Lesions of the anterior interosseous nerve in the forearm are rare and often misdiagnosed as tendon injuries. A consecutive series of 13 patients with this condition referred for electrodiagnosis is reviewed. Only three had originally a correct clinical diagnosis and three were initially considered to have tendon ruptures. Five cases were of mechanical origin and seven due to ‘neuritis’. All showed electrophysiological abnormalities, most commonly involving the pronator quadratus. Late spontaneous recovery was common, and only one case had surgical exploration

Aims

A variety of surgical methods and strategies have been demonstrated for Andersson lesion (AL) therapy. In 2011, we proposed and identified the feasibility of stabilizing the spine without curettaging the vertebral or discovertebral lesion to cure non-kyphotic AL. Additionally, due to the excellent reunion ability of ankylosing spondylitis, we further came up with minimally invasive spinal surgery (MIS) to avoid the need for both bone graft and lesion curettage in AL surgery. However, there is a paucity of research into the comparison between open spinal fusion (OSF) and early MIS in the treatment of AL. The purpose of this study was to investigate and compare the clinical outcomes and radiological evaluation of our early MIS approach and OSF for AL.

Aims

Osteofibrous dysplasia (OFD) is a rare benign lesion predominantly affecting the tibia in children. Its potential link to adamantinoma has influenced management. This international case series reviews the presentation of OFD and management approaches to improve our understanding of OFD.

Aims

The aim of this study is to define a core outcome set (COS) to allow consistency in outcome reporting amongst studies investigating the management of orthopaedic treatment in children with spinal dysraphism (SD).

We report 18 cases of pain and tenderness in the mid-part of the patellar ligament in athletes. The condition may be disabling, but it responds to surgery. Ultrasound and CT scans were positive in all 17 confirmed cases, but ultrasound gave a better distinction between the cysts, granulation tissue, metaplasia, mucoid degeneration and congenital defects found at operation.

1. A three-year survey of avascular necrosis of bone has been carried out in a community of some 400 professional divers for shell-fish who had used no modern technique of decompression.

2. Of 301 divers radiographed, 152 (50·5 per cent) had bone lesions.

3. The incidence of bone necrosis increased in proportion to the length of diving experience, being highest in men with over ten years, experience.

4. The incidence was also higher in men who usually dived deeper than thirty metres.

5. There was a high incidence in men with a history of the bends but no significant relationship between the sites of the bends and those of the lesions.

6. Bone lesions were more frequently multiple than solitary.

7. The upper end of the humerus was significantly more affected than the upper end of the femur or tibia, but not significantly more than the lower end of the femur.

8. At the upper ends of the humerus and femur the lesions were more frequently unilateral than bilateral.

1. Histochemical staining and correlated biochemical estimations of five hydrolytic enzymes were done on eighteen benign and twenty malignant fibroblastic lesions of bone and soft tissue.

2. Alkaline phosphatase activity was moderate in a fibroma and very high in fibrous dysplasia. In a typical fibrosarcoma the fibroblasts showed no enzyme activity and estimations were low. Exceptions indicated an osteogenic potential in the tumour.

3. ß-glucuronidase, leucine aminopeptidase, and to a less extent non-specific esterase, were more active in malignant than in benign lesions, and the highest activities were found in sarcomata arising in Paget's disease of bone.

4. Acid phosphatase showed no correlation with malignancy and was generally unremarkable except for high activity in osteoclasts, but was raised in two sarcomata that occurred after irradiation of giant-cell tumours.

5. A non-osteogenic fibroma and a fibrous cortical defect, though poorly represented in this series, are not uncommon; they sometimes lead to pathological fracture, but sarcoma is very rare in such lesions. They tend to show more alkaline phosphatase than fibrosarcoma but not the very high activity of fibrous dysplasia, which is related to its osteogenic potential.

6. Fibrous dysplasia most often presents in the five to fifteen age group but seldom leads to malignancy, though this may occur, usually as osteosarcoma, which has a similar high content of alkaline phosphatase. Fibrosarcoma is typically negative or very weak in this enzyme: the exceptional cases with high activity were tumours which were in part osteosarcoma. Generally the demonstration of high alkaline phosphatase activity in a fibroblastic lesion of bone, in the absence of trauma or inflammation, suggests the diagnosis of fibrous dysplasia.

The case histories of five young children are presented to demonstrate the radiological appearances of trauma to the spine thought to be the result of maltreatment by either parent or guardian. Four of the children were admitted to hospital within a period of three years, all being under the age of two years.

1. Sixty-one cases of compression of the ulnar nerve are reported, forty at the elbow and twenty-one at the wrist. Although contributory factors may include deformity, osteoarthritis, injury, ganglia and other tumours, the narrow anatomical confines of the nerve at these two levels are noteworthy and alone may produce nerve compression.

2. Careful clinical examination will usually determine the level of involvement if not the exact pathology. Surgical exploration is indicated both as a diagnostic and therapeutic procedure in most cases.

3. Following removal of the compressing agent rapid recovery occurred in most cases.

1. Five cases of pigmented villonodular synovitis with associated lesions within bone are recorded, two in the hip, two in the knee and one in the elbow.

2. The mode of formation of these intraosseous lesions is explained and methods of treatment are discussed.

1. One hundred and twenty cervical spines removed at routine necropsy from elderly patients dying in a general hospital have been examined.

2. There was some degree of degeneration of intervertebral discs in 110 cases–in forty-six this was severe.

3. Degenerative disc disease was found at an earlier age in men; mild damage preceded severe degeneration and collapse by about a decade.

4. Discs of the lower spine were most frequently and most severely affected.

5. Alterations of the normal cervical lordosis were produced by disc disease in thirty-two cases.

6. Osteoarthritis of the apophysial joints was found in seventy-eight, and by contrast to disc degeneration was commonest in the mid-cervical and upper cervical regions. In eighteen it was severe.

7. Degeneration and scarring of nerve roots was frequently associated with diseased discs; apophysial joint arthritis was found to be an important additional factor when it occurred in the lower cervical region.

8. No nerve root changes could be attributed to ischaemia resulting from narrowing or distortion of the vertebral arteries.

9. Cystic arachnoidal diverticula which excavate the posterior root ganglia were found in thirty-six cases.

1. A radiographic investigation of a group of 241 men who had worked in compressed air at pressures up to 35 pounds per square inch gauge on the construction of tunnels under the River Clyde showed that forty-seven men (19 per cent) had one or more lesions of aseptic necrosis of bone.

2. The radiological lesions have been classified as juxta-articular, which may lead to pain and limitation of movement, and head, neck and shaft lesions, which are usually symptomless. In 10 per cent of the men the lesions were juxta-articular and therefore potentially disabling. The treatment ofjuxta-articular lesions is described and reviewed.

3. The environmental factors associated with the occurrence of aseptic necrosis of bone, the radiological and histological appearances, and the pathogenesis of the lesions are discussed. Bone lesions were found to be related directly to the number of times a man had been decompressed, to the height of pressure at which he had worked and to attacks of bends for which treatment was given.

4. When the histological and radiographic appearances of aseptic necrosis of bone in compressed air workers are compared it is clear that a radiograph may not always reveal the full extent of the lesion, and some lesions may not show up at all. The cause of the necrosis is obscure because experimental and direct evidence of bone infarction by gas bubbles is lacking.

5. The currently accepted decompression procedures and treatment of bends used in civil engineering practice, do not prevent the occurrence of aseptic necrosis of bone in compressed air workers.

6. It is suggested that periodic radiological examination of the bones of compressed air workers should be carried out and the results correlated with other information about the men and the contracts on which they have worked in order to elucidate the causative factors in aseptic necrosis of bone. A central registry has been set up by the Medical Research Council in the University of Newcastle upon Tyne to fulfil this function.

1. Twenty-nine patients with traction lesions of the brachial plexus have been studied.

2. The methods of study have been by clinical examination, by operative exploration and biopsy and by examination of axon reflexes.

3. Results in each of these sections have been related to the progress of the lesions.

4. The results suggest: a) that the reason for the generally poor prognosis in traction lesions of the brachial plexus is the frequency of intradural preganglionic damage and of tearing apart of the plexus; b) that the former occurrence can with some accuracy be diagnosed by examination of axon reflexes and that the latter can be detected at operation.

5. Indications for operative exploration are given and a plan is outlined for the management of these cases.

1. A case of multiple bone lesions in a patient infected by Avian-Battey bacillus is reported.

2. It is suggested that the prognosis in future Heaf-negative cases may be improved by studies of the cellular response to the infection.

1. The results of treatment of 117 tuberculous and fourteen other types of infection of the spine in adults by anterior fusion and chemotherapy have been reviewed.

2. It is suggested that anterior fusion is justified because: a) it permits isolation of the organism, and hence the determination of drug sensitivities and appropriate chemotherapy; b) removal of the diseased tissue and the stabilisation of the affected segment by iliac bone grafts can be effected, leading to rapid healing by bony fusion with little further collapse; c) rehabilitation of the patient is hastened; and d) the incidence of reactivation is probably diminished.

1. French in 1946 presented eight cases of arachnoiditis complicating a lumbar disc lesion; five further cases are reported here.

2. It is suggested that repeated minor persistent trauma produces the strictly localised changes in the arachnoid, in the same sort of way that it may produce ulnar neuritis at the elbow.

3. The various causes of arachnoiditis are discussed.

4. The place of operation has been found difficult to assess.