1. Synovectomy of the elbow affected by rheumatoid arthritis is a worthwhile procedure even in the presence of advanced radiological changes. 2. Relief of pain is good (93 per cent) and movement is retained (87 per cent). 3. Although the follow-up in this series was short, averaging nineteen months, the results seem to be maintained. 4. Good access to the joint may be had through medial and lateral incisions, and division of the olecranon is unnecessary. A lateral incision alone is not recommended. 5. The ulnar nerve should be preserved during dissection. Anterior transposition is needed only if there are neurological symptoms before operation.
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. Three cases are described of a calf swelling occurring in rheumatoid arthritis. 2. This condition has been described by Baker, though many of his patients had tuberculous infection of the knee. 3. The diagnosis may present difficulty because of the distance of the swelling from its origin in the knee joint. 4. Excision of the cyst is advised when it causes pain, but recurrence is likely if disease of the joint remains active.
1. A method is described for measuring blood flow to the head of the femur after fracture of the femoral neck, by estimation of the rate of uptake of radioactive phosphorus. 2. Of one hundred cases investigated the readings in fifteen were incomplete, and in seventeen were unreliable. Reasons are given for discarding the latter seventeen cases. After two years seven patients had died, leaving sixty-one available for analysis. 3. The results in sixty-one surviving patients with a follow-up of not less than two years are analysed. In twenty of these radioactivity was measured by bone sampling and in forty-one by direct readings with a needle counter. 4. The twenty-one intertrochanteric fractures studied were used as controls. In these the P32 ratio varied from 0·4 to 3·0. Union occurred in all patients and none developed avascular necrosis. 5. Of the forty patients with displaced fractures of the femoral neck twenty-eight showed a low P32 ratio. In twenty-three of these (82 per cent) the fracture united. 6. Twelve patients with fractures of the femoral neck showed a borderline or abnormal P32 ratio. In ten of these there was subsequent avascular necrosis or non-union. 7. The possible reasons for the discrepancy between expected and actual results are discussed. 8. Almost 40 per cent of the cases investigated had to be abandoned because of technical faults and in one-fifth of the remaining cases the expected results failed to agree with the clinical results. The method of investigation is therefore not of much practical value at the present time. Improvements in apparatus and technique might make the method more reliable and more useful.
1. A case of posterior dislocation of both shoulders, in a patient believed to be epileptic, is described. 2. The difficulties of early diagnosis are discussed.
