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.