1. The literature on fractures of the postero-superior aspect of the calcaneus is reviewed.

2. The mechanical distinction between "beak" fractures and avulsion fractures is questioned, and the dangers of a purely radiological diagnosis are stressed.

3. When a complete avulsion is suspected on clinical grounds, open reduction should be done.

1. Five cases of avulsion fracture of the calcaneus are reported.

2. The "beak" fracture of the calcaneus is thought to be a variant of the avulsion fracture and not a separate entity.

3. The variable attachment of the calcaneal tendon to the calcaneus is described, and its relationship to the different forms of avulsion fractures discussed.

4. Operative reduction and fixation are appropriate for young and active patients in order to restore full heel-cord function.

5. Attention is drawn to the risk of pressure necrosis of skin overlying a displaced fragment. Early operative correction may be required to prevent skin damage.

1. Seventy patients with impacted fractures of the femoral neck treated from 1953 to 1965 have been reviewed. Forty-seven were treated conservatively and twenty-three by primary internal fixation.

2. The complications of both methods of treatment are recorded.

3. The prognosis following impacted femoral neck fractures is good. Seventy-nine per cent treated conservatively and 96 per cent treated by primary internal fixation had excellent or good results.

4. Primary internal fixation is the treatment of choice.

1. It appears that fracture of the humeral shaft occurs more often in persons over fifty. This incidence corresponds with that found in a study carried out by the Pennsylvania Orthopaedic Society in 1959.

2. The middle third of the bone is the most vulnerable portion of the shaft, where transverse fracture and radial nerve palsy most commonly occur.

3. Most fractures of the shaft of the humerus are best treated by simple splintage. The degree of radiological deformity that can be accepted is far greater than in other long bones. In this group anterior bowing of 20 degrees or varus of 30 degrees was present before it became clinically obvious and even then the function of the limb was good.

4. Internal fixation is only occasionally indicated but operation on the middle third of the bone increased the chances of delayed union.

5. In the treatment of delayed union intramedullary fixation and the application of slivers of iliac bone is effective in stimulating the fracture to join.

1. Stress fractures of the femoral neck in twenty-five patients are described.

2. Two distinct radiological types, compression fractures and transverse fractures, are described. A clinical distinction cannot be made in the early stages.

3. The importance of the early differential diagnosis between the two types is emphasised because the transverse stress fracture of the femoral neck will become displaced.

4. The morbidity after a displaced transverse fracture of the femoral neck can be severe.

1. The conservative school of treatment of fractures of the tibia, which bases part of its criticism of internal fixation on the ultimate risk of amputation, does not often publish its own rates of amputation.

2. Statistics from a hospital that treats one-third of closed fractured tibiae and two-thirds of compound fractures by internal fixation are therefore put up as a basis for criticism.

3. Comparisons are made with the few available statistics in the literature of conservative treatment.

4. Almost all of the causes for secondary amputation are now curable and in recent years the number of limbs being saved is increasing.

1. A series of 705 fractures of the tibia is reviewed, 674 of which were treated conservatively.

2. The factors most conducive to delayed or non-union are initial displacement, comminution, associated soft-tissue wound and infection. The extent to which these are combined in any fracture determines its "personality" and its inherent propensity for union.

3. Eight fracture types are differentiated based on the above "personality rating." The incidence of delayed union or non-union varies from 9 per cent in the most favourable type to 39 per cent in the least favourable. Infection raises the incidence to 60 per cent. Comparative statistics which fail to recognise these differences can be entirely misleading.

4. Continuous traction does not retard union.

5. The results of conservative treatment are analysed with regard to union, deformity, stiff joints and contractures and the conclusion is reached that no case has yet been made out for internal fixation as the method of choice in the treatment of this fracture.

1. During two years eighty-five children with supracondylar fractures of the humerus were admitted to a children's hospital. This paper is a study of the severe fractures which occurred in twenty-three children of whom fifteen had a deformity at review.

2. The only deformity found after treatment by closed manipulation was an alteration in the carrying angle. It is considered that cubitus varus was caused by medial angulation of the distal fragment.

1. Stress fractures are described in children. The fibula and tibia are most often affected.

2. Stress fractures of the humerus are described in two boys aged fifteen.

3. Stress fractures are described in the pelvis in children.

1. Experimental radiological and mechanical studies on a cadaveric cervical spine are reported.

2. A series of fifty-nine dislocations and fracture-dislocations of the cervical spine is reviewed.

3. The methods of reduction and indications for operation are discussed.

A study of a collected series of femoral neck fractures in seventy-one children observed for one to nineteen years shows:

1. This injury is rare but occurs in children of all ages from three to sixteen years old.

2. The fractures may be classified as transepiphysial, transcervical (the commonest), basal and pertrochanteric. Displacement was frequent.

3. The fracture usually followed severe violence, especially falls from a height or motor accidents.

4. Complications were frequent and included avascular necrosis, delayed union (seventeen cases), non-union (seven cases) and disturbances of growth at both the upper and lower ends of the femur.

5. Avascular necrosis occurred in thirty patients (42 per cent). Three patterns of necrosis are described : diffuse, localised and confined to the femoral neck. The radiographic appearances of avascular necrosis after this fracture are different from those of pseudocoxalgia (Legg-Calvé-Perthes' disease).

6. Non-union did not occur after adequate primary internal fixation or after primary subtrochanteric osteotomy.

7. The management of an undisplaced fracture presented no great problem and the results were good. A plaster spica is recommended for treatment of this fracture. Exceptionally, avascular necrosis developed.

8. Treatment of the displaced fractures (forty-nine cases) was less satisfactory. A good result was obtained from primary treatment in only fifteen patients.

9. The value of different methods of primary treatment is discussed, including manipulative reduction and immobilisation in a plaster spica, manipulative reduction and internal fixation, and primary subtrochanteric osteotomy. Manipulative reduction and immobilisation in a plaster spica is not recommended.

10. Salvage operations were required in nineteen patients. Late subtrochanteric osteotomy is of value in the management of some of these problems.

1. Aching pain in the thigh, hip or buttock in an elderly person should lead to radiological examination of the hip region. In patients who have been subjected to irradiation for pelvic neoplasms a spontaneous fracture should be strongly suspected and the patient kept under close review, even if the first radiograph is negative.

2. Patients with spontaneous fractures of the femoral neck can be satisfactorily treated by Smith-Petersen nailing even when symptoms have been present for as long as sixteen weeks and displacement for eight weeks. Osteotomy is unnecessary if adequate reduction can be obtained.

Six patients with longitudinal stress fractures of the tibia and femur are described. The difficulties of diagnosis and its confirmation are emphasised.

Case histories are given of three patients, two of whom had stress fractures of the patella, and one had a similar condition due to stress.

1. Three cases of metaphysial fractures in infants are described. Obstetrical trauma was probably responsible in two cases, and in the third case direct injury was admitted by the parents.

2. These fractures are associated with bone destruction and periosteal new bone formation in the metaphyses. They are important because they can be confused with syphilis, tuberculosis, scurvy, osteomyelitis and neoplasm.

3. The fractures respond to conservative treatment and usually heal rapidly in a matter of weeks.