Our investigations have shown that the late results of tarsal arthrodesis are good. We have endeavoured to find the disadvantages and to stress residual symptoms, but the general mpression after seeing these patients is that they were all well satisfied with the result. We think it should be added that these patients were selected in so far as they were all operated upon by masters of operative technique who were acknowledged authorities in this particular subject. Without the careful attention to detail and to the points discussed, these operations can be dismal failures and a burden to the patients concerned.

1. Published comparisons of the results of conservative and operative treatment of trochanteric fractures have been fallacious because the groups have not been strictly comparable and because all deaths during convalescence have not been included.

2. In a series of cases studied at Oxford, comparable groups have been secured by allotting alternate cases to each group. All deaths within three months of injury have been included, whether occurring in hospital or elsewhere.

3. There was no great difference in mortality or in functional results between the two groups. One type of trochanteric fracture gives poor results whatever the method of treatment.

4. The series is too small for statistical conclusions, but the results suggest that the only advantages of operative treatment are greater economy of hospital beds, and increased comfort and mobility for the patient. The latter factor is important in frail patients, who are believed to be less prone to develop non-fatal complications if treated by operation than if treated conservatively.

1. The advantages of internal fixation of trochanteric fractures of the femur are discussed.

2. It is suggested that a long oblique trifin nail driven across the fracture affords more rigid fixation than a nail-plate and facilitates earlier weight-bearing.

1. Nine hundred and fourteen cases of tuberculosis of the spine are analysed and the late results ascertained three or more years after discharge from hospital.

2. The relative frequency with which the various segments of the spine are involved has been found. Cervical disease was present in 3·5 per cent of cases, thoracic in 43·l per cent, lumbar in 32·9 per cent, thoraco-lumbar in 16· 7 per cent and lumbo-sacral in 3·8 per cent.

3. The mortality rate was 16·7 per cent. In patients with multiple lesions 25·5 per cent died, compared with 12·3 per cent in the group without complications. When chronic secondarily infected abscesses and sinuses were present the mortality rate was 19·1 per cent, and of patients with paraplegia 24·8 per cent died.

4. In the late results the working capacity of 390 patients was ascertained. It was full in 86 per cent, partial in 5·8 per cent and nil in 8·2 per cent.

5. An attempt has been made to determine the site of the primary bone focus from the radiograph. Early "epiphysial" changes were present in 33 per cent ; the central focus beginning in the spongy tissue of a vertebral body was present in 11·6 per cent; subperiosteal lesions were present in 2·1 per cent; and infection of the neural arch was present in only 0·5 per cent. In 52·8 per cent, however, widespread destruction had taken place when the patient first came under observation.

6. The ill effect of complications upon the prognosis is stressed—especially in the cases of multiple foci of active tuberculosis, secondarily infected abscesses and sinuses, and paraplegia. Paraplegia occurred in 31·2 per cent of the cases of thoracic disease.

7. An attempt has been made to determine the frequency with which tuberculosis of the spine heals by spontaneous bony fusion of the affected vertebral bodies. It was found in 27·3 per cent of the cases in the present series.

8. Reasons for further treatment after the initial discharge of the patient are examined.

1 . The principles and technique of flexor-extensor tendon transfers for claw toes are described. The operation is tedious, but it is effective in selected cases.

2. Sixty-eight patients have been operated upon and followed up; good results were obtained in fifty, fair results in eleven, and poor in seven. More careful selection and better operative technique might have avoided some of the failures.

3. The operation restores useful function to the toes at the cost of their prehensile action, diminishes any cavus deformity of the foot, and, by lessening the prominence of the metatarsal heads in the sole, avoids callosities and discomfort.

A case of cervical traumatic paraplegia is described in which there was no evidence of damage to vertebrae, discs or ligaments. Experimental evidence suggests that such injuries may be caused by inward bulging of the ligamentum flavum during hyperextension. The reasons why this inward bulging may occur, despite the elasticity of the ligamentum flavum, are discussed. Treatment of such cases is considered and the importance of avoiding extension emphasised.

An attempt has been made to describe some of the ways in which the element of rotation, which is so important a part of the function of the normal forearm, has a bearing upon the mechanism and treatment of forearm injuries. In particular, distinction is drawn between those injuries in which the shaft of the radius remains in continuity, and those in which there is a complete fracture of the bone. In the former, rotation of the hand in the reduction will be transmitted to the upper end of the radius, and extremes of rotational movement may safely be used to obtain and hold a reduction. In the latter there is likely to be a rotational deformity between the two radial fragments, and the lower radial fragment must be placed in accurate rotational alignment with the upper. In the first group reduction, and in certain cases immobilisation, in full pronation or full supination has been shown to have a place in the treatment of those cases in which a rotation violence has shaped the pattern of the injury. Soft tissues may be used to guide and hold a reduction in a rotational injury, just as in injuries of other types. An injury caused by forced pronation should logically be treated in full supination, for only thus are the intact soft tissues on the "pronation side" of the limb used to the best advantage.

In the mechanism of injuries caused by rotation violence it is emphasized that vertical compression is usually the basic force, to which a rotation force may be added by the direction of momentum of the body weight. Such injuries may be grouped into forced rotation injuries (in which the violence applied has taken the limb beyond the normal ranges of rotational movement), and injuries occurring while the limb is pronating or supinating. In the latter group the rotational element determines the pattern of the injury: pronation and flexion are closely allied, and a fracture occurring while the forearm is pronating will develop a backward angulation: so also a supination injury will produce a forward angulation.

On the basis of these considerations injuries of the forearm may be classified as follows:

Injuries in which the shaft of the radius remains in continuity

Forced proiiation injuries:

1) Forward dislocation of the head of the radius.

2) Backward dislocation of the lower end of the ulna.

3) The anterior Monteggia fracture-dislocation.

These injuries should be reduced and immobilised in full supination to prevent recurrence of deformity. The lateral and posterior Monteggia injuries are probably variants of dislocation of the elbow and are not caused by rotation violence. In general it is considered that all dislocations of the head of the radius are best treated in full supination.

Pronation injuries:

Greenstick fractures of the radius, and of both bones of the forearm, with backward angulation. Reduction of deformity is most easily obtained by manipulating into full supination. Certain fractures may with advantage be immobilised in this position.

Supination injuries:

Greenstick fractures of the forearm with forward angulation. Reduction is best obtained by full pronation.

Injuries in which the shaft of the radius is in two separate fragments

This group includes all complete fractures of the shaft of the radius and of both bones of the forearm. There is nearly always a rotational deformity between the two radial fragments and its correction is a dominant factor in the treatment.

A new concept of the etiology of congenital dislocation of the hip, which states that the process is simply an accident, is presented. It is observed that the diagnosis should be made at birth. The importance of obtaining movement of the hip, after the reduction has been stabilised, is stressed. Contact and function are mandatory for the natural production of a normal hip. A mobile brace is described which allows a wide range of movement while safely maintaining reduction. The success of this method of treatment supports the conception of the etiology on which it is based.

1. The salient features of calcinosis universalis and calcinosis circumscripta are described.

2. The term "calcinosis localisata" is suggested to distinguish the localised type of calcinosis from the more widespread calcinosis.

3. Thirteen cases of calcinosis localisata are described: in five the lesion was situated about the greater tuberosity of the humerus; one was in the axillarv aspect of the shoulder; one on the dorsum of the foot; two in the digits of the hand; one on the dorsum of the wrist; one in the region of the flexor carpi ulnaris tendon; one on the lateral aspect of the elbow; and one at the tip of the greater trochanter.

4. The value of rest is emphasised; in some cases chemotherapy appeared to be indicated.

1. Three cases of poliomyelitis complicated by myositis ossificans are reported.

2. A search of the literature has failed to reveal any similar reported cases.

3. The cause is still obscure.

1. The intervertebral disc is an organic viscous elastic structure capable of maintaining very great loads without disintegration.

2. Recovery of the disc after deformation depends upon: a) the imbibition of tissue fluid by the disc, b) the removal of the deforming force. Complete recovery is modified by the duration of the force.

3. Factors that interfere with the elasticity of the disc are: extreme youth (immaturity of the disc), chronic wasting diseases (general nutritional disturbance), and local pathological changes in the bodies of the vertebrae which interrupt or damage its blood supply. The intervertebral disc reaches its greatest state of efficiency in adult life—that is, when the nucleus pulposus has disappeared as an entity. The function of the disc appears not to depend upon the presence of the nucleus : rather does the presence of the nucleus indicate immaturity of the disc.

4. The highly resilient elastic nature of the vertebral column is provided by the intervertebral discs, which constitute one-third of the whole length of the column.

5. The imbibition of fluid requires further investigation. It appears that from lacunae in the adjacent bodies finger-like pockets dip into the discs and that fluid passes through the lining membrane of these pockets.

1. The normal anatomy of the intervertebral disc of immature rabbits is described.

2. An account is given of the changes that occur after an operative incision in the ventral part of the intervertebral discs of rabbits which allowed the escape of the nucleus pulposus. The account is based on observations made on fifty-five young animals killed at intervals during the twenty-five months after operation.

3. The superficial part of the wound in the annulus heals rapidly by active fibrosis. Thereafter there is a chondrification of the ventral region of the disc, followed by ossification. A prominent bony ridge ultimately ankyloses the vertebrae adjoining the disc.

4. The site of the nucleus pulposus is eventually occupied by a dense pad of fibrocartilage. A tongue of this tissue projects into the deep median part of the wound which remains unhealed.

5. A hypothesis is submitted regarding the mechanism of rupture of the annulus fibrosus and prolapse of the nucleus pulposus in man; this hypothesis is based in part on the observations of lesions in discs not subjected to operation.

Supraglenoidal dislocation of the humerus is uncommon. The anatomical findings in a bilateral example in which efficient pseudarthrosis had developed are described, and the probable evolution of the lesion is discussed.