1. Six cases of posterior dislocation of the shoulder are described. 2. In four cases the diagnosis was made on clinical grounds. 3. The important clinical signs are the adducted and medially rotated position of the arm, a hard mass posteriorly below the acromion representing the displaced humeral head, and limitation of movement, especially abduction and lateral rotation. 4. In two cases the dislocation was not recognised at the first examination. This confirms the statement of previous authors that posterior dislocation is easily missed. 5. The value of the vertical projection in the radiography of suspected posterior dislocation is emphasised. 6. Reduction was accomplished without difficulty in five cases and the subsequent progress of these was uneventful. In the remaining case reduction was difficult and unstable, and the final recovery incomplete. It is considered that this patient would have been better treated by early open reduction.
1 . Twenty-two cases of transplantation of the tibialis anterior for relapsed club-foot have been reviewed. Results were good in sixteen cases, fair in two and bad in four. 2. The operation and routine treatment are described. 3. The reasons for the four failures are discussed. 4. It is concluded that the operation is well worth while, and will often avoid the need for bony stabilisation at a later date.
A case of cervical traumatic paraplegia is described in which there was no evidence of damage to vertebrae, discs or ligaments. Experimental evidence suggests that such injuries may be caused by inward bulging of the ligamentum flavum during hyperextension. The reasons why this inward bulging may occur, despite the elasticity of the ligamentum flavum, are discussed. Treatment of such cases is considered and the importance of avoiding extension emphasised.
1 . The principles and technique of flexor-extensor tendon transfers for claw toes are described. The operation is tedious, but it is effective in selected cases. 2. Sixty-eight patients have been operated upon and followed up; good results were obtained in fifty, fair results in eleven, and poor in seven. More careful selection and better operative technique might have avoided some of the failures. 3. The operation restores useful function to the toes at the cost of their prehensile action, diminishes any cavus deformity of the foot, and, by lessening the prominence of the metatarsal heads in the sole, avoids callosities and discomfort.
1. The operation of pseudarthrosis of the hip joint is described and the results are assessed in ninety-three patients. 2. The result was good in eighty-three cases and poor in seven cases. Three patients died as a result of the operation. 3. Pseudarthrosis is the most satisfactory and the most reliable operation: 1) in ankvlosing spondylitis, and 2) in patients over sixty years of age with disabling osteoarthritis. 4. The more formidable operation of cup arthoplasty may prove to be superior in younger patients with osteoarthritis.
1) A case is reported of paraplegia with normal radiographic appearances in which cervical cord damage was shown at autopsy to have been due to hyperextension injury. 2) The mechanism of such injuries is discussed, together with the differential diagnosis from acute prolapse of an intervertebral disc. 3) The grave dangers of using the fully extended position of the cervical spine in the management of these cases is noted.
