1. A series of patients with recent ligamentous injuries of the ankle is presented. Stress radiography and arthrography were carried out in all cases, with surgical exploration where indicated. The findings are correlated.

2. Both stress radiography and arthrography are unreliable in the diagnosis of injuries to the "lateral ligament" of the ankle.

3. Arthrography may be useful in the demonstration of injury of the inferior tibio-fibular joint and of the medial ligament.

1. Three cases of delayed occlusion of the popliteal artery following trauma are described.

2. The lesion responsible is a partial rupture of the vessel with subsequent thrombosis.

3. All such lesions should be explored and preferably resected.

The use of the upright position of the patient, and a vertical incision for exposure of the brachial plexus, has been attended by no complications or serious hazards. The aid of skilled anaesthetists is acknowledged. The structures are visible and accessible; the operative field is steady; bleeding is controlled easily; and dissection is facilitated. By this technique it has been possible to explore a larger field from above, and division of the clavicle has seldom been necessary. Finally, and of importance, the operative area at shoulder level enables the surgeon to continue tedious dissection for some hours comfortably, and to escape postoperative postural complications in his own back.

1. Sixty-three traction injuries of the brachial plexus in adults are reviewed. Most of the patients were seen at regular intervals for more than three years after injury.

2. The mechanism of injury is described. Forcible separation of the head and shoulder is the essential factor, but the type of lesion is determined by the position of the upper limb at the time of the accident.

3. In traction injuries the main damage is intraneural, and the lesions are of considerable extent. Extraneural scarring is a conspicuous feature of old injuries, but it does not cause any damage to uninjured parts of the plexus.

4. The prognosis of each type of lesion of the plexus is discussed. Satisfactory recovery occurs in most lesions of the upper three roots. Degenerative lesions of the whole plexus never recover completely. Cases with Horner's syndrome always have severe residual paralysis.

5. Conservative treatment is advocated for traction injuries of the plexus and evidence is cited against early or late operations on the plexus. Reconstructive surgical procedures are sometimes indicated.

The operative treatment of lesions of the anterior cruciate ligament (ACL) in athletes has been widely advocated and performed. We have investigated the outcome of non-operative management in a lower-demand, general population. We reviewed a consecutive group of 228 patients, which excluded professional and high-level athletes, for two to 12 years after an ACL lesion had been diagnosed by arthroscopy.

There was a low incidence of secondary ACL and meniscal surgery, 5.4% and 3.5% respectively, and all these procedures were performed during the first three years after the ACL injury.

We studied a subgroup of 109 patients with follow-up of at least five years (mean 8.5 years) and evaluated them using the IKDC score. The general outcome was reasonably satisfactory, with 23% in grade A, 50% in grade B, 21% in grade C and only 6.4% in grade D. We found no statistically significant prognostic effect within this group as regards age, activity levels, or the incidence of associated lesions.

Four patients with injuries of the acetabular triradiate cartilage are presented. In three of them premature fusion of the cartilage occurred; two of these developed acetabular deformity and subluxation of the hip. In all patients the sacroiliac joint also was injured; in two, the joint was completely disrupted, leading to fusion and growth disturbance of the ilium. As injury of the triradiate cartilage is easily missed on the initial radiograph, it is advised that all patients with pelvic trauma should be followed clinically and radiographically for at least one year.

Two cases of laterally open knee joints with surrounding skin defects are reported. The joints were closed by muscle flaps fashioned from the lateral belly of the gastrocnemius, which was detached distally and folded upwards and forwards to cover the defect. The transposed muscle and the remainder of the wound were covered by free skin grafts. Results were satisfactory.

1. Four cases of vascular injury during lumbar disc removal are reported, and the literature is reviewed. One of the cases is unique in that the inferior mesenteric artery was transected.

2. Clinical syndromes associated with various vascular injuries are discussed.

3. The possibility ofvascular injury should always be kept in mind during lumbar lam inectomy for disc prolapse. Unexplained hypotension is strongly suggestive of a vascular catastrophe. The advent of high output cardiac failure in the patient who has recently undergone lumbar disc removal is almost diagnostic of traumatic arteriovenous fistula.

1. Sixty myelographs have been obtained in severe traction injuries of the brachial plexus.

2. Seventy-eight traumatic meningoceles were outlined.

3. Multiple meningoceles indicate a gloomy prognosis.

4. In forty patients the results were compared with those obtained with the "axon reflex."

5. Myelography is a valuable aid in obtaining an early prognosis but the results must be correlated with the clinical picture.

1. A series of six traction lesions of the common peroneal nerve in association with a severe adduction force to knee is described.

2. The reasons for failure of the nerve repair are discussed.

3. A new system of radiological marking of the anastomosis is described.

4. A less pessimistic view of the prognosis is taken than heretofore, and the management of the injury is discussed with a recommendation that a more conservative resection be done three months after the injury.

1 . Thirty-six patients with complete irrecoverable brachial plexus lesions have been studied.

2. Function has been compared after 1) arthrodesis of the shoulder with amputation through the arm, 2) so-called reconstructive procedures, and 3) no operative treatment.

3. The results of reconstructive operations have been so disappointing that we believe that this type of treatment should be abandoned.

4. Amputation-arthrodesis offers a better functional result than either reconstruction or no operation. Its value depends to a considerable extent on the manual dexterity of the patient.

5. A clerical worker who is not mechanically minded is less likely to use an artificial limb, and in this type of patient operation is perhaps best avoided.

1. A series of 149 consecutive cases of flexor tendon grafting in the fingers and thumb is reviewed and the results are analysed. A description of the technique which has evolved from this experience is given.

2. Replacement of a divided flexor digitorum profundus in the presence of an intact sublimis tendon restored a useful range of movement in 80 per cent of cases.

3. Replacement of both flexor digitorum profundus and sublimis gave good results in 70 to 80 per cent of cases.

4. Replacement of a divided flexor pollicis longus tendon gave good results in 85 per cent of cases.

5. The particular tendon used for the graft did not materially influence the result, but there are special indications for the use of the different tendons.

6. The choice of splintage or of early movement after operation does not appear to have a significant bearing upon the result.

7. The most important factor in determining the result is probably a precise and gentle surgical technique and complete haemostasis. Minor differences in method are of little importance. The failures in this series were due more to faulty performance of the operation than to any other single factor.