The outcome of 260 repairs of the radial and posterior interosseous nerves, graded by Seddon’s modification of the Medical Research Council Special Committee’s system, was analysed according to four patterns of injury; open ‘tidy’, open ‘untidy’, closed traction, and those associated with injury to the axillary or brachial artery. We studied the effect on the outcome of delay in effecting repair and of the length of the defect in the nerve trunk.

Of the 242 repairs of the radial nerve we found that 30% had good results and 28% fair; 42% of the repairs had failed. The violence of injury was the most important factor in determining the outcome. Of the open ‘tidy’ repairs, 79% achieved a good or fair result, and 36% of cases with arterial injury also reached this level. Most repairs failed when the defect in the nerve trunk exceeded 10 cm. When the repairs were carried out within 14 days of injury, 49% achieved a good result; only 28% of later repairs did so. All repairs undertaken after 12 months failed. Of the 18 repairs of the posterior interosseous nerve, 16 achieved a good result.

We have analysed the results of repair of traumatic lesions of the musculocutaneous nerve in 85 patients, which were graded by Seddon’s modification of the Medical Research Council system into three types of injury: open ‘tidy’, open ‘untidy’and closed ‘traction’. They were also correlated with associated arterial injury.

There were 57 good, 17 fair and 11 poor results. The type of injury was the most important factor in determining the result; 12 of 13 open-tidy lesions gave good results compared with 30 of 48 closed-traction lesions. The results were better when the nerves were repaired within 14 days of injury and when grafts were less than 10 cm long. They were worse in the presence of associated arterial or bony injury.

In this study, we discuss 68 cases in which peripheral nerve trunks were inadvertently divided by surgeons. Most of these accidents occurred in the course of planned operations. Delay in diagnosis and in effecting repair was common. We list the nerves particularly at risk and the operations in which special care is needed. We recommend steps to secure prompt diagnosis and early treatment.

We describe a method for approaching the lower cervical and upper thoracic spine, the brachial plexus and related vessels. The method involves the elevation of the medial corner of the manubrium, the sternoclavicular joint, and the medial half of the clavicle on a pedicle of the sternomastoid muscle. We have used this exposure in 17 cases with few complications and good results. Its successful performance requires high standards of anaesthesia, surgical technique and postoperative care.

We have reviewed 50 patients at a mean period of 2.7 years after operations to restore elbow flexion lost as a result of traction injuries of the brachial plexus. A variety of operations were used and, in general, patient satisfaction was high. Objectively, however, the power in the transferred muscles was poor; less than half of the patients had a significant improvement in function. Poor control of the shoulder often compromised the result. Latissimus dorsi and triceps transfers proved most reliable, and some Steindler flexorplasties also gave satisfactory results. Pectoralis major transfers were disappointing and we do not recommend their use in women.

We report 16 cases in which the upper cervical spine was approached through the mouth for operative decompression and stabilisation, with or without removal of diseased tissues. The indications are discussed and the technique is described. Results are compared with those of other reported series. We believe that this operation has a place in the treatment of certain conditions affecting the upper part of the cervical spine and the foramen magnum, with or without involvement of the medulla and spinal cord.

1. Thirteen instances of compression of the lower trunk of the brachial plexus at the thoracic inlet are described.

2. In each case the cause of compression was an aponeurotic band passing from the seventh cervical transverse process to the first rib.

3. The symptoms, physical signs, radiological features and findings at operation are described.

4. Satisfactory results followed removal of the band.

5. The anatomical arrangements are compared with those of the "normal" thoracic outlet and with those obtaining in cases of "vascular" thoracic outlet syndrome.

1. Twenty-nine patients with traction lesions of the brachial plexus have been studied.

2. The methods of study have been by clinical examination, by operative exploration and biopsy and by examination of axon reflexes.

3. Results in each of these sections have been related to the progress of the lesions.

4. The results suggest: a) that the reason for the generally poor prognosis in traction lesions of the brachial plexus is the frequency of intradural preganglionic damage and of tearing apart of the plexus; b) that the former occurrence can with some accuracy be diagnosed by examination of axon reflexes and that the latter can be detected at operation.

5. Indications for operative exploration are given and a plan is outlined for the management of these cases.

1. The etiology of hallux rigidus has been studied by an examination of ten adolescent and four adult patients.

2. Although osteochondritis dissecans of the metatarsal head has been seen in two cases, our evidence generally suggests that metatarsus primus elevatus is the important etiological factor in established hallux rigidus.

3. The common factor for the production of symptoms is the limitation of dorsiflexion of the first metatarso-phalangeal joint, just as the key to treatment is the existence of a good range of plantar-flexion of the joint.

4. The technique and results of the operation of phalangeal extension osteotomy for hallux rigidus are given.

1. Ten patients are described in whom pain due to arterial obstruction simulated pain caused by bone or joint disease or by disorder of the intervertebral disc.

2. The importance is stressed of arterial obstruction at the aortic bifurcation or in the iliac vessels as a possible cause of pain in patients attending orthopaedic clinics.

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

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

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

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

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

6. In hallux rigidus arthroplasty alone has no place in the treatment of the adult cases showing metatarsus primus elevatus, nor in the adolescent case. The possibilities of other methods of operative treatment, notably osteotomy, are discussed.