bluuebunny/crossref_metadata_2025_split huggingface dataset:
PARALYTIC SCOLIOSIS
Authors: Roaf Robert 
Published: February 2018

The etiological factors concerned in paralytic scoliosis are complex. Four main types of paralytic scoliosis can be recognised. 1. The general C-curve due to the body's anatomical attempt to shift its centre of gravity towards the weaker side. Vertebral rotation is not usually marked. This type usually occurs when patients with relatively slight paralysis have been allowed up too early ; it does not usually progress to severe deformity but may occasionally do so, gradually changing into Type 2. This type usually responds well to a period of rest and muscle redevelopment in recumbency. It also responds favourably to correction and fusion because correction is easy and there is little tendency to deterioration. Many of the "successes" of correction and fusion are in this classâalmost equal success would often have been gained without "correction." The spine is slightly, but not very, unstable and a relatively localised fusion will give the little extra support that is needed. 2. The "general collapse" type of curve due to extensive spinal weakness. This is the type in which simple head suspension produces marked correction. Rotation is moderate. Provided the patient's general condition is satisfactory extensive spinal fusion is usually the best treatment and produces gratifying improvement. 3. The primary lumbar curve due to a combination of pelvic obliquity, extraspinal imbalance and imbalance of the deep rotator muscles. Rotation is usually marked. Treatment must include the correction of all these factors. In mild cases correction of the pelvic obliquity is enough, but in marked cases the spine must also be corrected. The disability from a lumbar paralytic scoliosis is much greater than that from a lumbar idiopathic scoliosis of the same degree; so correction is necessary in this type. Correction in a Risser-type jacket is often inadequate and recourse to operative correction is usually required. 4. The primary thoracic curveâoften associated with weakness of the scapular muscles. The indications for and methods of treatment are practically the same as in primary idiopathic thoracic curves. These curves tend to be progressive and uncompensated. Although the most popular treatment is correction and fusion, wedge osteotomy of the spine gives better correction in intractable cases. The main need is for further investigation into the etiology of paralytic scoliosis so that adequate preventive measures may be undertaken at an early stage. It is essential that every child who contracts poliomyelitis should have his back muscles examined before he gets up. If there is any suggestion of scoliosis further investigations including radiography and electromyography are essential.
LOAD DISTRIBUTION IN A MODEL OF A HIP JOINT
Authors: Fessler H. 
Published: February 2018

Photoelastic techniques were used to study the stresses in models which represented the central frontal plane of a normal hip joint. The pelvis and the femur were inclined and the direction of the resultant thrust on the joint was estimated. Inward tilting of the pelvis causes a force which tends to push the head of the femur out of joint. The load distribution on the joint is not significantly changed if the line of action of the load is moved relative to the joint. The directions of the lines of principal stress in both bones are shown.
THE TREATMENT OF DISPLACED FRACTURES OF THE NECK OF THE FEMUR BY COMPRESSION
Authors: Charnley J. , Blockey N. J. , Purser D. W. 
Published: February 2018

We adduce the following conclusions from our experience of using this spring-loaded compression screw on completely displaced medial fractures of the femoral neck: 1. That this method probably eliminates non-union when the head is fully viable. 2. That primary "first-intention" osseous union occurs in approximately 33Â·3 per cent of cases. 3. That a vascular complication, of varying severity, undetectable by orthodox radiological tests, is revealed by extrusion of the screw in 66Â·6 per cent of cases. 4. That these observations disprove the idea that the main obstacle to revascularisation of an ischaemic head is the existence of forces so inclined to the axis of the femoral neck as to cause "shear." 5. That, compared with the Smith-Petersen nail used for completely displaced fractures, continuous spring compression can materially reduce the incidence of utter mechanical failure within the first year after operation. This is the result of "mushroom" impaction which itself can resist shearing strain and so can permit function as a fibrous union. 6. That early and rapid extrusion is a sensitive indication of a vascular complication in the head. Forewarned by this, activity can be restricted, or possibly other measures adopted, to anticipate or permanently postpone serious trouble.
POSTERIOR DISLOCATION OF THE SHOULDER
Authors: Scougall Stuart 
Published: February 2018

1. At an operation for recurrent posterior dislocation of the shoulder observations were made on the mechanism, head defect, method of reduction, and the position of greatest stability. 2. Experimentally, avulsion of the glenoid labrum in a monkey was shown to be capable of sound repair without operation. 3. In the treatment of primary posterior dislocation it is suggested that the position of abduction, lateral rotation and extension is favourable for the approximation of the stripped labrum and capsule to the glenoid rim, and for an effective buttress after cicatrisation. 4. If the risk of recurrence is to be reduced to a minimum the shoulder should be retained in the position of greatest stability for at least four weeks, to allow firm union of the avulsed soft tissues. 5. This position for an optimum buttress would also apply after surgical repair for recurrent posterior dislocation.
THE EFFECT OF INTERMITTENT CORTISONE ADMINISTRATION IN THE RABBIT
Authors: Storey Elsdon 
Published: February 2018

The intermittent administration of cortisone in both the young and the mature rabbit is associated with appositional bone growth on the periosteal surfaces of the cranium, premaxilla and middle of the shaft of the femur; each new layer of bone is separated from the next by a darkly haematoxylin-staining "reversal" line. The internal architecture of the bone also changes in consequence of the repeated waves of resorption and deposition of bone round vascular spaces. Cartilaginous growth at the epiphysis in the young rabbit is also affected. The long columns of metaphysial cartilage are replaced by a layer of new bone which partly seals the epiphysial cartilage from the marrow spaces.
PROGNOSIS OF EPIPHYSIAL SEPARATION
Authors: Dale G. G. , Harris W. Robert 
Published: February 2018

1. The methods by which epiphyses receive their blood supply was studied by means of India ink injections in monkeys. Two types were identified depending upon whether the epiphysis was entirely or partly covered by articular cartilage. In the former, nutrient vessels enter the epiphysis by traversing the perichondrium at the periphery of the plate. In the latter they enter the epiphysis by penetrating the cortex at the side of the epiphysis at a point remote from the epiphysial plate. 2. The histological changes after separation of the second type of epiphysis were also studied. After temporary interference with endochondral ossification marked by increased thickness of the epiphysial plate, healing occurred so rapidly that within three weeks it was difficult to determine that the epiphysis had been separated at all. 3. It is concluded that when nutrient vessels enter an epiphysis at a point remote from the epiphysial plate, that epiphysis can be separated without serious disturbance to its blood supply and accordingly without interference with its capacity for growth. As it has been established that an epiphysis which is entirely covered by articular cartilage cannot be separated without destruction of its blood supply and subsequent avascular necrosis (Harris and Hobson 1956), it is concluded that the prognosis of an epiphysial separation is dependent upon the degree of damage to its blood supply rather than the mechanical disturbance of the epiphysial plate.
CONGENITAL VERTICAL TALUS
Authors: Lloyd-Roberts G. C. , Spence A. J. 
Published: February 2018

1. The clinical and radiological features of thirty-two feet with congenital vertical talus are described and subdivided into groups determined by the presence or absence of associated abnormalities. 2. The differential diagnosis of congenital vertical talus from flat foot, talipes calcaneus and uncorrected club foot is discussed. 3. No benefit came from either non-operative treatment or tenotomy of the tibialis anterior.
HYPERKALAEMIA IN TRAUMATIC RENAL FAILURE
Authors: Morton Kenneth S. , Patterson Frank P. 
Published: February 2018

1. Two cases are reported in which hyperkalaemia was a prominent feature in acute renal failure and in which obvious sources of excess potassium were apparent. 2. The literature pertaining to potassium in acute renal failure is briefly reviewed. 3. A return to the surgical elimination of large and expendable tissue sources of potassium in the management of acute renal failure with hyperkalaemia is suggested.
LEGG-CALVEÌ-PERTHES' DISEASE
Authors: Evans David L. 
Published: February 2018

1. Fifty-two patients with Perthes' disease (affecting both hips in six instances) have been reviewed ten or more years after the beginning of treatment. 2. Judged radiographically, approximately one-third developed good, one-third fair and one-third poor femoral heads. 3. The clinical results paralleled the radiographic. Except with the worst shaped heads, function was excellent. 4. Certain constant early and late radiographic features are recorded. 5. Of the factors influencing prognosis, the age at onset of the disease and the sex of the patient appear to be important.
TREATMENT IN LEGG-CALVEÌ-PERTHES' DISEASE
Authors: Evans David L. , Lloyd-Roberts G. C. 
Published: February 2018

I. There is no significant difference in the final radiographic appearance of the femoral head between patients treated in hospital or as out-patients. 2. In view of this, from both a social and economic standpoint, out-patient treatment appears to be the method of choice.
INTERTROCHANTERIC OSTEOTOMY FOR OSTEOARTHRITIS OF THE HIP
Authors: Adam A. , Spence A. J. 
Published: February 2018

1 . Intertrochanteric osteotomy is valuable in the treatment of patients with osteoarthritis of the hip, giving a high percentage of satisfactory results. It often relieves the pain immediately, is long-lasting in its effects, and may even increase the range of movement. 2. There is no evidence from our figures that the extent of medial displacement of the lower fragment influences the result as judged from relief of pain, performance, and the patient's assessment. Movement, however, is less improved if displacement exceeds half the diameter of the divided bone. 3. Our observations did not support the view that improvement is caused by a changed relationship between the upper fragment and the acetabulum. When measurements were possible the position of the upper fragment usually remained virtually unaltered. 4. Our figures confirm that in most patients relief of pain is immediate; that is to say, the patient is aware on regaining consciousness that his pain has gone, even though he formerly had pain at rest. Whatever may be the mechanism that relieves the pain, it acts immediately.
FUNNEL CHEST
Authors: Sutherland Ian D. 
Published: February 2018

1 . Funnel chest deformity is a common cause of progressive postural defects in children. 2. The underlying pathology of the funnel chest is a congenital deficiency of the muscle fibres of the anterior part of the diaphragm which allows the stronger posterior element to pull backwards the xiphoid and sternum. The postural changes are secondary to the chest deformity. 3. Operative correction of the chest deformity is described. 4. Post-operative physiotherapy is essential to correct the postural deformities. Patients must remain under orthopaedic supervision to maintain the correction obtained. 5. A series of twelve children treated by operation is reported, with excellent results in all.
THE FLEXOR-EXTENSOR TRANSPLANT OPERATION FOR CLAW TOES
Authors: Pyper J. B. 
Published: February 2018

1. Patients subjected to the flexor-extensor transplant have been reviewed. The results in forty feet were assessed by direct questioning and examination, and the results of a further five operations were assessed from the records. 2. Worthwhile improvement was gained in a little over half the cases. The chances of success are greatest when the symptoms are mildest. 3. The operation appears to be inadequate in certain respects and it seems doubtful whether it has any advantage over the multiple arthrodesis (Lambrinudi) operation.
THE VALUE OF INTRA-ARTICULAR INJECTIONS IN OSTEOARTHRITIS OF THE KNEE
Authors: Miller James H. , White John , Norton Thomas H. 
Published: February 2018

1 . Criticisms are expressed of previous reports on the use of intra-articular injections in the treatment of osteoarthritis of the knee. 2. A series of 181 patients with primary osteoarthritis of the knee treated by certain intra-articular injections is reported. Three solutions in common use were studied; normal saline and mock injections served as controls. 3. Irrespective of the injection used, including the controls, no significant difference in the effects was demonstrated in the results. 4. The place of intra-articular injection therapy in osteoarthritis is discussed. Attention is drawn to the psychological implications.
TROCHANTERIC FRACTURES OF THE FEMUR TREATED BY THE VITALLIUM McLAUGHLIN NAIL AND PLATE
Authors: Foster J. C. 
Published: February 2018

1. A series of 142 fractures of the trochanteric region treated by fixation with Vitallium nail-plates of the original McLaughlin pattern is described. The hospital mortality was 9 per cent. Disruption of the nail-plate junction occurred in 8 per cent of cases. This confirms McLaughlin and Garcia's (1955) view that this pattern of nail-plate should no longer be used. 2. Despite this, satisfactory functional results were achieved in 78 per cent of the survivors. 3. The new Model V McLaughlin nail-plate is described, and the stresses in nail-plates are considered. On theoretical grounds and laboratory tests the weakness at the nail-plate junction has been eliminated in the new model, and the strength of the appliance as a whole compares favourably with other types of nail-plate. Full clinical trial is therefore justified, and seventy-one patients have so far been operated on, with satisfactory early results. 4. Marked stiffness of the hip joint greatly increases angulatory and rotational stresses on the nail-plate, and a high incidence of disruption is to be expected in these cases.
THE TREATMENT OF UNREDUCED CONGENITAL DISLOCATION OF THE HIP IN ADULTS
Authors: Ring P. A. 
Published: February 2018

1. The results of fifty-three operations in forty adults with a persistent congenital dislocation of the hip have been reviewed. 2. Arthrodesis as a primary operation was successful in five of six patients, giving a pain-free hip and good function. After an arthroplasty or an osteotomy that had failed to relieve symptoms it was successful in only one patient. 3. Cup arthroplasty on one hip relieved pain in five of nine patients, giving an increase in functional activity, although the range of hip movement was often disappointing. Bilateral cup arthroplasty, performed in four patients, gave partial relief in three, but did not permit an increase in activity. 4. High osteotomy of the femur was undertaken in eleven patients with a unilateral dislocation; pain was rarely relieved, and a stiff hip resulted in seven. 5. Low osteotomy in nine patients gave some relief from pain with a good range of hip movement. 6. In unilateral dislocation arthrodesis appeared to be the operation of choice, although cup arthroplasty was capable of giving a good functional result. 7. In bilateral dislocation, when only one hip was painful, the results of both these operations were on the whole good. When both hips were painful the operations that had been performed seldom gave clinical improvement. 8. High osteotomy of the femur appeared to have little place in the treatment of the painful dislocated hip. Low osteotomy, either of the Schanz or Batchelor type, appeared to be of value mainly as a salvage procedure when other measures had failed to give relief.
MECHANISM OF DERANGEMENTS OF THE MEDIAL SEMILUNAR CARTILAGE AND THEIR MANAGEMENT
Authors: Helfet Arthur J. 
Published: February 2018

1. The semilunar cartilages are part of the rotator mechanism of the knee joint. 2. Movement of the weight-bearing knee comprises synchronous lateral rotation of the tibia with extension and medial rotation of the tibia with flexion. 3. When this synchrony is disturbed, injuries to the semilunar cartilages result. 4. Damage to the anterior two-thirds of the medial cartilage blocks lateral rotation of the tibia, with consequent physical signs that are pathognomonic of the retracted and the bowstring cartilage, which are the most common types of injury. 5. Each type of cartilage injury produces its own pattern of erosion of articular cartilage and its own sequence of symptoms as so-called arthritis develops. 6. The sequence of symptoms may be halted and often reversed by removal of the torn cartilage. Operation is warranted in most cases however long the history and whatever the age of the patient. 7. The development of medial retropatellar arthritis is explained. The symptoms are often relieved by removal of the medial semilunar cartilage and adequate post-operative rehabilitation.
PRIMARY INTERNAL FIXATION IN OPEN FRACTURES OF THE TIBIAL SHAFT
Authors: Veliskakis Konstantin P. 
Published: February 2018

1. Eighty consecutive open fractures of the tibial shaft were treated by primary internal fixation and wound closure. Wound healing was complicated by deep infection in eight patients (10 per cent) and by skin loss of varying degree in ten (l2·5 per cent). 2. Careful selection of patients on the basis of associated soft-tissue injuries is urged. A simple method of grading open fractures by the appearance of the wound and adjacent skin and the effectiveness of wound closure is suggested. If internal fixation is indicated on mechanical grounds, the nature of the soft-tissue injury should be the deciding factor in the choice of the method of treatment. In the less severe (Grade 1) fractures internal fixation and wound closure may be safely employed. In the severe (Grade 3) injuries, primary wound closure with or without internal fixation should be avoided. Moderately severe (Grade 2) fractures should be carefully assessed and treated by internal fixation and wound closure only if primary wound healing is confidently expected. 3. Wound healing by first intention requires, in addition to adequate debridement of the deep layers of the wound, careful approximation of healthy wound edges without excessive tension. An adequate knowledge of skin-plastic procedures is essential to achieve this. 4. A combination of systemic penicillin and streptomycin in adequate doses is a safe and effective prophylactic antibiotic for use in the treatment of open fractures.
A CASE OF CONGENITAL ARTERIOVENOUS ANEURYSM INVOLVING THE FEMUR
Authors: Howard R. C. 
Published: February 2018

1. A case of congenital arteriovenous aneurysm involving the left femur, with dangerous cystic changes in the shaft of the bone, is described. 2. After ligation of the anastomosing fistulae the radiological appearance of the femur became normal.
THE RESULTS OF TREATMENT OF MALLET FINGER
Authors: Robb W. A. T. 
Published: February 2018

1. The method of treatment of a mallet finger deformity by immobilisation in a plaster in the position of hyperextension of the distal interphalangeal joint and flexion of the proximal interphalangeal joint is, on the whole, unsatisfactory because the splint is difficult to apply, it may need to be changed frequently, and it is sometimes complicated by pressure sores. 2. In many cases the deformity is still present after six weeks of adequate immobilisation, but gradual improvement from the contraction of fibrous tissue occurs for up to six months. Therefore an assessment of the results of any method of treatment should be made only after an interval of at least six months. 3. The subjective end results at the end of six months are satisfactory whether or not there has been efficient immobilisation in hyperextension. Few patients have any disability and only rarely is this sufficient to cause interference with normal activities. A high proportion of patients show slight persistent deformity and limitation of movement, and this is seemingly uninfluenced appreciably by the type or duration of treatment. 4. The only treatment necessary for most cases of mallet finger is the application of elastic adhesive strapping or a straight spatula splint in order to relieve the initial discomfort from the injury.
THE BONE CHANGES IN SICKLE CELL ANAEMIA AND ITS GENETIC VARIANTS
Authors: Golding J. S. R. , MacIver J. E. , Went L. N. 
Published: February 2018

1. The bone changes are described in fifty-one cases of sickle cell anaemia. nineteen cases of sickle cell haemoglobin C disease and two cases of sickle cell thalassaemia. 2. Avascular necrosis of the head of the femur has been found in all three types of sickle cell disease. These responded to treatment. 3. The changes found in six cases of Perthes' disease in the negro are compared with the changes in avascular necrosis of the head of the femur in sickle cell disease. 4. Hyperplastic bone changes are seen only in true sickle cell anaemia and not in the variants. 5. Secondary osteomyelitis appears to be fairly common in sickle cell anaemia. Organisms of the salmonella group have often been found in these cases.
TRIPHALANGEAL THUMB IN A BANTU FAMILY
Authors: Abramowitz I. 
Published: February 2018

1 . Three cases of triphalangeal thumb are described in three generations of a Bantu family. In the youngest member both thumbs were affected; in his mother and grandfather only one thumb was abnormal. 2. The literature is reviewed and the etiology of the anomaly is discussed. 3. Attention is drawn to the hereditary tendency of this condition.
THE VASCULAR REACTION OF TUBULAR BONE TO ISCHAEMIA IN PERIPHERAL OCCLUSIVE VASCULAR DISEASE
Authors: Brookes M. 
Published: February 2018

1. Twenty-five lower limbs, amputated above the knee for senile atherosclerosis with peripheral gangrene, have been investigated radiologically and histologically to determine the vascular patterns in ischaemic bone with particular reference to the tibia. These have been contrasted with the patterns found in non-atherosclerotic tubular bone. 2. The principal changes are the development of a diffuse vascularisation of compact and spongy bone; a widening of Haversian spaces which come to contain a variable number of sinusoidal blood vessels; and an increasing periosteal participation in cortical nutrition which is related to the severity and chronicity of the ischaemic process. 3. Views on the normal blood supply of long bones are discussed, and evidence is presented for regarding this as discrete and end-arterial in nature; in particular it is suggested that the normal cortex has a wholly medullary, centrifugal, arterial supply.
AMPUTATION OF ALL TOES
Authors: Flint Michael , Sweetnam Rodney 
Published: February 2018

1. The indications for amputation of all the toes for severe toe deformity in rheumatoid arthritis, hallux valgus and pes cavus are discussed. 2. The results of forty-seven amputations in twenty-eight patients are analysed: 93 per cent were found to be very satisfied with the operation. 3. The technique of the operation and the subsequent management are described. The importance of retaining full-length shoes fitted with metatarsal insoles and toe blocks to preserve a good gait and balance is emphasised.