The oldest texts describing infantile paralysis (Underwood's 1789 and Salzmann's 1734) are reviewed and discussed. Salzmann's case report is likely to be a description of acute anterior poliomyelitis and is documented by details of the history, clinical picture and postmortem findings

1. The nature of paralytic deformity arising in poliomyelitis, cerebral palsy and spina bifida is considered and three types of deformity–acute contracture, postural contracture and deformity from muscle imbalance are described. 2. The place of physiotherapy, splintage and surgery in the management of these varieties of paralytic deformity is discussed and the overall results of treatment are reviewed

A method of triple arthrodesis is described which involves inlay of the subtalar and midtarsal joints. It is applicable to the undeformed and valgus foot as is encountered in poliomyelitis, spasmodic flat foot, cerebral palsy and spina bifida. The operation was successful in controlling deformity and pain. The only significant complication was failure of fusion of the midtarsal joint which occurred in three of eighty-five feet (3-5%)

We believe that this technique has several advantages. After poliomyelitis recovery in the clavicular head of pectoralis major may exceed that in the sternal head; there may be considerable but incomplete recovery in both heads and it is then desirable to use all the active muscle available. Girls and women dislike conspicuous scars; the incisions used in this technique are unobtrusive when the arm is by the side

We have reviewed 26 patients treated by trapezius transfer for deltoid paralysis due to brachial plexus injury or old poliomyelitis. We assessed the power of shoulder abduction and the tendency for subluxation. There were good results in 16 patients (60%); five were fair and five poor. Trapezius transfer appears to give reasonable results in the salvage of abductor paralysis of the shoulder

1. Methods of correcting flexion contractures of the knee following poliomyelitis fail if posterior subluxation of the tibia is allowed to occur. 2. Careful serial manipulations will give straight, congruous joints in younger patients. Posterior capsulotomy does not facilitate correction. 3. Supracondylar femoral osteotomy is indicated in children over fifteen and in adults, although sometimes arthrodesis of the knee is necessary

periosteal stripping in the long lower limb bones of thirty children with shortening after poliomyelitis was performed. All have been followed up for five years. A relative increase in length attributable to the periosteal stripping procedure was seen in the majority. The conclusions are that this simple procedure is indicated in minor degrees of limb inequality in growing children, but that the haphazard response precludes any accurate estimation of the final outcome of such a procedure

The technique of storing bone by refrigeration is described and the following advantages are indicated: 1) A patient avoids a second wound and the loss of bone from some other part of the body; this is a very important matter for patients in whom poliomyelitis has affected both legs. 2) Almost unlimited bone is available to the surgeon and he is consequently able to insert very large grafts and so obtain better results

In cases of established calcaneus after anterior poliomyelitis the deformity can be greatly reduced by combining an extensive plantar release with an oblique transverse osteotomy of the calcaneus that permits displacement upwards and backwards of the posterior weight-bearing part of the bone. The procedure greatly improves the mechanical advantage of subsequent tendon transplantations to the heel. Between 1956 and 1969 fifteen such osteotomies were carried out and the long-term results have been reviewed

1. The history of the development of the operation of sympathetic ganglionectomy for vasospasm is related. 2. A simple classification is given of the common diseases of the peripheral arteries. 3. The symptoms of peripheral arterial disease are described. 4. The investigations are discussed. 5. The treatment, both conservative and surgical, is discussed, with comments on arterial grafts. 6. Special points are made regarding poliomyelitis, acrocyanosis, Bazin's disease, cervical rib, vascular injuries and crutch arteritis. 7. The long-term results of sympathectomy are reviewed

1. Forty-five cases of acute osteomyelitis have been reviewed with the object of determining the causes of relapse. The importance of an early diagnosis and prompt treatment is stressed, and the question of when to stop antibiotic drugs is discussed. 2. The provisional diagnosis was anterior poliomyelitis in seventeen out of forty-five patients; acute osteomyelitis was diagnosed in twelve only. The criteria for making an early diagnosis are discussed, including the value and limitation of blood culture. 3. The place of operation is discussed and certain conclusions are set out

1. It is possible that neonatal sciatic palsy occurs more often than is suggested by perusal of the literature: paralysis of a foot may easily be overlooked in the new-born infant; it may be regarded as a temporary paresis due to mild birth trauma; or in later months it may be attributed to poliomyelitis. 2. Eleven cases of neonatal sciatic palsy are reported. Autopsy in one suggested that the paralysis was due to direct pressure on the sciatic nerve before birth. 3. A hypothesis is advanced by which to explain how pressure on the nerve trunk may arise in utero

1. A series of patients with respiratory paralysis after anterior poliomyelitis is reported. 2. The examination routine is described and its value discussed. 3. Details are given of methods of respiratory rehabilitation and of the various pitfalls encountered, with suggestions for their avoidance. 4. The rates of recovery of vital capacity (and percentage of the expected vital capacity) in adults and children are analysed and compared with the rates given by Sharrard for nonrespiratory individual muscles in treated patients. It is shown that during the first year treated patients tend to recover approximately 3 to 4 per cent of their expected vital capacity per month rather than to regain any definite proportion of their current vital capacity

1. The belief that the cessation of spinal growth and curve progression coincides with the completion of growth in the iliac apophyses has been confirmed in a review of material from 224 cases. This applies also to paralytic curves. 2. In a high number of cases this ossification centre showed an asymmetrical development on the two sides of the pelvis. The appearance of a separate posterior centre of ossification is also common, and probably represents an advanced stage in the growth of the iliac apophysis. 3. Menarche and the growth of the apophyses of the vertebral bodies almost always occurred in advance of the iliac apophyses. They should be regarded as early signs of maturation, not reliable in the prognosis of curve progression. 4. The growth of the iliac apophysis appeared to be unaffected by poliomyelitis

Twenty complex tibial deformities due to anterior poliomyelitis in 18 patients were corrected by a modified O’Donoghue osteotomy. This technique allowed correction of the deformity in three planes. This was achieved by widening the rectangular window distally to correct both rotation and valgus and by trimming the anterior edges of the step cuts to correct flexion deformity. An above-knee cast was applied for eight to 13 weeks and the patients followed up for a mean of 3.2 years. One of the 18 patients developed delayed union because of fracture of the medial limb of the step cut. The results showed excellent correction of the three-plane deformity and there was no recurrence. This method of osteotomy is a safe and simple procedure which does not require internal fixation and allows correction of torsional and angular deformity

1. A survey of 112 cases of residual poliomyelitis with leg shortening of 2·5 centimetres or more is reported. 2. In eighty-seven patients paralysed in early infancy the fibular shortening was greater than the tibial shortening. 3. The absence of the normal "to and fro" motion of the fibula causes delay in the appearance of the fibular epiphyses and retards fibular development. 4. The shortening of the fibula in infancy causes deformity at the ankle, in the tibia itself and at the knee. 5. At the ankle the poorly developed lateral malleolus causes wedging of the lower tibial epiphysis and valgus at the ankle, which is often unstable. 6. At the knee progressive genu valgum is produced and in the tibia lateral torsion occurs. 7. The clinical significance of these deformities in relation to reconstructive procedures is stressed

A new technique of shoulder fusion is presented using a posterior approach. After removal of the articular cartilage, a Rush pin is introduced from the spine of the scapula, through the glenoid into the medullary canal of the humerus. This is supplemented by tension-band wiring from the acromion to the neck of the humerus and a muscle pedicle graft attached to the acromion. A shoulder spica is applied for four to six weeks. Four patients with injuries to the upper brachial plexus and 14 with paralysis of the upper arm due to anterior poliomyelitis have been followed for three years. One of the 18 patients developed nonunion; she had removed her own cast prematurely. This method of fixation provides high shear resistance and low axial stiffness without deforming plastically. It does not affect bone growth in young patients, is effective in patients with osteoporosis, and gives a high rate of union

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

1. Forty-eight paralytic dislocations of the hip have been studied and twenty-seven operations for correction of valgus deformity of the femoral neck have been done. 2. The differing features of dislocations occurring in poliomyelitis, cerebral palsy and meningomyelocoele are considered in relation to management after operation. 3. Early recognition of subluxation is essential to a successful varus osteotomy. An angle of 105 degrees rather than the 120 degrees previously recommended is advisable for children under the age of five. 4. Redislocation is most likely to occur in meningomyelocoele in which muscular imbalance is greatest, and in later cases where the acetabulum has become shallow by growth without the femoral head within it. It has not occurred as a late complication after weight bearing has been established, from a recurrence of valgus deformity

1. The treatment of contractures at the hip secondary to poliomyelitis by Soutter's muscle slide or by Yount's fasciotomy gives excellent results. So does high femoral osteotomy, but it is not superior to the other two and should therefore be kept in reserve as a supplementary operation for the completion of correction of a deformity so gross as not to be wholly remediable by division of the soft parts. 2. Subluxation of the hip occurs only if the paralysis comes on during the first eighteen months of life and is a product not of severe paralysis but of unbalanced and often slight weakness of muscles. Correction of the invariable valgus deformity of the femoral neck by osteotomy is followed by relapse; acetabuloplasty too is unreliable. The most promising remedy seems to be some form of acetabuloplasty combined with transplantation of an iliopsoas of adequate strength into the greater trochanter. The indications for arthrodesis are few, but the results of this operation are good. 3. In the few patients with abductor weakness and little else the dipping gait may be abolished by iliopsoas transplantation