1. Three cases are reported of ischaemic necrosis of the anterior tibial muscles which were not due to injury. In two, ischaemia was the result of strenuous or unaccustomed exercise in young adults; in the third it was an incident in a systemic disturbance. All three cases were probably the result of spasm of a large segment of the anterior tibial artery.

2. The clinical features during the first few hours resemble those of tenosynovitis of the tibialis anterior; and after twelve to twenty-four hours those of cellulitis of the leg. Later there is "drop foot" due to muscle weakness, contracture limiting plantar-flexion movement, and woody hardness of the muscles in the middle third.

3. The morbid histology is similar to that of Volkmann's ischaemic contracture.

4. The possible explanations—primary arterial disease, arterial occlusion by pressure of the interosseous membrane, occlusion by tension within the fascial space, intraluminary occlusion by embolism or thrombosis, and fatigue arterial spasm, are discussed.

5. The vascular pattern of the anterior tibial muscles has been studied by experimental injections in cadavers.

6. It is concluded that the most likely cause is spasm of the anterior tibial artery due to muscle fatigue, aggravated by increased tension within the anterior fascial compartment due to reaction after strenuous exercise.

7. Treatment is outlined. Exploration of the anterior tibial artery within the first twelve hours is warranted, but late exploration may be dangerous.

8. Although not previously recognised, evidence is shown that regeneration of necrotic muscle is possible in the human being.

Most of what I have said has been said before by various writers. Abduction osteotomy is the recognised form of treatment for developmental coxa vara. The results from this operation are usually good. But the results of treatment would probably be better if the condition could be diagnosed before deformity had become disabling, and if the gap in the bone could be closed by other means than osteotomy. Good results of bone grafting in early cases of developmental coxa vara are reported.

Congenital anomalous bands of the extremities are variable in position, depth, and in the completeness of their encirclement. They represent one of a group of abnormalities which are often present in the same individual. Cases associated with gross lymphoedema are rare. The treatment of such a case is presented.

1. Two types of spinal extradural cyst are discussed: 1) the type which occurs in adolescents in the dorsal spine with evidence of kyphosis juvenilis; 2) the type which occurs in adults in the dorso-lumbar spine without kyphosis.

2. A fifth case of dorso-lumbar spinal extradural cyst in the adult without deformity is reported. Cysts in this region present common features distinguishing them from the more frequent type which occurs in adolescents.

3. The relationship between spinal extradural cysts, venous drainage of vertebral bodies, and spinal deformity, is discussed.

1. Peroneal spastic flat foot is a term loosely and often inaccurately used to describe rigid valgus feet developing from widely different causes.

2. The most common causes are two anomalies of the bones of the tarsus—the calcaneonavicular bar, and the talocalcaneal bridge. The first was described in 1921 by Sloman and in 1927 by Badgley; the other is described for the first time in this paper as an etiological factor in rigid flat foot though it has been recognised by anatomists for fifty years as a skeletal variation. The term peroneal spastic flat foot, as applied to these cases, is inaccurate since there is no spasm of the peroneal muscles. The deformity is a fixed structural deformity due to anomalous bone structure, and the apparent spasm of peroneal muscles is in reality an adaptive shortening. A better term would be rigid flat foot due to talocalcaneal bridge or calcaneonavicular bar.

3. The smaller group of patients who suffer from inflammatory lesions of the tarsal joints, chiefly due to rheumatoid arthritis, do in fact develop valgus deformity from peroneal spasm. The resemblance between the two groups is superficial and it is limited to the apparent similarity of the deformity. Though it might be justifiable to designate this type as peroneal spastic flat foot, it would be better to use the more accurate title—arthritic flat foot with peroneal spasm.

4. Lipping of the upper margin of the talonavicular joint strongly suggests the existence of one or other of the congenital anomalies. Both anomalies are visualised only by special radiological projections.

1. A method of denervating the elbow joint, based upon observations on the articular branches of the main nerve trunks, is presented.

2. In a small group of cases with post-traumatic arthritis and osteoarthritis, relief of pain and restoration of painless movement has been gained.

3. There was recurrence of pain after six months in one patient with acute rheumatoid arthritis; in such cases denervation is not recommended until further study is completed.

4. Denervation must be as complete as possible and full exposure with stripping of nerve trunks is recommended. There have been no complications.

5. The results in this small series of cases are encouraging, but patients should be warned that there will be no significant increase in the range of movement, and that a normal joint is not to be expected.

6. Articular neurectomy is still on trial. If the limitations are recognised, the procedure may have a useful place in the relief of pain in the elbow joint.

It will be seen that the proportion of successful fusions in this series of ninety-five patients treated by ischio-femoral arthrodesis of the hip was over 80 per cent. Similar percentages of successful fusion have been reported by Knight (1945), Freiberg (1946), Langston (1947), and Nisbet, who was resident surgical officer at the Robert Jones and Agnes Hunt Orthopaedic Hospital, and informed me in a personal communication that he had carried out twenty-six operations with an approximate fusion rate of 80 per cent. He stated: "It is the only operation which gives a reasonable chance of a successful arthrodesis in children. Up till now at Oswestry the chances of a fusion by the other methods in children have proved so disappointing that the operation had been abandoned. Dame Agnes Hunt, with her vast experience of the condition, was always very annoyed when she found a surgeon trying to fuse a child's hip. All this has been changed."

Posterior dislocation of the shoulder is an unusual injury and there is often much delay before the diagnosis is made. Nevertheless, if the condition is borne in mind when examining the patient and studying the X-ray films the diagnosis should not be missed. A single antero-posterior radiograph of the shoulder joint is inadequate. For the radiologist a pair of stereoscopic films is desirable; but for routine emergency work in hospital other projections are necessary. A vertical view should be taken, either with the limb abducted and the tube in the axilla, or with the tube above the shoulder and a curved cassette in the axilla. When this is impossible a profile or posterior oblique view of the scapula may be substituted.

1. It is suggested that slow recovery and post-operative effusion after meniscectomy may often be due to "scar friction" when the incision in the synovial membrane is in contact with the non-articular surface of the femoral condyle.

2. The advantages of a horizontal incision are discussed, particularly with regard to early recovery.

3. The results of one hundred and three cases of meniscectomy are analysed. An attempt to trace the cause of incompletely successful results in 25 per cent. of cases failed to show any relation to minor coincident lesions discovered at operation, or to the amount of meniscus removed.

Changes in the knee joint after meniscectomy include ridge formation, narrowing of the joint space, and flattening of the femoral condyle. Investigations suggest that these changes are due to loss of the weight-bearing function of the meniscus. Meniscectomy is not wholly innocuous; it interferes, at least temporarily, with the mechanics of the joint. It seems likely that narrowing of the joint space will predispose to early degenerative changes, but a connection between these appearances and later osteoarthritis is not yet established and is too indefinite to justify clinical deductions.

1 . A personal series of twenty-nine discoid menisci is reviewed.

2. Three anatomical types are recognised and described.

3. The characteristic lesions incurred by each type is recorded.

4. The anatomical and pathological features of the specimens are compared with those of cases previously recorded.

5. A discoid medial meniscus is described, and compared with the only other specimen known to be recorded in the literature.