This investigation examined the validity of the hypothesis that the acetabulum in congenital dislocation of the hip will develop satisfactorily provided accurate congruous and concentric reduction is obtained as early as possible, and is maintained throughout growth.

Seventy-two patients with eighty-five hips were studied. The children were more than one year old on admission and over ten years at the time of review. Acetabular development was assessed radiologically by measurement of the acetabular angle. Angles of less than 21 degrees were regarded as normal, and more than 21 degrees as indicating some failure of development. Satisfactory acetabular development occurred in 80 per cent (angles 24 degrees or below), and was unsatisfactory in 20 per cent (angles above 24 degrees).

If three errors in management, namely failure to obtain congruity, failure to maintain congruity and ischaemic necrosis secondary to manipulative reductions, are excluded from the analysis, it is found that 95 per cent of acetabula develop satisfactorily. The outcome is largely independent of the age on admission up to four years old, and of bilateral involvement. It is concluded that acetabuloplasty should not be necessary if the patient is admitted under the age of four or congruity is obtained in the functional position under four and a half years.

The cause of pseudarthrosis of the clavicle is obscure. Right-sidedness is an almost constant feature. We have proposed that the lesion is sometimes due to pressure upon the developing clavicle by the subclavian artery which is normally at a higher level on the right side. This may be accentuated in the presence of cervical ribs or unduly elevated first ribs, both of which we have observed in association with pseudarthrosis. We have also noted pseudarthrosis on the left side in association with dextrocardia (when the relative positions of the subclavian arteries are reversed) and in the presence of a large left cervical rib.

We have speculated upon the nature of the clavicular defect in cranio-cleido dysostosis, in which disorder the first ribs are habitually elevated. A similar mechanism may be involved.

1. Attention is drawn to the danger of avascular necrosis developing in the capital femoral epiphysis as a complication of osteomyelitis in the intertrochanteric region.

2. This necrosis is commonly aseptic. It is believed to be caused by compression or thrombosis of the epiphysial vessels.

3. The situation will be aggravated if infection spreads to involve the joint.

4. We believe that prompt decompression of both the joint and the bone is indicated in order to reduce the incidence and severity of these complications.

1. Further consideration has been given to the lateral rotation which occurs at the ankle joint in uncorrected club feet.

2. Medial rotation osteotomy of the tibia may be used to restore more normal alignment to the hind foot at the expense of an increase in varus of the forefoot, which must be corrected at a second operation.

3. The early results in seven feet treated in this manner are reported.

4. We hope that this paper will be regarded more as a contribution to the understanding of the anatomy of uncorrected club foot than as advocacy of a new method of surgical treatment.

1. Early recognition of femoro-pelvic instability in proximal femoral dysplasia is essential to rational management.

2. Certain radiological signs helpful in identifying such patients within the first year are described.

3. Early operation is recommended to prevent displacement of a pseudarthrosis and to encourage healing. Alternative methods are described for established defects.

4. Radiological signs are described which indicate that healing without loss of femoro-pelvic stability will occur. Such patients may be managed expectantly.

1. Attention is drawn to the progressive disability caused by irreparable defects of the ulna in growing children.

2. Cross-union between the radius and the ulna resolves some of these problems and contributes greater stability and power to the hand.

1. Three children with metatarsus adductus varus have been found to have ball and socket ankle joints.

2. The effect of this finding on treatment is discussed.

1. We have reported our experience in fifty-two patients with arthrogryposis multiplex congenita.

2. The nature of the disorder, its possible cause, the clinical features and differential diagnosis are discussed.

3. Early management is described with special reference to the infant, his parents, and general principles of selection and timing. The treatment of the individual deformities which commonly occur is outlined.

4. We have emphasised that lower limb deformities should be treated vigorously in the first year, whereas in the upper limb treatment is better delayed until an accurate assessment can be made.

5. Correction in the young child should be by soft-tissue release rather than by osteotomy.

6. Prolonged splinting after operation is necessary.

7. Severe weakness may dominate the problem and make operation unrewarding.

8. The intelligence, determination and adaptability of these children flatters even modest surgical success.

1. We have considered torsional deformity in club feet and conclude that medial torsion does not occur in the tibia.

2. It is suggested that in uncorrected feet the hindfoot with the ankle mortise is laterally rotated.

3. We have discussed the cause, prevention and consequences of spurious correction by lateral rotation.

4. The "bean-shaped foot" seems an appropriate description of the final deformity as it is commonly seen.

1. The danger of fracture and subsequent pseudarthrosis in congenital anterior bowing of the tibia is emphasised. The fate of seven such patients is described.

2. With the object of preventing fracture, early and urgent bone grafting is advocated.

The management of a personal series of over 500 patients with congenital hip dislocations has been reviewed with special reference to the mistakes that have been made and the safeguards which have now been adopted.

1. One hundred babies under the age of one year with untreated structural idiopathic scoliosis have been studied and the outcome assessed.

2. Ninety-two recovered spontaneously. Five developed progressive curves of bad prognosis and three developed secondary structural (double primary) scoliosis.

3. It is suggested that intrauterine moulding may cause the deformity.

1. Six cases of quadriceps contracture in children are described. All were either premature or suffered severe illnesses soon after birth.

2. Some additional information is given about cases of the same condition previously published by other authors.

3. It is suggested that injections and infusions given to newborn babies are sometimes the cause of the condition.

4. Some of the therapeutic substances and measures which may be responsible are discussed. These include antibiotics, vitamin K preparations and "subcutaneous" fluid therapy.

1. The surgical management of two children with congenital hypoplasia of the upper end of the femur is described.

2. Early exploration is advocated to establish the nature and extent of the anomaly and to attempt its correction.

3. The preliminary results are sufficiently encouraging for us to recommend that further attempts at surgical treatment be considered in patients with this disorder.

1. Regional osteoporosis is a common finding in osteoid osteoma. It may in fact be a constant feature because it was present in all the patients reported in this paper and was suspected in others who have not been included in this report because of insufficient information.

2. Five of our six cases showed osteoporosis about the hip. Osteoporosis is more likely to be noticed in this region than in other parts of the extremities because both hips are usually radiographed on one film. We have seen several instances in which we suspected generalised osteoporosis of an extremity but Case 5 was the only one in which comparable radiographs had been taken of both feet.

3. When there is osteoporosis in the region of a joint with symptoms referred to that joint an osteoid osteoma may be the cause. The nidus may lie at some distance from the joint surfaces and may not be seen in standard radiographs of the joint (Case 4). Additional radiographs including a wider area than usual may be necessary to show the lesion, and tomography is sometimes required.

1. Attention is drawn to the powers of resistance of the growing ends of bones in suppurative pyogenic arthritis of the knee and hip in infancy.

2. It is emphasised that a translucent zone in the radiograph does not necessarily mean that this part of the bone, epiphysial cartilage or plate is destroyed.

3. Diagnostic criteria are described to confirm that cartilage or decalcified bone has survived the infection in the knee joint.

4. The prognosis for the knee joint is discussed.

5. The hip joint presents greater difficulties in diagnosis and greater issues are at stake. It is recommended therefore that the hip joint be manipulated or explored if the radiograph and the physical signs suggest that destruction of the joint has either caused dislocation or has so damaged it that dislocation is likely to occur in the future. In favourable cases stability may be restored to the hip. In the others a diagnosis of irreparable destruction is established and the surgeon is satisfied that an opportunity to help the patient has not been lost.

1. We have described an operation the aim of which is to reduce the gap at the pubic symphysis which accompanies ectopia vesicae.

2. The operation. as it is now performed, simplifies subsequent bladder closure and repair of the associated divarication of the recti.

I. There is no significant difference in the final radiographic appearance of the femoral head between patients treated in hospital or as out-patients.

2. In view of this, from both a social and economic standpoint, out-patient treatment appears to be the method of choice.

1. The clinical and radiological features of thirty-two feet with congenital vertical talus are described and subdivided into groups determined by the presence or absence of associated abnormalities.

2. The differential diagnosis of congenital vertical talus from flat foot, talipes calcaneus and uncorrected club foot is discussed.

3. No benefit came from either non-operative treatment or tenotomy of the tibialis anterior.

1. The capsular changes in osteoarthritis of the hip and their pathogenesis are described, and it is concluded that symptoms are due mainly to this abnormality.

2. The clinical significance and pathogenesis of subchondral sclerosis, cysts, osteophytes, secondary subluxation and new bone formation on the lower border of the femoral neck are discussed.

3. These bony features which can be seen in the radiograph may, under certain circumstances, be correlated with the symptoms.

4. The influence of joint debris and capsular fibrosis upon the symptoms arising in other osteoarthritic joints is considered.

5. The mechanism by which osteoarthritis develops in hip joints with an anatomical abnormality is discussed in relation to the normal functional anatomy of the hip.

6. The evolution of osteoarthritis in dysplasia of the hip is considered with special reference to its diagnosis, prognosis and early treatment.

7. The supposition that osteoarthritis is commonly due to progressive ischaemia in the femoral head has been investigated and is rejected.

8. The cause of idiopathic osteoarthritis remains obscure but the evidence suggests that constitutional rather than local conditions in the joint account for many of these cases.

1. The synovial membrane and capsule in osteoarthritis of the hip have been studied in twenty-five cases. Dissections have been made on fresh cadavers to establish the normal structure and function of these tissues at different ages.

2. Fragments of bone and cartilage were found beneath the synovial surface in twenty-three cases of the twenty-five cases of osteoarthritis.

3. The source of these fragments is the degenerate articular surfaces.

4. The fibrosis of the synovial membrane and capsule follows the synovial hyperplasia which accompanies the phagocytosis of these fragments.

5. A similar histological picture has been produced by injecting fragmented cartilage into the knee joints of rabbits. The injected fragments are found beneath the surface, and synovial hyperplasia is followed by subsynovial fibrosis.

6. The greatest amount of this joint debris is found in the lowest part of the joint cavity.

7. The joint capsule is particularly sensitive to traction.

8. All parts of the capsule are tight in extension, which is the weight-bearing position.

9. Fibrotic shortening of the capsule in the lowest part of the joint cavity explains many of the symptoms and signs of the disease: pain is caused by an attempt to stretch the capsule; muscle spasm occurs in the muscles supplied by the sensory nerves of this part of the capsule; extension, medial rotation and abduction, which tighten this area, are lost first; progressive shortening causes deformity in the opposite direction, namely flexion, lateral rotation and adduction; the loss of extension causes a more rapid wearing of articular cartilage on weight bearing; subperiosteal new bone is formed on the under-surface of the neck of the femur.

10. The symptomatology is discussed.