bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE TREATMENT OF RELAPSED CLUB FOOT BY THE INSERTION OF A WEDGE INTO THE CALCANEUM
Authors: Dwyer F. C. 
Published: February 2018

1. In a club foot the small inverted and elevated heel is considered to be the most important deforming influence in preventing complete correction and in promoting relapse. 2. Correction of the varus and an increase in the vertical height of the heel are achieved by opening up the medial aspect of the calcaneum and inserting a wedge of bone. This abolishes the inverting action of the calcaneal tendon and brings the heel down on to the ground directly under the line of the tibia so that it touches first in walking. The weight is then shifted on to the forefoot, as in the normal gait, thus producing gradual correction of supination and adduction. 3. The operation may have to be repeated, but with the varus fully corrected and a plantigrade heel there is no chance of relapse, and progressive improvement, not only in gait and shoe wear but also in the development of the foot and leg, can be expected. 4. Skin closure is a difficulty, and though the resulting scar is sometimes conspicuous, it is masked to some extent by being on the postero-medial aspect of the ankle. 5. The ideal age for the operation is about three to four years, but there is virtually no upper age limit. 6. In older patients presenting severe residual deformity it may be necessary to correct the heel and then the equinus of the forefoot by a tarso-metatarsal wedge, thus avoiding damage to the mid-tarsal and subtalar joints. 7. By adopting these principles, soft-tissue release operations, so often disappointing and sometimes damaging, can be avoided and in no patient should there ever be the need to resort to the mutilating "triple wedge" resection. 8. The most important feature of the operation is correction of the varus; it is better to over-correct than to under-correct (Figs. 20 and 21). It is a simple matter to deal with the valgus later if necessary.
PATHOLOGICAL OSSIFICATION IN TRAUMATIC PARAPLEGIA
Authors: Hardy A. G. , Dickson J. W. 
Published: February 2018

1. Ectopic ossification is commonest in, but not confined to, traumatic paraplegia. It occurs also in many other neurological disorders which have in common a gross disturbance of spinal cord reflex activity. It is a true ossification and must be distinguished from calcification. 2. The neurological lesion may lie anywhere from the cerebral cortex to the mixed peripheral nerve. It may involve motor tracts, sensory tracts or a mixture of both. 3. The ossification is localised and self-limiting. It occurs mainly in the lower limbs and is restricted to certain muscles or muscle groups, the nerve supply of which is always below the level of the central neurological lesion. 4. The blood chemistry is usually normal. 5. A true arthropathy is rare except as part of a secondary suppurative arthritis. 6. The resemblance to myositis ossificans progressiva or to ossifying haematoma is only superficial, although the pathological process at cellular level may be the same. 7. The period of onset after paraplegia is variable. The earliest recorded example is in one of our own cases in which ossification occurred nineteen days after injury. Other patients have developed ossification after several years. 8. The condition is commonest in acquired nervous disease rather than in congenital disorders, and so far as we know it has not been described in the myopathies. The presence of muscular spasticity or flaccidity is relevant only in that it indicates a disturbance of reflex activity. 9. Soft-tissue ulceration appears to be frequently associated with ectopic ossification. The type of new bone formation associated with large chronic ulcers is not to be compared with the new bone formation in the muscles of a paraplegic patient in otherwise good general condition. 10. The occurrence of urinary tract infections with calculi and generalised sepsis is not specifically related to the onset of new bone formation. 11. Localised soft-tissue oedema often precedes the formation of new bone. Its appearance is undoubtedly important, but the mechanism of its origin is obscure. 12. It is not yet known what initiates ectopic ossification, what limits its spread and what finally causes it to stop. 13. We have described 100 examples of ectopic ossification in 603 paraplegic patients. 14. Surgery has been required in only eight patients. The only indication for surgery is bony ankylosis of the hip in an unacceptable position.
REHABILITATION AFTER FRACTURES OF THE SHAFF OF THE FEMUR
Authors: Nichols P. J. R. 
Published: February 2018

1. The results of rehabilitation of 181 patients with fractures of the shaft of the femur are analysed 2. The results are mainly dependent on the severity of the fracture and the method of reduction and immobilisation. It is stressed that full-time rehabilitation can help to attain the best results. 3. The advantages of intramedullary nailing of fractures of the femoral shaft are discussed.
MAJOR ARTERIAL INJURY COMPLICATING FRACTURE OF THE FEMORAL SHAFT
Authors: Kirkup J. R. 
Published: February 2018

1. Three cases of injury to the femoro-popliteal artery complicating fracture of the femoral shaft are described. 2. In all three cases restoration of peripheral circulation by arterial repair carried out within ten hours of injury succeeded in saving the limb from permanent damage. 3. The importance of adequate resuscitation, early diagnosis and early adequate surgical intervention is stressed. 4. The mechanism of injury and the clinical features of help in early diagnosis are discussed. 5. The place of internal fixation of the femoral fragments is discussed and its advantages and disadvantages are compared with those of treatment by skeletal or skin traction.
THE ROLE OF THE VESSELS IN OSTEOGENESIS
Authors: Trueta J. 
Published: February 2018

We have attempted to summarise in a short space investigations that have occupied several years, and we realise that whatever the merits of such an effort the results can only be modest. Many important aspects of the osteogenetic process still remain a mystery and thus are subjected to theory and controversy. Such is the case with this constant attendant at osteogenesis which is alkaline phosphatase. But of one thing we are certain, namely that bone is an organised "soft" tissue of which only part has been made rigid by the deposit of calcium salts. The organiser is the osteogenetic vessel from which springs the syncytial frame of cells and their connections on which the bone architecture is established. Endothelial cell, intermediate cell, osteoblast, osteocyte, osteoclast; these constitute the normal sequence of cellular phylogeny in the constant elaboration and removal of the bone substance. The initial cells on which the whole process rests are those of the capillary-sinusoid vessel which is responsible for providing the transudates on which the life and health of the whole syncytium depends. If our findings were confirmed, a better understanding of the nature and characteristics of primitive malignant bone tumours would be possible. Each type of tumour from endothelioma to malignant osteoclastoma, including reticulum-cell sarcoma and osteogenic sarcoma, would be initiated by a different cell of the syncytium, but in its monstrous deviation from the normal would still preserve most of the characteristics of its healthy ancestor. Thus the endothelioma causes bone expansion, bone reaction and even bone necrosis, but not proper bone formation, whereas the osteogenic sarcoma or osteoblastoma forms bone; and with the same fidelity to their origin osteoclasts are seen in the malignant osteolytic tumour. Over thirty years ago the late Sir Arthur Keith (1927) expressed his suspicion that the cells which assume a bone-forming role are derived from the endothelium of the capillary system. We hope we have contributed to show that his suspicion was right.
PROGNOSIS IN SUPRACONDYLAR FRACTURES
Authors: Mann T. S. 
Published: February 2018

1. During two years eighty-five children with supracondylar fractures of the humerus were admitted to a children's hospital. This paper is a study of the severe fractures which occurred in twenty-three children of whom fifteen had a deformity at review. 2. The only deformity found after treatment by closed manipulation was an alteration in the carrying angle. It is considered that cubitus varus was caused by medial angulation of the distal fragment.
CONGENITAL HYPOPLASIA OF THE UPPER FEMUR
Authors: Lloyd-Roberts G. C. , Stone K. H. 
Published: February 2018

1. The surgical management of two children with congenital hypoplasia of the upper end of the femur is described. 2. Early exploration is advocated to establish the nature and extent of the anomaly and to attempt its correction. 3. The preliminary results are sufficiently encouraging for us to recommend that further attempts at surgical treatment be considered in patients with this disorder.
OSTEOCHONDRITIS OF THE HUMERAL CAPITULUM
Authors: Smith M. G. H. 
Published: February 2018

1. Two boys with osteochondritis of the humeral capitulum are described. 2. Similarities between this condition and Perthes' disease are noted. 3. From a review of the reported cases it is concluded 1) that osteochondritis of the capitulum occurs almost exclusively in boys between the ages of four and ten years; 2) that treatment and immobilisation are unnecessary; and 3) that advanced maturation of the epiphysis of the radial head is a possible sequel.
THE ETIOLOGY OF QUADRICEPS CONTRACTURE IN CHILDREN
Authors: Lloyd-Roberts G. C. , Thomas T. G. 
Published: February 2018

1. Six cases of quadriceps contracture in children are described. All were either premature or suffered severe illnesses soon after birth. 2. Some additional information is given about cases of the same condition previously published by other authors. 3. It is suggested that injections and infusions given to newborn babies are sometimes the cause of the condition. 4. Some of the therapeutic substances and measures which may be responsible are discussed. These include antibiotics, vitamin K preparations and "subcutaneous" fluid therapy.
EXOSTOSIS BURSATA
Authors: Smithuis Th. 
Published: February 2018

1. Exostosis bursata in a patient with hereditary multiple exostoses is described. 2. Fracture of the tip of the exostosis had occurred causing acute pain and haemorrhage into the bursa. 3. Although it appeared that it might be a pseudo-joint cavity the histological appearance indicated that it was a bursa caused by friction between the exostosis and the surrounding soft tissue.
EXCISION OF THE PROXIMAL ROW OF THE CARPUS
Authors: Crabbe W. A. 
Published: February 2018

1. Excision of the proximal row of the carpus is a useful procedure, with a limited application in patients with ununited fractures of the scaphoid, Kienböck's disease, dislocation of the lunate bone, unreduced mid-carpal dislocations and similar injuries which do not respond to conservative management. 2. It is an acceptable alternative to arthrodesis, even when the wrist is likely to be subjected to heavy use. 3. In the event of failure arthrodesis can still be carried out. 4. Advanced degenerative changes are a contra-indication but mild to moderate changes do not appear to affect the results.
THE INFLUENCE OF IMMOBILISATION ON BONE FORMATION AS EVALUATED BY OSSEOUS INCORPORATION OF TETRACYCLINES
Authors: Landry M. , Fleisch H. 
Published: February 2018

1. The effect of immobilisation on bone formation has been investigated in the rat. As chlortetracycline has the property of being deposited preferentially in areas of newly deposited bone, its uptake can be used as a reflection of osseous formation. 2. One hind limb of albino rats was immobilised either by section of the second, third and fourth lumbar nerve trunks or by section of tendo calcaneus and ligamentum patellae. The incorporation of chlortetracycline was determined quantitatively in the femur and tibia of both hind limbs at intervals after immobilisation. 3. Tetracycline uptake is expressed in terms of bone weight, this being most important in order to obtain correct values. 4. A comparison between the tetracycline uptake and the weight of the bones gives information about the rate of bone destruction. 5. In animals immobilised by nerve section three phases can be distinguished: a first phase with diminished bone formation, a second with increased formation and increased destruction and a third phase with diminished bone formation. Both mechanisms, decreased formation and increased destruction, are therefore important in the production of immobilisation osteoporosis; their relative importance depending upon the duration of the immobilisation. 6. In animals immobilised by tendon section the mechanical function becomes restored in the second week as a result of healing: this explains the rapid compensation for the initial loss of weight of the bones accompanied by a marked increase in tetracycline uptake. 7. These results are discussed and compared with information in the literature. Variations in bone formation and destruction rates with time could explain the varied results reported by other authors.
TRAUMATIC FEMORAL BONE LOSS
Authors: Kirkup J. R. 
Published: February 2018

1. A motor-cyclist's temporary loss of ten inches (25 centimetres) of femoral shaft and its replacement are recorded. 2. The mechanism of injury is considered. 3. The management of extensive bone loss is discussed. 4. Attention is drawn to the importance of retained periosteum and its contribution to healing in such injuries.
EXPERIMENTAL EPIPHYSIAL CARTILAGE GROWTH ANOMALIES
Authors: Storey E. 
Published: February 2018

1. Stable strontium in large amount in the diet of rats initially inhibits calcification and induces rickets. 2. Changes later become atypical and a complex series of epiphysial plate defects develops: formation of localised osteoid wedges in the metaphysis; invagination of the epiphysial plate and sequestration of multiple cartilage nodules into the marrow cavity; and, in severely affected animals, localised loss of part or parts of the epiphysial plate with formation of large cartilage nodules in the metaphysis and epiphysis. 3. The appearance of cartilage nodules in the metaphysis in man has been shown to be associated with changes in the epiphysial plate, but much of the information is radiological and therefore incomplete, and detailed cellular changes are seldom available. 4. Some of the conditions mentioned, which have presented difficulty in interpretation, partly because of their rarity but also because of lack of knowledge of the fundamental processes concerned, are multiple exostoses and endochondromatoses, metaphysial dysostosis and osteochondritis. 5. Comparison of basic mechanisms revealed in this study with those supposed to occur in human cartilage dystrophies demonstrates that strontium rickets mimics some changes occurring in chronic renal rickets; that invagination of the epiphysial plate and cartilage nodule sequestration could account for the development of multiple exostoses and some endochondromatoses; and that localised endochondral defects in calcification can induce epiphysial changes resembling osteochondritis juvenilis, demonstrating that avascular necrosis is not necessarily the mechanism initiating epiphysial deformity.
CALCIUM ACCRETION AND BONE FORMATION IN DOGS
Authors: Lee W. R. , Marshall J. H. , Sissons H. A. 
Published: February 2018

1. In two dogs, approximately one to two years and three to four months of age, an experimental comparison was made between the calcium accretion rate as defined by the Bauer-Carlsson-Lindquist equation, and the bone formation rate determined by double tetracycline labelling. 2. The overall calcium accretion rate was determined from the specific activity of the blood plasma, and the urinary and faecal excretion of isotope, following an intravenous tracer dose of Ca45. A time of five days after injection was used for the calculation of accretion rates, but data for shorter times of calculation are included. 3. Local accretion rates were obtained for different parts of the skeleton by determining the specific activities of bone samples at the end of the experiment. 4. The amount of isotope the uptake of which was not related to new bone formation (the diffuse component) was determined autoradiographically. 5. Local values for appositional growth rate and bone formation rate were obtained, using sections of undecalcified bone specimens, by measuring the linear separation between two tetracycline bone markers and the area of new bone enclosed by them. 6. In the older dog, the measurements for cortical bone showed that the accretion rate was two to three times as great as the bone formation rate: the observed diffuse component was sufficient to account for the greater part of this difference. Measurement of the bone formation rate for cancellous bone presented difficulties, but the approximate values obtained suggested that the accretion rate and the bone formation rate were of about the same order for this tissue. 7. In the younger dog, the bone formation rate could be determined only in cortical bone: at the sites studied, the values for the accretion rate and the bone formation rate did not differ by more than 20 per cent. It is suggested that this is due partly to the low specific activity of the diffuse component in this young animal, and partly to the relatively large amounts of new bone formed during the period of the experiment. 8. Despite the important differences between the rates of calcium accretion and bone formation that were found to exist in regions where there was only a small amount of new bone formation, there was a strong correlation between the two rates. The value of the accretion rate as a parameter of bone metabolism is clear.
REPAIR OF RUPTURES OF THE ROTATOR CUFF OF THE SHOULDER
Authors: Debeyre J. , Patte D. , Elmelik E. 
Published: February 2018

1. The results of operation in sixty-three patients with rupture of the rotator cuff of the shoulder have been reviewed. 2. In seventeen patients the classical delto-pectoral route was found to give poor access and mediocre results. 3. In forty-six patients a superior approach along the supraspinatus fossa and through the divided acromion process was found to give excellent access and to permit lateral advancement of the supraspinatus muscle in order to enable wide gaps to be closed. With this improved surgical access the proportion of good results has been doubled. 4. It is suggested that when a case of rupture of the cuff, confirmed by arthrography, fails to respond to physiotherapy, operative repair should be undertaken.
AINHIJM
Authors: Cole G. J. 
Published: February 2018

1. An account of fifty-four patients suffering from ainhum is presented, and the clinical and pathological findings are discussed. 2. Etiology is considered, and a plan of treatment proposed. 3. Ainhum in Ibadan is a disease of all ages and both sexes. 4. Most patients have considerable pain. 5. It is due to a non-inflammatory change in the basal layer of the epidermis. 6. Surgical treatment has gratifying results.
THE ELIMINATION OF SLIP BETWEEN PROSTHESIS AND FEMUR
Authors: Charnley J. , Kettlewell J. 
Published: February 2018

1. The customary method of broaching and of knocking the prosthesis down into the neck of the femur produces an indeterminate interference fit. 2. The usual interference fit may suffer progressive breakdown under even small, steady loads. This results in a permanent relative movement between prosthesis and femur as the metal insert "beds " into the bone. 3. Modification of the usual practice by providing a clearance fit between prosthesis and femur and cementing of the metal into the bone provides a system which has been shown to be free of breakdown under steady loads up to about 450 pounds. 4. By cementing the prosthesis shaft into the femur permanent relative movement between the elements has been shown to be reduced from approximately four-hundredths of an inch per 100 pounds load to two ten-thousandths of an inch per 100 pounds load–that is, a reduction of 200 to 1.
DURATION OF SPLINTING AFTER REPAIR OF EXTENSOR TENDONS IN THE HAND
Authors: Stuart David 
Published: February 2018

1. This clinical investigation compares the results with varying periods of immobilisation after the primary repair of extensor tendons over the metacarpo-phalangeal joints of the fingers. 2. One hundred and thirty-seven Bantu mine workers with such injuries were each splinted for either one day, ten days or three weeks, and the results were compared. 3. The results indicate that the optimum period of splintage is ten days.
THE HAEMOPHILIC PSEUDOTUMOUR OR HAEMOPHILIC SUBPERIOSTEAL HAEMATOMA
Authors: de Valderrama J. A. Fernandez , Matthews J. M. 
Published: February 2018

1. The case history of a haemophiliac in whom a large haematoma of the thigh was treated by amputation of the limb is described. 2. Examination of the available radiographs and of the histology led to the conclusion that the cyst was subperiosteal in origin. 3. Evidence is presented to support the hypothesis that haemophilic pseudotumours are always associated with subperiosteal haemorrhage, and that those haemophilic cysts which are confined to muscle have little or no effect on the adjacent bone.
THE TREATMENT OF DISPLACED FRACTURES AT THE ANKLE BY RIGID INTERNAL FIXATION AND EARLY JOINT MOVEMENT
Authors: Burwell H. Nevile , Charnley Arnold D. 
Published: February 2018

1. This paper presents a series of 135 patients with displaced ankle fractures treated by rigid internal fixation followed by early joint exercises in bed until movements were restored and followed then by full weight bearing in a plaster. 2. The advantages obtained are as follows: A high standard of reduction can be achieved and maintained. The joint movements are established before organisation of the traumatic exudate. Weight bearing in a plaster reduces the degree of disability and prevents osteoporosis. Further remedial treatment after removal of the plaster is usually unnecessary. 3. All but five of the fractures (3·7 per cent) could be classified in the manner described by Lauge-Hansen. 4. This classification is the most satisfactory of those available and is recommended for general use. 5. Anatomical reduction was obtained in 102 patients (77 per cent), with good objective clinical results in 108 patients (82 per cent). 6. The quality of the clinical result depends mostly on the accuracy of the reduction, to a lesser extent on the degree of initial displacement, and least on the type of fracture. 7. It is considered that the traditional concept of diastasis requires modification; it is felt that the term lateral ankle instability, which includes low fracture of the fibula (intraosseous diastasis) is preferable. 8. Internal fixation of the syndesmosis is to be avoided except in rare instances. 9. The incidence of arthritis is shown to depend mostly upon the accuracy of reduction; the initial degree of displacement is also of importance.
STRESS FRACTURES OF THE FEMORAL NECK
Authors: Devas M. B. 
Published: February 2018

1. Stress fractures of the femoral neck in twenty-five patients are described. 2. Two distinct radiological types, compression fractures and transverse fractures, are described. A clinical distinction cannot be made in the early stages. 3. The importance of the early differential diagnosis between the two types is emphasised because the transverse stress fracture of the femoral neck will become displaced. 4. The morbidity after a displaced transverse fracture of the femoral neck can be severe.