The clinical and radiological state of the hips of a group of children with cerebral palsy treated without operation is compared with that in a group treated by operation to correct adduction and flexion deformity and to obtain balanced action in the hip muscles. In the first group, 11 per cent of hips were dislocated, 28 per cent subluxated, 46 per cent dysplastic and 15 per cent normal. In the second group no hip was dislocated, 13 per cent were subluxated, 35 per cent dysplastic and 52 per cent normal. Surgical intervention is indicated clinically for a range of abduction diminishing to less than 45 degrees and–on radiological criteria–for early dysplastic changes, especially a break in Shenton's line, irrespective of the patient's age, severity of involvement or neurological maturity. Prevention of subluxation or dislocation improves function and diminishes the liability to develop a painful hip in adolescence or early adult life.

1 . The indications, technique and results of supra-malleolar wedge osteotomy of the tibia in the management of valgus or varus deformity of the ankle in children with myelomeningocele are described.

2. This operation should not be performed until as much correction as possible has been obtained by soft-tissue release and muscle balance has been restored by tendon transfer.

3. In sixteen feet satisfactory correction was obtained and maintained in fourteen, one of which had required revision for over-correction.

4. A closing-wedge osteotomy is recommended ; the two failures occurred after opening-wedge osteotomies.

5. In the fourteen feet with satisfactory correction the complications were negligible, deformity has not recurred and epiphysial growth has been well sustained.

1. Correction of equinus deformity in cerebral palsy either by elongation of the tendo calcaneus or by gastrocnemius recession gives satisfactory results without splintage or bracing after operation.

2. Gastrocnemius recession is the operation of choice in paraplegic spastic cerebral palsy, and wherever possible in tetraplegic cerebral palsy. In hemiplegia the whole of the triceps surae is usually involved, and elongation of the tendo calcaneus is almost always needed.

3. Correction at operation should aim to result in a mild degree of equinus deformity at the end of the growth period in hemiplegic spastic cerebral palsy. Over-enthusiastic gastrocnemius recession can lead to excessive weakness of the calf in some patients.

1. The etiology and natural progress of lumbar kyphosis in children from three to twelve years of age with myelomeningocele are reviewed.

2. The indications for operation have included intractable or recurrent skin ulceration, inability to wear calipers for walking, inability to sit in a wheel-chair and inability to perform ileal conduit operations.

3. The technique of osteotomy-excision of lumbar vertebrae used in eighteen cases is described.

4. The results in fourteen children are described. The primary aims of operation have been achieved in all patients.

5. A comparison is made with the results of neonatal osteotomy-excision of the spine in the newborn. Recurrence of deformity, but at a much reduced rate, must be anticipated after either operation.

1. The pathological anatomy in a case of convex pes valgus in a patient with myelomeningocele is described.

2. A neuromuscular imbalance between the tibialis posterior and the evertors of the foot is suggested as the underlying cause of this type of foot deformity.

A case of anterior interosseous neuritis due to compression of the nerve over an abnormally large tendon of origin of the flexor digitorum profundus is described. Excision of the band relieved the paralysis.

1. The management of severe kyphosis of the lumbar spine in association with myelomeningocele is discussed.

2. Neonatal spinal osteotomy-resection has been performed in six patients with partial correction of the deformity and a greatly improved ease of closure and healing of the skin defect. The severity of lower limb paralysis has been diminished compared with the complete paraplegia that almost always results from conservative management of closure of the defect without osteotomy.

3. In an older child who has not had the benefit of neonatal osteotomy and who has complete lower limb paralysis, transverse spinal osteotomy or excision of the prominent laminae and pedicles on each side of the midline makes possible the fitting of apparatus for walking and diminishes the liability to recurrent ulceration of the skin.

1. Deformities of the foot in children with myelomeningocele are described and classified. The results of a policy of operative correction of deformity in 148 patients all of whom had had at least one operation on the foot between 1947 and 1965 are described.

2. In 241 feet in which there were deformities 433 operations were performed, including tenotomies, soft-tissue divisions, tendon transfers and bony procedures. At the time of review successful correction of deformity had been obtained in 81 per cent with a plantigrade foot that could bear weight safely, and with a distribution of muscle activity that required minimal external support and presented the least liability to recurrent deformity.

3. The management of individual deformities is described and the causes of failure are analysed and discussed.

1. In children with cerebral palsy and spastic paraplegia or tetraplegia with no fixed fiexion of the knees, tightness of the hamstrings may limit the stride, restrict passive straight leg raising and cause inability to sit up with the knees extended.

2. Nine such children have been treated by bilateral release of the hamstrings from the ischial tuberosity, with marked benefit in all patients.

1. The nature of paralytic deformity arising in poliomyelitis, cerebral palsy and spina bifida is considered and three types of deformity–acute contracture, postural contracture and deformity from muscle imbalance are described.

2. The place of physiotherapy, splintage and surgery in the management of these varieties of paralytic deformity is discussed and the overall results of treatment are reviewed.

1. Six patients suffering from spontaneous posterior interosseous paralysis are described.

2. Two were due to benign tumour and four due to traumatic neuritis, three of which were associated with minor hyperextension injuries to the elbow joint and one with long standing cubitus varus.

3. Surgical exploration was performed in each patient with recovery of nerve function.

1. The indications for and technique of posterior iliopsoas transplantation are described with particular reference to paralytic dislocation and subluxation of the hip in children.

2. Experience of 150 operations in ninety-five patients and of the long-term results of forty-one operations are given.

3. Reduction of the dislocation has been maintained in every case even when there was complete paralysis of all gluteal muscles.

4. All the children are able to walk without the aid of hip splintage.