1. A technique of arthrodesis of the trapezio-metacarpal joint of the thumb is described. Primary fusion was achieved in thirty-six of thirty-nine cases.

2. Compensatory movement at the adjacent joints permits a good range of thumb movement.

3. Trapezio-metacarpal arthrodesis is the operation of choice for patients under fifty with isolated osteoarthritis of this joint. It is also useful for stabilising the thumb in patients with paralysis of the thumb when adequate muscles for transfer are not available.

1. The Batchelor method of subtalar fusion by a fibular graft inserted through the neck of the talus is described.

2. The results of the operation appear to be satisfactory.

1 . The results of compression arthrodesis of the hip have been studied in fifty-six patients. There was one post-operative death from pulmonary embolism on the tenth day.

2. Bony union for the whole series (fifty-five patients) was achieved in 76·4 per cent. Sound fibrous ankylosis, indistinguishable from bony union clinically and functionally, was achieved in 10·9 per cent. Residual movement occurred in 12·7 per cent.

3. Thirty-five patients were treated by the standard technique of eight weeks in plaster, followed by full weight bearing, irrespective of whether any movement was detected on clinical testing. 82·8 per cent achieved sound bony union; 5·7 per cent achieved sound fibrous ankylosis, and residual movement occurred in 11·4 per cent.

4. Ten patients were treated without plaster protection; six achieved bony union; three had sound fibrous ankylosis and one had residual movement. Healing was delayed in this group and there was more residual deformity.

5. 67·5 per cent of all patients recovered full knee range. Only one patient with reduced range had knee flexion of less than 90 degrees. Twenty-four of the thirty-five patients treated by the standard technique of eight weeks in plaster were examined. Fifteen had full knee movement; in only four was knee flexion less than 120 degrees and in no case was it less than 90 degrees.

6. Return to full activity was rapid. Sixty per cent of patients returned to work within six months and 80 per cent within nine months of surgery. Five of the six patients examined with residual movement in the hip joint were back at work within six months of surgery.

7. This study lends support to the view that arthrodesis of the hip, in the presence of normal function in the opposite hip, is compatible with vigorous and full activity.

1. The results of ischio-femoral arthrodesis for tuberculous arthritis of the hip in thirty-five adults and in twenty-nine children are reported. The "blind" technique of Brittain was used in thirteen patients and the open technique in fifty-one.

2. Bony fusion was obtained by the first operation in thirty-three out of the thirty-five adults and in twenty-three out of twenty-nine children. In children strikingly better results were gained from the posterior open technique than from the original "blind"technique of Brittain.

3. There was no evidence that ischio-femoral arthrodesis in children interfered with the growth of the limb.

The Brittain V-arthrodesis is a satisfactory procedure for osteoarthritis of the hip. It is particularly suitable for elderly patients when the range of hip flexion is less than 60 degrees. If the four deaths are excluded, two-thirds of the patients secured a sound bony fusion. This occurs slowly. All but one of the patients who survived for three years or more after operation had a sound bony fusion. It is evident that the operation, given time, yields a high rate of sound bony fusion in the hip. It seems likely that use of the McLaughlin nail plate would prevent the one serious complication, namely fracture of the shaft of the femur through or immediately below the drill hole made for the fibular graft.

1. A medial approach is preferred for arthrodesis of the wrist in reconstructive surgery because there is no interference with the extensor tendons.

2. The value of pre-operative assessment by a trial period in plaster is mentioned.

3. The technique of operation is described.

4. In the absence of active pronation, screwing the ulna to the radius in 45 degrees of pronation is advised.

5. The necessity for securing haemostasis before closing the wound is emphasised.

6. Thirty-four cases are reviewed. The shortest follow-up was one year and the longest twelve years. The result was satisfactory in all cases. Most patients were discharged from hospital after the plaster had been changed two weeks after operation. Union occurred in about sixteen weeks.

1. This is a simple clinical study of the end-results of arthrodesis of the hip joint in patients followed up and re-examined five to twenty-five years after operation.

2. The study was stimulated by our astonishment at recent reports which suggested that arthrodesis of the hip caused serious operative mortality, a high rate of wound infection, and failure of sound fusion in one of every two cases; and that even when sound fusion was gained there was always pain in the back and usually stiffness of the knee. To say that we were astonished puts it mildly.

3. This review includes 120 patients aged from ten to seventy years, treated for osteoarthritis of the hip joint by intra-articular arthrodesis with the internal fixation of a nail, usually with an iliac graft, and with immobilisation in plaster for not less than four months.

4. Of these 120 patients there was sound fusion of the joint, proved radiographically, in 94 per cent; a mortality of nil; and recovery of free movement of the knee joint to the right angle or far beyond in 91·5 per cent. Almost half of the patients regained normal movement, the heel touching the buttock. Only in eight patients was there less than right-angled flexion.

5. There was no pain in the back—none whatever—in 64 per cent of the patients. In 36 per cent there was some pain or discomfort. One alone said that the low back pain was worse than before the operation. Many others said that pain in the back had been relieved by the operation.

6. It is emphasised that these results were gained only from sound fixation of the joint in the mid-position with neutral rotation, no more abduction than is needed to correct true shortening, and no more flexion of the joint than that with which the patient lies on the table. The limb was immobilised in plaster for at least four months after operation. The stiff knee was mobilised by the patient's own exercise without passive stretching, force or manipulation.

7. Two other groups of patients are considered. There are fourteen treated by fixation of the joint with nail alone, an operation that was never intended to arthrodese the joint and which has long since been abandoned. The other small group is that of patients with old unreduced traumatic dislocation of the hip, a procedure in which the risks of operation are so great and the number of successful results so small as to dissuade us from attempting operative reduction.

8. After successful arthrodesis of the hip joint patients can return to every household activity and every recreation including ski-ing, mountaineering, rock climbing, or whatever else they want.

1. The usual methods of posterior arthrodesis of the lumbo-sacral joint are not satisfactory in cases in which laminectomy has been performed.

2. Estimation of fusion by mobility radiographs is unreliable and cannot distinguish between fibrous ankylosis and bony fusion.

3. Bone grafts inserted from behind between the vertebral bodies almost invariably fail to become incorporated.

4. Intertransverse arthrodesis has given promising results and is probably the best method available at present.

1. The indications for ischio-femoral arthrodesis are considered.

2. The technique of operation through an open posterior approach is described.

3. Indications for the modified Trumble operation are given.

4. The results of ischio-femoral arthrodesis in a series of forty-seven patients (mostly suffering from tuberculous hip disease) are presented.

5. The writers consider that ischio-femoral arthrodesis is the operation of choice in tuberculous disease of the hip, especially in children.

1. Fifty cases of arthrodesis of the hip joint in tuberculous arthritis are analysed; in forty cases the late end-result has been ascertained two or more years after operation.

2. The indications for arthrodesis are discussed. The operation should not be performed when disease is active; it should not be undertaken before the age of twelve to thirteen years; it is not advisable in elderly patients; it may be contra-indicated when there are multiple foci of infection. Subject to these limitations every patient with unsound ankylosis after adequate conservative treatment should be treated by arthrodesis; painful fibrous ankylosis and late onset of deformity are definite indications.

3. Three types of operation have been used: intra-articular arthrodesis; extra-articular ilio-femoral arthrodesis; combined intra- and extra-articular arthrodesis. Extra-articular ilio-femoral arthrodesis is preferred, deformity being first corrected by traction or osteotomy.

4. Post-operation complications were few; the mortality rate was low (2 per cent.).

5. There was bone ankylosis with solid incorporation of the graft in 87·5 per cent., failure of union of the graft (to the trochanter) in 10 per cent., and destruction of the graft in 2·5 per cent.

6. Late end-results show full working capacity in 87·5 per cent. of patients, part working capacity in 2·5 per cent. and inability to work in 7·5 per cent.

The writer wishes to express his thanks to Professor Harry Platt and Professor T. P.. McMurray for criticism and advice in the preparation of this paper, and to Dr F. C. S. Bradbury, Central Consultant Tuberculosis Officer of the Lancashire County Council, for permission to publish these cases.

Our investigations have shown that the late results of tarsal arthrodesis are good. We have endeavoured to find the disadvantages and to stress residual symptoms, but the general mpression after seeing these patients is that they were all well satisfied with the result. We think it should be added that these patients were selected in so far as they were all operated upon by masters of operative technique who were acknowledged authorities in this particular subject. Without the careful attention to detail and to the points discussed, these operations can be dismal failures and a burden to the patients concerned.

1. The anatomical and physiological principles underlying the operation of ischio-femoral arthrodesis by an anterior approach are discussed.

2. The technique of the operation is described.

1. A long term review of arthrodesis in the management of hallux valgus and rigidus is presented.

2. This is briefly compared with Keller's operation.

3. Eighty-five per cent of patients had a satisfactory result.

4. The reasons for failure and the errors in operative technique are discussed.

1. A simple cone arthrodesis of the metatarso-phalangeal joint of the big toe based on the Rose and Mann operations is described.

2. New instruments have been devised to simplify the procedure.

3. Thirty-one operations have been performed on twenty-three patients. Bony fusion has occurred in all but one case. There have been no complications.

1. Central dislocation of the hip combined with ilio-femoral intramedullary nailing is a technically difficult operation, but one which, if well done, provides a high percentage of hip fusion without external fixation.

2. Fifteen hips have been operated upon. Twelve have fused; two cannot yet be assessed as the time since operation is too short; and one failed, presumably due to osteoporosis resulting from rheumatoid arthritis.

1. An analysis of 171 cases of compression arthrodesis in the knee is presented.

2. A total success rate of 98·8 per cent was revealed.

3. The average time between operation and walking free of splintage was nine weeks.

4. When the compression was removed, after an average period of four weeks, 88·2 per cent of the knees already showed clinical union.