1. This paper presents the neurological findings in forty-one patients with rheumatoid arthritis complicated by atlanto-axial subluxation.

2. A method of radiological measurement of the subluxation is described. The extent of neurological involvement was found not to correspond with the degree of subluxation.

3. Fusion of the atlanto-axial complex or of the occipito-atlanto-axial complex is indicated only in patients with progressive neurological signs and in those suffering from acute neurological episodes.

4. Difficulty in obtaining fusion with cancellous bone grafts alone was encountered and we recommend wiring of the laminae C.1 to C.2 in addition.

1. The results of excision of the distal end of the ulna in eighty-six wrists of seventy patients suffering from rheumatoid arthritis are presented.

2. There was relief of pain in 93 per cent and restoration of full rotation in 87 per cent.

3. Further destructive changes of the radio-carpal joint were seen in 85 per cent, but these did not affect the good clinical results.

1. The results have been reviewed of forty-two traumatic dislocations of the knee in forty-one patients, twenty-six of which were treated conservatively.

2. Primary operative repair was carried out in only three cases, although a further ten had operative intervention for various complications.

3. It was not possible to compare the results of operation with those of conservative treatment, because the operative procedures were so diverse in nature.

4. The conservative treatment of twenty-six dislocations yielded surprisingly good results with regard to stability, absence of pain, and range of flexion movement.

5. In general, immobilisation for long periods, like operative repair, led to reduced movement.

6. In the absence of complications, conservative treatment is the method of choice.

1. In twenty-five patients with rheumatoid arthritis of the knee examined by contrast arthrography certain typical features were encountered. These consisted of enlargement of the suprapatellar pouch and loss of the normally smooth outline of the joint cavity because of nodular filling defects. In some cases less definite filling defects were seen, due to loose fibrinous deposits, particularly in popliteal cysts.

2. This method of assessment of the results of synovectomy of the knee correlated well with the clinical findings. The more satisfactory the clinical result the more normal the arthrograph. Patients who had recurrence of pain, swelling and tenderness in the knee showed arthrographic findings similar to those before operation.

1. Anterior transperitoneal lumbar fusion is a successful method of stabilising painful mechanical derangements which have not responded to the usual conservative measures.

2. The operation in this series was done mainly for backache; it should not be contemplated if there is definite evidence of nerve root compression, because sequestrated disc material cannot be removed from the spinal canal from the anterior route.

3. Careful technique has resulted in few complications attributable to the operation.

4. This method is sometimes thought to be inapplicable in cases of spondylolisthesis with a displacement of more than one-third. However, in this series we have seen the block type of graft used with a good measure of clinical and radiological success.

5. There is no doubt that for those patients who have had previous unsuccessful laminectomies or posterior fusions anterior interbody fusion offers an excellent prospect of recovery.

A case of a ganglion arising from a distal lumbar articular facet joint associated with low back pain and sciatica is reported and the pertinent literature reviewed.

1. The uptake of S³⁵ labelled sodium sulphate has been studied autoradiographically in the intervertebral disc of the young rabbit.

2. The sojourn of the isotope in the tissues includes an intracellular phase of approximately twenty-four hours, followed by an extracellular phase.

3. The cells exhibiting by far the greatest affinity for the sulphate ion are the peripheral groups of cells of the nucleus pulposus, while the chondrocyte-like cells of the cartilaginous segment of the annulus fibrosus are also fairly active. The central cells of the nucleus and the fibroblasts of the outer one-third of the annulus have a much lower uptake.

4. By analogy with similar studies on hyaline cartilage, and on the basis of correlation between the alcinophilia of the tissues and the concentration of the label, both before and after hyalase digestion of the tissue, it is considered that in the young rabbit disc, as in articular cartilage, the sulphate is incorporated primarily into chondroitin sulphate.

5. The elimination of the isotope from the nucleus at twenty-four days and the persistence of the label in the annulus fibrosus at thirty-two days tends to suggest that the metabolic turnover of acid mucopolysaccharide is considerably slower in the annulus than in the nucleus.

1. Fifty-eight major injuries in the region of the talus were reviewed regarding treatment, incidence of complications and long-term results.

2. The prognosis for simple fractures of the head, neck or body was good, as was that for dislocations of the midtarsal and peritalar joints.

3. The prognosis for fracture-dislocations of the neck and body was better than has been frequently reported. It was related to the degree of initial trauma. A good result occurs only if accurate reduction is effected and maintained. Fixation with a Kirschner wire is a useful method of maintaining the reduction after unstable fracture-dislocations.

4. Avascular necrosis occurred only in the more severe injuries and its incidence was related to the degree of initial displacement. The late results were better than have been previously described. The condition is best treated conservatively by protection from weight-bearing until revascularisation is well advanced.

5. A case with an unusual pattern of fracture of the neck of the talus is described following a plantar-flexion inversion injury.

1. A technique of closed instillation-suction for the treatment of chronic bone infection is described in which infected bone is first exposed and all necrotic material removed. Three perforated drainage tubes are inserted, and brought out through the skin some distance from the wound. The perforated parts of the tubes are laid close to the infected area and the wound closed in layers. Two of the tubes are connected to a drip bottle containing antibiotic solution, and the third to a continuous suction pump. Closed continuous instillation-suction is thus established, and has been maintained for up to six weeks.

2. The results in twelve cases are presented, two-thirds of which showed clinical resolution of the infection.

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. Fifty-eight adult patients who had been treated for radial head fractures by excision of the head of the radius have been reviewed at periods varying between two and nineteen years after operation.

2. Symptoms referable to the inferior radio-ulnar joint were present in half of the patients and the mechanisms of the disorder in these patients are discussed in the light of a radiographic study.

3. We feel it justifiable to conclude from our observations that this complication of surgical treatment of radial head fractures deserves greater attention than has been given to it in the past, and that it is of sufficient importance to be taken into consideration when planning the management of these fractures, especially the less severe injuries.

4. Prosthetic replacement of the proximal end of the radius is the logical and, indeed, the only way in which the distal radio-ulnar joint subluxation can be avoided, but no clearly defined indications for the routine use of a prosthesis as a primary procedure can be suggested on the basis of this investigation.

1. Two patients are reported with progressive fibrosis of the vastus intermedius muscle causing limitation of flexion of the knee. The first patient, a girl of ten years who was one of binovular twins, noticed difficulty in walking at the age of five, the disability increasing with age. The other girl, aged three, was one of uniovular twins and displayed the abnormality as soon as she started walking.

2. The nature of the condition remains obscure.

3. Surgery is effective, and simple division of the affected muscle segment is recommended. A good range of passive flexion is obtained at once; the active range can be obtained thereafter by physiotherapy. Because this requires the patient's cooperation it is suggested that the best age for surgery is about five or six years.

1 . Young Wistar rats fed on a diet containing 0·3 per cent semicarbazide hydrochloride developed the characteristic lesions of osteolathyrism. This consisted of kyphoscoliosis, displacement of epiphyses and dislocations of joints. A pathological study of the skeletal lesions showed widening, disorganisation and tears of the epiphysial plate with the zone of maturing cartilage showing the greatest increase in width. The severe kyphoscoliosis was due to a derangement and displacement at and through the epiphysial plates of the twelfth thoracic or first lumbar vertebra.

2. Some of the compounds that are known to produce osteolathyrism in laboratory animals are beta aminopropionitrile, amino acetonitrile, mercaptoethylamine and semicarbazide. The mode of action of the lathyrogenic compounds was analysed in the light of a number of experiments done in this laboratory.

3. lt is possible that they interfere with the metabolism of the epiphysial plate. There appears to be a decreased polymerisation of the ground substance of the epiphysial cartilage, but the exact metabolic reaction involved is not known. Other chemicals of similar structure, with the same reactive groups, did not show lathyrogenic properties. It is concluded that it is not a particular chemical structure, configuration or specific reactive group that is responsible for the production of osteolathyrism. The chemistry of the lesions still remains to be solved.

1. Twenty-seven patients with a Brown-Séquard syndrome resulting from trauma have been studied, fourteen of the left side of the cord and thirteen of the right. There were sixteen gunshot wounds and eleven closed injuries.

2. The prognosis for recovery is much better than the initial catastrophic nature of the symptoms and signs would indicate.

3. The pattern of recovery is discussed in detail and the long and rather tedious course of the treatment is indicated.

4. Spasticity on the side worse affected still presents a difficult problem, but a less severe one than that presented by flaccid paralysis.

1. In this series of posterior onlay grafting with fresh autogenous bone and without internal fixation, in the treatment of non-infective structural lesions in the lumbo-sacral area, 71 per cent of the patients were relieved of their symptoms, but bony fusion was obtained in only 60 per cent.

2. It is probable that with this technique twelve weeks' immobilisation in a plaster bed is required.

3. Some failures are ascribed to the use of an insufficient quantity of bone or to poor apposition of the graft to its bed.

4. It is evident that the more vertebrae one attempts to fuse the more difficult it is to succeed. When the diseased area is successfully fused but an unnecessarily long graft has been used, a pseudarthrosis above the level of the pre-operative pathology may be the cause of persisting backache. For these reasons we believe that one should not attempt to graft more vertebrae than is necessary to stabilise the local lesion.

5. The complication rate, particularly from deep vein thrombosis, was high. This major complication could perhaps be overcome by using banked bone.

6. The indications for the operation are assessed as follows. It should be done for low back pain only when there is a definite diagnosis and a limited extent of structural pathology; one can then expect excellent results when successful fusion is achieved and also an appreciably high proportion of satisfied patients even when bony fusion has not been obtained, presumably because there is a fibrous union strong enough to stabilise the affected spine.

It is inadvisable to undertake lumbar-lumbo-sacral fusion for intervertebral disc degeneration when there are more than three adjacent vertebrae involved, and in any case operation should be confined to the indicated extent.

1. Three cases of aneurysmal bone cyst are recorded. It is suggested that the condition is a type of cavernous haemangioma and the term haemangiomatous bone cyst is preferred.

2. A survey of the published cases suggests that in its early stages the lesion is amenable to local surgery, which is the treatment of choice, but for inaccessible lesions deep x-ray therapy may be effective.