the femoral head. Thirdly, it is certainly a valuable operation for some cases of recent fracture of the femoral neck. Avascular necrosis of the femoral head after trifin nailing can be satisfactorily treated by Moore's arthroplasty, particularly in the early stages before the acetabulum becomes involved. Finally, Moore's arthroplasty gave many fairly elderly patients considerable relief of pain at a time when nothing better was available. Much of the relief afforded has proved to be lasting, but deterioration sometimes occurred with time. In the few patients whose deterioration amounted to failure a definite cause for the failure was found. In the majority the deterioration was slight, and it seems likely that the operation will last most of these elderly patients for the rest of their lives.
TWO-NAIL FIXATION OF THE HIP
Authors: Somerville E. W.
Published: February 2018

1. A simple technique of arthrodesis of the hip is described.

2. Two triflanged nails are driven across the joint. The joint is not opened. No bone graft and no extensive fixation is used.

3. Symptoms were relieved in 90 per cent of patients and bony union was achieved in 63 per cent. Backache after operation was not a problem.

4. The period of hospitalisation was short and rapid return to heavy work was common.
THE INFLUENCE OF WRIST POSITION ON FINGER DEVIATION IN THE RHEUMATOID HAND
Authors: Pahle Jan A. , Raunio Pauli
Published: February 2018

A study has been made of fifty-six patients suffering from rheumatoid arthritis in whom sixty-nine wrists were fused. The purpose of the investigation was to evaluate to what extent the position of the fused wrist influenced the position of the fingers in the frontal plane. All sixty-nine wrists were followed up by radiographic examination controls, and thirty-seven of the wrists were also examined clinically. The mean period of observation after operation was seven years and ten months.

The findings support the so-called "zigzag" theory based on the concept of carpus-metacarpus acting as Landsmeer's intercalated bone in a bi-articular system.

When the wrists were fused in more than 5 degrees of radial deviation seventeen of twenty hands showed ulnar drift of the fingers on radiographic examination. Of the nine patients in this group examined clinically, all showed ulnar drift.

A strong tendency to correction of the finger position is seen when the hands are pressed against the cassette. For this reason the clinical examination, during which the finger deviation was examined with the metacarpo-phalangeal joints in 30 degrees of flexion regularly revealed an ulnar deviation of 5 degrees more than that shown by radiographic examination.

In eighteen wrists the fusion had been done in more than 5 degrees of ulnar deviation. Fourteen of these hands showed a resulting radial deviation of the fingers on radiographic examination.

In a group of thirty-one wrists fused in neutral position (0 degrees±5 degrees) only six hands showed more than 5 degrees of finger deviation to either side.

The condition of the metacarpo-phalangeal joints asjudged from radiographs did not seem to influence the deviation of the fingers either in direction or in degree. The direction of the deviation of the fingers was almost regularly the opposite to that of the fused wrist. Five hands showing no visible pathological changes in the metacarpo-phalangeal joints displayed finger drift.
NORMAL VARIATION IN THE DENSITY OF SELECTED HUMAN BONES IN NORTH INDIA
Authors: Ahuja M.
Published: February 2018

1. A review of the literature on the normal variations in bone mass in a given population in relation to age, sex, nutritional and genetic background shows several lacunae in our knowledge. Consequently, the separation of milder degrees of osteoporosis is difficult and the definition of osteoporosis itself is uncertain.

2. This paper presents a necropsy study to determine variations in the bone mass that occur with age and sex in a normal Indian population in the Delhi area. Two hundred persons between nine months and seventy-six years of age who died by accident and with no evidence of chronic disease were studied.

3. The parameters of bone mass employed were : apparent bone density, ash per millilitre of bone, cortical thickness and visual grading of porosity of bone in macerated specimens. The first lumbar vertebra, the iliac crest, the fourth rib and the femoral shaft were the bones evaluated.

4. After an initial rise up to the third decade, the apparent bone density and ash per millilitre showed a progressive and significant decline with age in all the three trabecular bones: vertebra, iliac crest and rib. Although these values were in general lower in the females than in males at all ages, and the rate of decrease with age was faster in them than in males, it was only in the rib that a statistically significant difference between the sexes could be established with respect to decrease with age.

5. Decreases in apparent bone density and ash per millilitre of the vertebral bone with age were associated with an increase with age in the porosity as assessed by visual grading.

6. In the case of the femur no significant change was demonstrable with age in any of the parameters used in the present study.

7. From a comparison of the values for apparent density and ash per millilitre with grading of macerates and histological preparations, it is suggested that osteoporosis may be said to be present in this population if the apparent bone density is less than 020 and 046 in the vertebra and the iliac crest respectively or ifthe ash per millilitre is less than 0l2 in the vertebra.

8. The study has revealed that 44 per cent of persons studied in this sample over the age of fifty exhibit significant osteoporosis. It is considered possible that nutritional factors such as protein-calorie malnutrition may be responsible for this relatively high incidence.
A PATHWAY FOR NUTRIENTS FROM THE MEDULLARY CAVITY TO THE ARTICULAR CARTILAGE OF THE HUMAN FEMORAL HEAD
Authors: Greenwald A. S. , Haynes D. W.
Published: February 2018

1. The routes by which adult human articular cartilage can receive its nutrition is still a subject of controversy.

2. Microscopic examination of normal adult human femoral heads has revealed vascular channels which penetrate the subchondral plate and calcified cartilage. These channels bring the medullary soft tissue into contact with the articular cartilage.

3. A fluorescent dye migration technique was used to show that the observed vascular channels are pathways for dye from the medullary cavity to the articular cartilage. It is suggested that these pathways could also be routes by which articular cartilage receives part of its nutrition.

4. The nutritional mechanism in the mature rabbit and adult human femoral heads cannot be compared because histological studies revealed differences in their subchondral structures.
GASTROCNEMIUS-PLASTY FOR PRIMARY CLOSURE OF COMPOUND INJURIES OF THE KNEE
Authors: Barfod Bent , Michael Damee
Published: February 2018

Two cases of laterally open knee joints with surrounding skin defects are reported. The joints were closed by muscle flaps fashioned from the lateral belly of the gastrocnemius, which was detached distally and folded upwards and forwards to cover the defect. The transposed muscle and the remainder of the wound were covered by free skin grafts. Results were satisfactory.
DOMINANT INHERITANCE IN FAMILIAL GENERALISED ARTICULAR HYPERMOBILITY
Authors: Beighton P. H. , Horan F. T.
Published: February 2018

Two individuals with generalised articular hypermobility are described. There are many affected members in both kindreds, and the pedigrees indicate that the disorder is transmitted as an autosomal dominant trait. Orthopaedic complications and deformities are common in one family but absent in the other. It is suggested therefore that the two disorders are distinct and separate genetic entities.
THE MANAGEMENT OF OPEN SKELETAL TRAUMA WITH PARTICULAR REFERENCE TO INTERNAL FIXATION
Authors: McNeur J. Clarke
Published: February 2018

1. The use of metallic internal fixation in the primary treatment of 176 open skeletal injuries is discussed and the results presented.

2. The use of metal (stainless steel) in this type of injury is shown not to have any harmful effects. it can be used with safety and benefit in the primary treatment of open skeletal trauma, especially in the multiple and complicated injuries of war and motor vehicle accidents.

3. The place of antibiotics is discussed and adequate treatment of the soft-tissue wound is stressed.
THE ROLE OF SURGERY IN THE TREATMENT OF MALIGNANT TUMOURS OF THE SPINE
Authors: Martin N. S. , Williamson Jean
Published: February 2018

1. A review of nineteen cases of malignant spinal tumour treated surgically is presented.

2. Four cases are presented in detail.

3. The results in terms of survival are not assessed, because the effect of operation on survival cannot be estimated in a small series without controls. However, if the patient does survive for a considerable time, the value of operation can be assessed in terms of its contribution to the quality of survival, in relieving pain or improving or protecting neurological function.

4. The limitations of laminectomy are compared with the possible advantages of anterior approaches.
SULPHATED ACID MUCOPOLYSACCHARIDE METABOLISM IN THE RABBIT INTERVERTEBRAL DISC
Authors: Souter William A. , Taylor Thomas K. F.
Published: February 2018

1. The uptake of S35 labelled sodium sulphate has been studied autoradiographically in the intervertebral disc of the young rabbit.

2. The sojourn of the isotope in the tissues includes an intracellular phase of approximately twenty-four hours, followed by an extracellular phase.

3. The cells exhibiting by far the greatest affinity for the sulphate ion are the peripheral groups of cells of the nucleus pulposus, while the chondrocyte-like cells of the cartilaginous segment of the annulus fibrosus are also fairly active. The central cells of the nucleus and the fibroblasts of the outer one-third of the annulus have a much lower uptake.

4. By analogy with similar studies on hyaline cartilage, and on the basis of correlation between the alcinophilia of the tissues and the concentration of the label, both before and after hyalase digestion of the tissue, it is considered that in the young rabbit disc, as in articular cartilage, the sulphate is incorporated primarily into chondroitin sulphate.

5. The elimination of the isotope from the nucleus at twenty-four days and the persistence of the label in the annulus fibrosus at thirty-two days tends to suggest that the metabolic turnover of acid mucopolysaccharide is considerably slower in the annulus than in the nucleus.
POSTERIOR SPINAL FUSION FOR SCOLIOSIS DUE TO ANTERIOR POLIOMYELITIS
Authors: Pavon Salvador J. , Argentina Buenos Aires , Manning Charles
Published: February 2018

1. The results of posterior spinal fusion for paralytic scoliosis in 118 patients have been reviewed after growth had finished. The criteria for skeletal maturity were both clinical and radiological, with emphasis on ossification of the iliac apophyses.

2. The age of onset of anterior poliomyelitis and the age at which scoliosis was first noticed, as well as the extent of the muscle weakness and the curve patterns, all have a bearing on the severity of the deformity and the indication for operative treatment.

3. The method of treatment including operation is described and the complications detailed. The use of a tibial strut has now been abandoned and Harrington instrumentation has become routine.

4. There were five deaths in the series, three early and two late.

5. The difference in height, changes in respiratory function and eventual functional capacity have been analysed.
POSTERIOR FRACTURE-DISLOCATION OF THE SHOULDER
Authors: Chattopadhyaya P. K.
Published: February 2018

A case of posterior fracture-dislocation of the shoulder is reported, and the method of closed reduction is described.