Acute colonic pseudo-obstruction is a poorly recognised and potentially fatal complication of hip surgery.

Between 1991 and 1994 six patients were observed who required laparotomy after failure of medical management. In three the indication was signs of peritonism, while in the other three exploration was required to exclude segmental ischaemia and to decompress the bowel. In all, there was no evidence of mechanical obstruction.

Patients having total hip replacement are at risk of developing pseudo-obstruction due to their age, comorbidity, high doses of analgesics and the nature of the operation. If postoperative ileus persists for more than 48 hours acute colonic pseudo-obstruction should be suspected and confirmed by plain radiography. Prompt recognition and treatment with early referral to a colorectal unit are indicated. Laparotomy appears to carry less risk than that for patients with idiopathic pseudo-obstruction, but should be performed only if colonic ischaemia is suspected.

We present a prospective study of the treatment of 32 unstable Colles’ fractures by external fixation and cancellous grafting with minimal exposure. We inserted an external fixator between the radius and the second metacarpal, and maintained ligamentotaxis for five weeks.

In 27 patients the result was good or excellent, but five fractures healed with malunion. All patients made a satisfactory functional recovery. At a mean follow-up of three years (1 to 5) after injury none had pain in the wrist and all were satisfied with the result. The average grip strength was 95% of normal. Seven patients had algodystrophy with mild impairment of finger movements in four.

We conclude that the combination of cancellous grafting and external fixation is effective for the treatment of unstable Colles’ fractures.

We studied 40 patients in whom the patella was not severely deformed and who were undergoing primary total knee arthroplasty (TKA) for osteoarthritis by one surgeon using one type of prosthesis. They were randomly allocated either to have the patella retained or resurfaced with a cemented, all-polyethylene component regardless of the state of the patellar articular cartilage. Apart from removal of osteophytes, no surgery was undertaken on the retained patellae. All 38 surviving patients were evaluated at three years using the HSS knee score and a new, specifically designed Patellar score (maximum score of 30). No TKA was revised, but two patients in the resurfacing group had a further unrelated procedure.

The mean HSS and Patellar scores at follow-up were 89 and 28 in the patellar retention group and 83 and 26 in the patellar resurfacing group. Statistically significant lower scores for both were recorded in women and in heavier patients. Stair-climbing ability was significantly better in the retention group. Although there were no complications related to patellar resurfacing, in the medium term we did not find any significant benefit from resurfacing the patella during TKA for osteoarthritis if it was not severely deformed.

We describe unexpected adverse psychological and social results in three adult men with severe Little's disease who were made more mobile by successful surgery.

1. The normal vascular anatomy of flexor tendons and extensor tendons in the hind limb of the rabbit is outlined. A marked difference between a tendon in a sheath and a tendon with a paratenon is shown, the latter having a much better blood supply.

2. The vascular reaction in flexor tendon divided within a sheath is shown.

3. The revascularisation of free grafts is illustrated and the differences between tendon with sheath and tendon with paratenon are detailed.

4. Experiments are reported to show that the microcirculation within a "vascular" tendon can support a pedicle graft in the rabbit. Such pedicle grafts are shown to be inferior to free grafts of "avascular" tendon, but the vascularity within the pedicle tendon graft may be modified by "blocking" the surface with silastic tubing.

5. The implications of this work on tendon grafting are discussed, together with a review of additional experimental work in related fields.

1. Two cases of pseudomalignant osseous tumour of soft tissue are reported and added to the nineteen cases in the literature.

2. The clinical and histological features are described and distinguished from myositis ossificans, osteogenic sarcoma in soft tissue and parosteal fasciitis.

3. In one case the non-malignant nature of the lesion has been confirmed by its spontaneous regression.

1. Fifty knees affected by rheumatoid arthritis were studied in detail at synovectomy.

2. The destructive lesions found were relatively constant and are described in detail.

3. Cartilage lesions were much more common than was expected radiologically.

4. The pattern described suggests that articular cartilage is destroyed by contact with diseased synovial membrane but protected by contact with another cartilaginous surface.

1. Twenty-eight patients with pyogenic infection of the spine are reported.

2. Diagnosis was by clinical, radiological and bacteriological means. Investigations of the spinal lesions by needle aspiration or open operation was needed in four patients.

3. Treatment consisted primarily of antibiotics and rest.

4. Twenty-five patients were fit and well after follow-up of one to fifteen years. Three deaths occurred, but only one was directly connected with the infection ; urinary infection with paraplegia and haemophilia were the cause in two others.

5. The relatively benign course is stressed, as are some of the diagnostic pitfalls in the early stages, particularly with thoracic lesions.

1. In chronic osteomyelitis grafting a cavity with split skin is a reliable method of treatment. The skin cover so obtained is durable.

2. The method may be used with good prospects of success even when the cavity is large and there is extensive disease of bone.

3. Operation is indicated for the relief of pain, to close a sinus or sinuses, to obtain healing of an ulcer or to prevent recurrent episodes of acute infection.

4. The technique of operation employed in eleven cases is described and illustrative case reports are given.

1. Sixty-seven patients with subacute haematogenous osteomyelitis are reported.

2. The benign nature of the disease is noted.

3. The clinical types of infection are reported, with regard to the site of the lesion.

4. The treatment is described.

1. A woman of seventy-four presenting with gigantism of the left hand and foot, lipomatosis, progressive arthropathy and psoriasis is described.

2. The associations of the various conditions are examined in the light of the previously reported cases and the differential diagnosis of this condition (macrodystrophia lipomatosa) from other causes of localised gigantism is discussed.

A brief review of the literature on malignant change occurring in fibrous dysplasia is given and a further case of a sarcoma arising in a patient with polyostotic fibrous dysplasia is reported.

1. Forty-eight patients with spontaneous rupture of the tendon of the extensor pollicis longus have been studied and the results of forty-four operations by tendon transfer are reported.

2. The etiology and the pathology of the condition are discussed.

3. Transfer of the extensor indicis in general gives a better result than transfer of the extensor carpi radialis longus, but each method has its advantages and disadvantages.

4. The best results are obtained when the suture is done so as to leave the tendon in the fullest degree of tension obtainable.