1. Experimental evidence suggests that the autogenous graft exhibits some advantage over refrigerated homogenous grafts in that healing takes place more rapidly but that in the end the results are the same.

2. Histological study of fragments of healing grafts, both autogenous and refrigerated, that have been removed from human hosts shows no significant difference in the rate or method of repair.

3. Study of the clinical results of the use of homogenous transplants in 307 operations shows the bone to be well tolerated. The rate of infection in clean cases was 2·6 per cent; loss of bone occurred in only two cases.

4. Follow-up studies of 248 cases showed successful results obtained in 210, or 85 per cent. These are comparable with the results obtained with autogenous grafts. The healing of cancellous transplants takes place more rapidly than with cortical grafts. Transplants that have been preserved for more than one year do not heal as well as those that have been preserved for a shorter period and the failure rate is higher.

5. The operation of a bone bank is safe and practical. It offers great advantages to the patient and the surgeon from the standpoint of availability, abundance and the elimination of the necessity of secondary operations to obtain bone. When a bone bank is available the number of operations in which bone transplants are used will show a sharp increase.

The technique of storing bone by refrigeration is described and the following advantages are indicated: 1) A patient avoids a second wound and the loss of bone from some other part of the body; this is a very important matter for patients in whom poliomyelitis has affected both legs. 2) Almost unlimited bone is available to the surgeon and he is consequently able to insert very large grafts and so obtain better results.

Sarcoma complicating Paget's disease is uncommon; ninety-five cases have been collected and seven further cases are now reported. Sarcoma probably complicates less than 2 per cent of all cases of Paget's disease. There is a relatively high incidence in males, especially in the sixth decade, whereas bone sarcoma over the age of fifty years without osteitis deformans is rare. Injury is prominent in the history of many cases.

Comparison of Paget's sarcoma, "ordinary" bone sarcoma and the bones affected by uncomplicated osteitis deformans reveals some important differences. As to the type of tumour, osteogenic sarcoma is the commonest, but fibrosarcoma and round-cell sarcoma are also frequent.

The serum phosphatase is a most useful prognostic guide in a disease with a generally poor prognosis. Magnesium metabolism in relation to bone sarcoma requires further study.

Prophvlaxis is based on a clinical suspicion of this complication in Paget's disease, and measures are outlined which may be of assistance.

Sarcoma in Paget's bone is highly lethal, but Nature in striking down these old people may have provided us with facts which will ultimately solve problems common to all sarcomas of bone.

1. Volkmann’s ischaemia is a real and threatening complication of fracture of the femur, and it is more common than reports in the literature would suggest.

2. The early signs and symptoms in the calf are ominous whereas the early vascular signs of a good tibial pulse, colour and temperature are often misleading.

3. Muscle decompression with or without arterial exploration has proved to be of no value.

4. Early recognition and radical treatment are imperative. Temporary paralysis of the lumbar sympathetic outflow has been shown to be an effective measure.

5. Transfixion of the calcaneum with a Kirschner wire for traction has the advantage of eliminating all bandages, suspending the tender calf and preventing an equinovarus deformity.

6. The only essential difference between the histological appearance of muscle which recovers and that which does not appears to be degeneration of muscle nuclei. The significance of engorged blood vessels remains in doubt.

7. Histological studies suggest that despite the typical gross appearance of an infarct some regeneration of muscle may occur.

1. A clinico-pathological study of a patient who suffered traumatic rupture of his right popliteal artery is outlined.

2. Collateral circulation from the genicular anastomosis developed within twenty hours.

3. Ischaemic necrosis of the belly of the tibialis anterior occurred, but voluntary power began to return about twenty-one weeks after injury.

4. Biopsy of the muscle nineteen, fifty-seven and seventy-six weeks after injury showed that the muscle belly was being reconstituted by new fibres and that the ischaemic tissue remained entombed in the deepest part of the muscle. The regenerating fibres arose from small numbers of subfascial fibres which either survived the ischaemic episode or had arisen by myoblastic differentiation of connective tissue cells. Sarcoplasmic outgrowths produced new contractile substance, and new fibres were formed by amitotic fission. Many of the fibres matured and the regenerative process was still active seventy-six weeks after injury.

5. Growth of new nerve bundles containing myelinated axons accompanied the development of new muscle fibres.

A method of treatment of Volkmann's ischaemic contracture is described which retains wrist movement and restores reasonably good function to the hand in suitable cases.

1. The indications for ischio-femoral arthrodesis are considered.

2. The technique of operation through an open posterior approach is described.

3. Indications for the modified Trumble operation are given.

4. The results of ischio-femoral arthrodesis in a series of forty-seven patients (mostly suffering from tuberculous hip disease) are presented.

5. The writers consider that ischio-femoral arthrodesis is the operation of choice in tuberculous disease of the hip, especially in children.

A survey of this type cannot be used to point to any definite factor or factors predisposing to the development of hallux valgus. Nevertheless, a comparison of measurements in the morbid and control groups shows several outstanding differences:

1) There was a high degree of correlation between valgus and intermetatarsal angle in the two groups combined (coefficient, 0·7) but the correlation was higher in those cases with a degree of valgus greater than 25 degrees than in the remainder (coefficients, 0·36 and 0·53).

2) In the control group the first metatarsal was longer than tile second by a mean measure of 2 millimetres; in the morbid group by a mean measure of 4 millimetres. For a high degree of valgus and a low intermetatarsal angle the first metatarsal tends to be longer than the second by a significantly greater amount than when the high valgus is associated with iligh intermetatarsal angle.

3) In 90 per cent of the control cases there was a lateral displacement of the medial sesamoid of the first metatarsal of 3 degrees or less, whereas 88 per cent of the morbid group showed a displacement of 4 degrees or more. There was very little overlap in the distributions of this observation in the two groups. There was a high correlation between the degree of this displacement and the severity of hallux valgus.

4) Rotation of the hallux was not observed among the controls; in the morbid group those cases showing rotation had an average degree of valgus of 36 degrees while the rest had an average of 19 degrees. The mean degree of valgus in the morbid group was 32·0 degrees and that of the controls 15·5 degrees. The mean angle between the axes of the first and second metatarsals was 13·0 degrees in the morbid group and 8·5 degrees in the controls.

Since tile morbid group consisted largely of women (98 per cent) it is important to know that in the control group the only measure showing a statistically significant sex difference is that of intermetatarsal angle, but that, even so, the mean difference is only 1·3 degrees. Thus tile sex difference between the two groups is probably only of minor importance. The role of age in influencing the observations cannot be clearly elucidated from the data at present available. It can only be stated that there is no positive indication that age is a controlling factor in the departure observed in the morbid group from the control observations.

In addition to its orthopaedic interest, this case illustrates the special behaviour of fine particles of a synthetic material when implanted in the human body. These results may interest those engaged in the control of dusts in the plastics industry, for the inhalation of such dusts may well result in "implantation" of the material in the lung, with consequent histological changes.

Infantile idiopathic scoliosis is a structural scoliosis seen in infants, usually boys, with the major curve to the left in almost all cases, and almost invariably in the mid-or lower thoracic region. It occasionally disappears, but in general the curve tends to increase. In the absence of any discoverable etiology it is termed "idiopathic" and it is believed not to differ in essentials from the more common adolescent scoliosis.

Lumbar idiopathic scoliosis has a good prognosis as to deformity, but leads more often than any other curvature to degenerative arthritis and pain in later life.

Internal fixation with a trifin nail after displacement osteotomy of the femur permits reduction of external splintage to a degree that any patient can tolerate with ease; it also eliminates the problem of the stiff knee.

The method has been used successfully for recent and old fractures of the femoral neck, for post-irradiation fractures, for failed nailing operations or arthroplastics, for osteoarthritis, for rheumatoid arthritis, for old congenital dislocations and subluxations, and to stabilise the hip after excision of the head and neck to create a pseudarthrosis.

Three elderly sibling dwarfs are reported from a large and otherwise normal family. Their condition is an unusual and irregular form of cartilaginous defect, combined with club-feet, and bearing some resemblance to the Morquio type.

A brief consideration of the literature of the generahised developmental bony syndromes shows confusion of thought and nomenclature. A plea is therefore made for simplification and a rational and simple grouping of these conditions is attempted. It seems particularly desirable that many confusing names for particular syndromes should be scrapped (for example, dyschondroplasia, chondro-osteodystrophy), although quite evidently the terms achondroplasia and osteogenesis imperfecta must remain because of their long-standing and general usage. Incidentally I have suggested elsewhere (Jackson 1951) that the name cleido-cranial dysostosis should be dropped, because it tends to lead the investigator away from the clinically more important lesions in the teeth and the cartilage bones of the pelvis and legs. It seems reasonable to confine the nomenclature of these various syndromes to the names used in the above classification, or something on those lines.

1. Rusty staining of the synovial membrane is the gross manifestation of loading of phagocytic synovial-lining cells and of macrophages in the stratum synoviale with haemosiderin.

2. Absorption of blood effused into the joint cavities is the commonest cause of such synovial pigmentation.

3. Obvious discolouration of the synovial tissues usually follows only after repeated haemarthroses, in such conditions as haemophilia, synovial tumour and in some cases of chronic rheumatoid arthritis.

4. An identical naked-eye appearance is seen in multiple joints of patients with generalised haemochromatosis.

5. In haemochromatosis the iron-containing pigment tends to be confined to the surface layer of cells of the synovial membrane.

6. The presence of haemosiderin in synovial cells, per se, leads to no disability of the joint and is unaccompanied either by inflammatory reaction or fibrosis. Arthritis in a patient with haemochromatosis is fortuitous.