Objectives

Long bone defects often require surgical intervention for functional restoration. The ‘gold standard’ treatment is autologous bone graft (ABG), usually from the patient’s iliac crest. However, autograft is plagued by complications including limited supply, donor site morbidity, and the need for an additional surgery. Thus, alternative therapies are being actively investigated. Autologous bone marrow (BM) is considered as a candidate due to the presence of both endogenous reparative cells and growth factors. We aimed to compare the therapeutic potentials of autologous bone marrow aspirate (BMA) and ABG, which has not previously been done.

In the literature 21 children have been reported with haematogenous osteomyelitis involving only the epiphyses of long bones; in 20 the epiphyses of the knee were involved and the radiographs showed a lytic lesion. Most patients gave a history of pain, limp or refusal to walk for weeks or months without general illness. The erythrocyte sedimentation rate and white cell count were of little diagnostic value, but a bone scan was usually positive. All the patients were cured by antibiotics alone or in combination with curettage

A review of 77 patients with traumatic central cord syndrome revealed that atypical variations are more common than the existing literature suggests and that these may be seen in a wide variety of acute injuries to the cervical spine. In general the outcome is good; a favourable prognosis on admission is suggested by good hand function, hyperpathia, Lhermitte's sign and normal perianal sensation. The study has highlighted the value of regular muscle charting and has cast doubt on previous neuroanatomical assumptions about the syndrome

A total of 67 patients with 94 resistant club feet were treated operatively as soon after birth as all other postnatal problems could be excluded, the mean age of the patients being 12 days. No treatment was attempted before operation. The results, after a follow-up period of a minimum of two years (mean 4.4 years) are comparable with the best published results. This method of treatment has many advantages but cannot be recommended for general use without reservations

1. The femoral head has been examined in specimens taken from cadavers, patients suffering subcapital fracture of the femoral neck and patients undergoing total replacement arthroplasty for osteoarthrosis and rheumatoid arthritis. 2. Lesions have been seen, some of which appear to be uniting fatigue fractures of individual trabeculae. 3. It is suggested that excessive cyclical loading, sometimes leading to fatigue fractures, may represent a fundamental pathological process of general importance in the evolution of certain skeletal and articular diseases

We report the long-term results of the Matti-Russe operation for pseudarthrosis of the scaphoid in 100 cases, reported previously by Mulder in 1968. Clinical results for 77 patients and radiographic data for 74 were reviewed at 22 to 34.8 years after surgery. In general, there was satisfactory relief of pain and stiffness but some patients had limitation of motion and reduced grip-strength, with usually slight osteoarthritic changes. There was poor correlation between subjective, objective, and radiographic results but 88% of the patients were satisfied with their results

One hundred and fifty asymptomatic shoulders in 75 schoolchildren were studied. The shoulders were tested for instability and a hyperextensometer was used to assess joint laxity. Signs of instability were found in 57% of the shoulders in boys and 48% in girls; the commonest sign was a positive posterior drawer test which was found in 63 shoulders. A positive sulcus sign was found in 17 shoulders and 17 subjects had signs of multidirectional instability. General joint laxity was not a feature of subjects whose shoulders had positive instability signs

The clinical data from 19 patients with brucellar spondylitis and 15 with tuberculous spondylitis were compared. The former disease affects males whose occupations expose them to Brucella. The lumbar spine is usually involved and there are other symptoms of brucellosis. Tuberculous spondylitis is not usually accompanied by general symptoms. The dorsal spine is more frequently affected and may exhibit vertebral collapse and paraspinal abscesses. These differences permit a presumptive aetiological diagnosis, but the definitive diagnosis depends upon bacteriological tests

Problem drinking was found to be likely in 21% of inpatients in a general orthopaedic and fracture service, and in 42% of outpatients attending the fracture clinics. The questionnaire showed that the problem was most common among young men, particularly among outpatients. Previous hospital admissions were more frequent in this group. Many of the health problems associated with the chronic abuse of alcohol are directly relevant to orthopaedic practice. Early intervention may be highly successful, and it is recommended that screening for problem drinking be considered in orthopaedic and fracture services

Aims

The aim of this study was to review the value of accepting referrals for children with ‘clicky hips’ in a selective screening programme for hip dysplasia.

1. Talipes equinovarus is a specific type of club foot which has a genetic basis. Its occurrence along with certain neurological disorders has been noted. 2. An investigation of its incidence in 1,447 mental defectives, excluding those with cerebral palsy, revealed an incidence of 228 per 1,000, which is about ten times that for the general population. 3. There may be an upset early in embryonic development to account for the co-existence of both mental deficiency and talipes equinovarus

1. In growing rats oestrogen, cortisone and thyroxine in high doses suppress bone formation, and this effect is probably part of a general suppression of body growth. 2. Growth hormone and thyroxine in small doses stimulate both body growth and bone formation. 3. Testosterone has no effect on bone formation. 4. Oestrogen and cortisone suppress bone resorption. The effect of cortisone may be modified in conditions of calcium depletion. 5. Thyroxine appears on the other hand to increase bone resorption. 6. Testosterone has no effect on bone resorption

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

In 1948 Jaffe and Lichtenstein published a series of bone tumours as chondromyxoid fibromata, stressing that this newly recognised entity was likely to be mistaken for chondrosarcoma but was a benign growth. The accumulated experience of thirty-seven cases, which are all that have been recorded in detail, is briefly reviewed. A further series of nine similar cases is reported here and comparisons are made which show general agreement with the experiences and conclusions of earlier authors. It is however suggested that the tendency to recur may have been underestimated, particularly in younger patients

One of the most important factors in the rehabilitation of the amputee is the preparation of the patient and stump for limb fitting and training. The different procedures for the upper and lower extremities are described. Emphasis is laid on the importance of early reassurance and rehabilitation whenever possible. Patients unavoidably immobilised for long periods require general physical reconditioning before limb fitting and training can be undertaken. Special care is needed to avoid the upper limb amputee's becoming dependent on the surviving hand and using the artificial limb only for its cosmetic effect

Infantile idiopathic scoliosis is a structural scoliosis seen in infants, usually boys, with the major curve to the left in almost all cases, and almost invariably in the mid-or lower thoracic region. It occasionally disappears, but in general the curve tends to increase. In the absence of any discoverable etiology it is termed "idiopathic" and it is believed not to differ in essentials from the more common adolescent scoliosis. Lumbar idiopathic scoliosis has a good prognosis as to deformity, but leads more often than any other curvature to degenerative arthritis and pain in later life