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.
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.
1. Regional osteoporosis is a common finding in osteoid osteoma. It may in fact be a constant feature because it was present in all the patients reported in this paper and was suspected in others who have not been included in this report because of insufficient information. 2. Five of our six cases showed osteoporosis about the hip. Osteoporosis is more likely to be noticed in this region than in other parts of the extremities because both hips are usually radiographed on one film. We have seen several instances in which we suspected generalised osteoporosis of an extremity but Case 5 was the only one in which comparable radiographs had been taken of both feet. 3. When there is osteoporosis in the region of a joint with symptoms referred to that joint an osteoid osteoma may be the cause. The nidus may lie at some distance from the joint surfaces and may not be seen in standard radiographs of the joint (Case 4). Additional radiographs including a wider area than usual may be necessary to show the lesion, and tomography is sometimes required.
1. Attention is drawn to the powers of resistance of the growing ends of bones in suppurative pyogenic arthritis of the knee and hip in infancy. 2. It is emphasised that a translucent zone in the radiograph does not necessarily mean that this part of the bone, epiphysial cartilage or plate is destroyed. 3. Diagnostic criteria are described to confirm that cartilage or decalcified bone has survived the infection in the knee joint. 4. The prognosis for the knee joint is discussed. 5. The hip joint presents greater difficulties in diagnosis and greater issues are at stake. It is recommended therefore that the hip joint be manipulated or explored if the radiograph and the physical signs suggest that destruction of the joint has either caused dislocation or has so damaged it that dislocation is likely to occur in the future. In favourable cases stability may be restored to the hip. In the others a diagnosis of irreparable destruction is established and the surgeon is satisfied that an opportunity to help the patient has not been lost.
1. We have described an operation the aim of which is to reduce the gap at the pubic symphysis which accompanies ectopia vesicae. 2. The operation. as it is now performed, simplifies subsequent bladder closure and repair of the associated divarication of the recti.
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.
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.
1. The capsular changes in osteoarthritis of the hip and their pathogenesis are described, and it is concluded that symptoms are due mainly to this abnormality. 2. The clinical significance and pathogenesis of subchondral sclerosis, cysts, osteophytes, secondary subluxation and new bone formation on the lower border of the femoral neck are discussed. 3. These bony features which can be seen in the radiograph may, under certain circumstances, be correlated with the symptoms. 4. The influence of joint debris and capsular fibrosis upon the symptoms arising in other osteoarthritic joints is considered. 5. The mechanism by which osteoarthritis develops in hip joints with an anatomical abnormality is discussed in relation to the normal functional anatomy of the hip. 6. The evolution of osteoarthritis in dysplasia of the hip is considered with special reference to its diagnosis, prognosis and early treatment. 7. The supposition that osteoarthritis is commonly due to progressive ischaemia in the femoral head has been investigated and is rejected. 8. The cause of idiopathic osteoarthritis remains obscure but the evidence suggests that constitutional rather than local conditions in the joint account for many of these cases.
1. The synovial membrane and capsule in osteoarthritis of the hip have been studied in twenty-five cases. Dissections have been made on fresh cadavers to establish the normal structure and function of these tissues at different ages. 2. Fragments of bone and cartilage were found beneath the synovial surface in twenty-three cases of the twenty-five cases of osteoarthritis. 3. The source of these fragments is the degenerate articular surfaces. 4. The fibrosis of the synovial membrane and capsule follows the synovial hyperplasia which accompanies the phagocytosis of these fragments. 5. A similar histological picture has been produced by injecting fragmented cartilage into the knee joints of rabbits. The injected fragments are found beneath the surface, and synovial hyperplasia is followed by subsynovial fibrosis. 6. The greatest amount of this joint debris is found in the lowest part of the joint cavity. 7. The joint capsule is particularly sensitive to traction. 8. All parts of the capsule are tight in extension, which is the weight-bearing position. 9. Fibrotic shortening of the capsule in the lowest part of the joint cavity explains many of the symptoms and signs of the disease: pain is caused by an attempt to stretch the capsule; muscle spasm occurs in the muscles supplied by the sensory nerves of this part of the capsule; extension, medial rotation and abduction, which tighten this area, are lost first; progressive shortening causes deformity in the opposite direction, namely flexion, lateral rotation and adduction; the loss of extension causes a more rapid wearing of articular cartilage on weight bearing; subperiosteal new bone is formed on the under-surface of the neck of the femur. 10. The symptomatology is discussed.
