1. A method of bridging gaps in long bones is described, using cancellous insert grafts supplemented by internal fixation with a metal plate.

2. The experimental work on transplantation of bone is reviewed in so far as it affects the practical problem of bone grafting.

3. Twenty-seven cases have been treated, with no failures. Seven of these are presented as illustrations.

1. A defect of the middle of one tibial crest is described in young healthy ballet dancers.

2. The clinical and radiological characteristics have been studied in four cases, and the histological appearances in two.

3. The defect is concluded to be an incomplete fatigue fracture—a fatigue infraction.

4. A fifth, uncertain, case has been added tentatively, as presenting a possible serious complication, namely acute fracture from muscle action.

5. The diagnosis, treatment and prognosis are mentioned, with emphasis on the importance of adequate clinical and radiological examination in cases of obscure mid-tibial pain, tenderness or swelling.

1. Chondromalacia, sometimes a precursor of osteoarthritis, is present in the articular cartilage of the patella of most people by the age of thirty; it causes symptoms in only a few, and it gives rise to osteoarthritis in fewer still. It may progress slowly or quickly but there is no clinical method of assessing the prognosis at an early stage.

2. The earliest change is swelling of the cartilage associated with a decrease in the chondroitin sulphuric acid content of the matrix. Later the cartilage fissures and flakes off to expose the bone, and there are reactive changes in the cartilage, bone and synovial membrane. The process is described and the etiology discussed.

3. The symptoms, signs and treatment are discussed. Operation, which has been performed only when there are disabling symptoms, may consist in removing part or the whole of the articular cartilage, or in excision of the patella. The results in forty-six knees are given.

We surgeons are privileged in having a profession which also encompasses a craft; by it we should have understanding of the problems of craftsmanship in modern life. Ultimately it is at the core of human happiness. Craftsmanship is based upon creative ability, good design, the almost loving conflict of man and material, and the consequent unification of both in completion. Craftsmanship is only possible as a manifestation of individuality. Integrity and invulnerability are its outcome.

May it not be that in the atomic age (if there is one outside of destruction) there may be a return to the craftsman's life of the eighteenth century; not of necessity for the maintenance of economic life, because that will be done for him by the machine, but rather for the maintenance of health?

1 . In the common type of Volkmann's ischaemic contracture affecting the forearm flexors, the infarct takes the form of an ellipsoid with its axis in the line of the anterior interosseous artery and with its central point a little above the middle of the forearm. The greatest damage is at the centre and usually falls most heavily on flexor digitorum profundus and flexor pollicis longus, which are often necrotic. Those muscles more superficially placed, and sometimes the deep extensors, are more likely to exhibit fibrosis.

2. The median nerve runs near the centre of the ellipsoid and may exhibit profound ischaemia. The ulnar nerve, lying at the edge of the ischaemic zone, tends to be less severely affected.

3. The treatment for this condition is excision of all tissues irreparably damaged by ischaemia. If this operation is performed within twelve months from the time of injury, correction of the contracture should be almost complete. The tendons of shortened but active muscles are lengthened or transplanted.

4. After such excision it is possible to carry out reconstructive procedures commonly used in the surgery of lower motor neurone disorders and of trauma. A wide variety of tendon transplantations is available. The median nerve may be repaired either by a free graft or, in cases where both nerves have been extensively damaged by ischaemia, by an ulnar to median nerve-pedicle graft.

1. A series of 149 consecutive cases of flexor tendon grafting in the fingers and thumb is reviewed and the results are analysed. A description of the technique which has evolved from this experience is given.

2. Replacement of a divided flexor digitorum profundus in the presence of an intact sublimis tendon restored a useful range of movement in 80 per cent of cases.

3. Replacement of both flexor digitorum profundus and sublimis gave good results in 70 to 80 per cent of cases.

4. Replacement of a divided flexor pollicis longus tendon gave good results in 85 per cent of cases.

5. The particular tendon used for the graft did not materially influence the result, but there are special indications for the use of the different tendons.

6. The choice of splintage or of early movement after operation does not appear to have a significant bearing upon the result.

7. The most important factor in determining the result is probably a precise and gentle surgical technique and complete haemostasis. Minor differences in method are of little importance. The failures in this series were due more to faulty performance of the operation than to any other single factor.

1. The incidence of Sudeck's syndrome in the hand is about once in 2,000 accidents of all kinds.

2. The onset of signs and symptoms occurs some weeks after injury and the typical radiographic changes (spotty atrophy) appear six to eight weeks later.

3. Conservative treatment by heat, elevation and graded function is effective if initiated within six weeks of the onset of symptoms.

4. There is some close relationship between Sudeck's atrophy and thickening of the palmar fascia.

1. We have described here various forms of rickets and osteomalacia that we have studied ourselves and have come to recognise as comprising definite syndromes. We have included only diseases in which hereditary factors have been proved or might be suspected to play a part.

2. There are more of these syndromes than previously defined.

3. All these hereditary diseases can be treated, usually very satisfactorily, using the same general principles and with only very few simple medicines such as vitamin D and sodium bicarbonate. Careful control and long follow-up, however, may be required to achieve best results and to avoid accidents.

4. A study of the genetics of the diseases is a help in diagnosis and treatment. Broadly speaking the group of diseases which mimic vitamin D deficiency more or less closely tend to be inherited in dominant fashion. The groups with more severe degree of renal-tubule abnormality are inherited as recessives.

5. When more than one member of a family is affected it has been found that in each family each syndrome runs true to type.

1. Seven new cases of primary reticulo-sarcoma of bone are recorded, including one in which a full necropsy was carried out.

2. The literature of Ewing's tumour and reticulo-sarcoma of bone has been examined and the conclusion reached that the separation of these two tumours is an artificial one.

3. The investigation of our cases confirms this observation.

1. Three cases of aneurysmal bone cyst are recorded. It is suggested that the condition is a type of cavernous haemangioma and the term haemangiomatous bone cyst is preferred.

2. A survey of the published cases suggests that in its early stages the lesion is amenable to local surgery, which is the treatment of choice, but for inaccessible lesions deep x-ray therapy may be effective.

1. The clinical, radiographic and pathological features of aneurysmal bone cyst are described and illustrated by case reports.

2. Reasons are given for accepting the lesion as a clinical and pathological entity.

3. The cyst has a tendency to spontaneous regression and healing may occur after partial excision.

1. A case of polyarteritis nodosa is reported, the presenting manifestation of which was subperiosteal new bone formation in both legs.

2. The effect of cortisone on the symptoms is recorded.

3. The histology is reported after biopsy of bone and adjacent tissue.

4. Skeletal involvement in polyarteritis nodosa is believed to be hitherto unrecorded.

1. Attention is drawn to that type of rigid congenital flat foot in which the talus lies vertically instead of horizontally.

2. This deformity is rare, but if not treated successfully leads to an ugly, painful foot in adolescence.

3. The experience of five patients forms the basis of the present preliminary account. One adolescent and two young children under the age of five were treated unsuccessfully by both conservative and operative measures. More recently in two children with bilateral deformity open operation has been successful in restoring the shape of the foot.

4. The operation is essentially a reduction of a subluxation at the talo-navicular and subtalar joints. It entails freeing the head of the talus sufficiently to allow it to be lifted dorsally and laterally. The talus is then anchored in position by transplanting the distal end of the peroneus brevis tendon through the neck of the bone.

1. One hundred and forty-two cases of extra-articular arthrodesis of quiescent tuberculous hips with fibrous ankylosis have been reviewed.

2. The methods used were the ilio-femoral graft with and without osteotomy, and the ischio-femoral graft by the Brittain or Foley technique.

3. Success occurs more frequently when the grafting operation is combined with or followed by a femoral osteotomy.

4. It is suggested that this success is due largely to the increased immobilisation afforded by the osteotomy.

5. It appears that equally good results can be obtained with either an ilio-femoral or an ischio-femoral graft in these cases provided that an upper femoral osteotomy is also carried out, preferably at or soon after the grafting operation.

6. An upper femoral osteotomy will frequently convert an unsuccessful extra-articular hip graft into a successful one without further grafting.

1. This is a simple clinical study of the end-results of arthrodesis of the hip joint in patients followed up and re-examined five to twenty-five years after operation.

2. The study was stimulated by our astonishment at recent reports which suggested that arthrodesis of the hip caused serious operative mortality, a high rate of wound infection, and failure of sound fusion in one of every two cases; and that even when sound fusion was gained there was always pain in the back and usually stiffness of the knee. To say that we were astonished puts it mildly.

3. This review includes 120 patients aged from ten to seventy years, treated for osteoarthritis of the hip joint by intra-articular arthrodesis with the internal fixation of a nail, usually with an iliac graft, and with immobilisation in plaster for not less than four months.

4. Of these 120 patients there was sound fusion of the joint, proved radiographically, in 94 per cent; a mortality of nil; and recovery of free movement of the knee joint to the right angle or far beyond in 91·5 per cent. Almost half of the patients regained normal movement, the heel touching the buttock. Only in eight patients was there less than right-angled flexion.

5. There was no pain in the back—none whatever—in 64 per cent of the patients. In 36 per cent there was some pain or discomfort. One alone said that the low back pain was worse than before the operation. Many others said that pain in the back had been relieved by the operation.

6. It is emphasised that these results were gained only from sound fixation of the joint in the mid-position with neutral rotation, no more abduction than is needed to correct true shortening, and no more flexion of the joint than that with which the patient lies on the table. The limb was immobilised in plaster for at least four months after operation. The stiff knee was mobilised by the patient's own exercise without passive stretching, force or manipulation.

7. Two other groups of patients are considered. There are fourteen treated by fixation of the joint with nail alone, an operation that was never intended to arthrodese the joint and which has long since been abandoned. The other small group is that of patients with old unreduced traumatic dislocation of the hip, a procedure in which the risks of operation are so great and the number of successful results so small as to dissuade us from attempting operative reduction.

8. After successful arthrodesis of the hip joint patients can return to every household activity and every recreation including ski-ing, mountaineering, rock climbing, or whatever else they want.

1. A description is given of the pathology of a generalised skeletal disease characterised by a defect in the formation of the collagen fibres of the bone matrix—"fibrogenesis imperfecta ossium."

2. Material from two cases, a woman of fifty-six and a man of sixty-four, was examined. All the samples of bone from both patients showed the same defect, which was severe in most of the specimens, and there was radiographic evidence of similar widespread bone changes in both cases.

3. The defect is clear-cut and striking histologically, provided that sections are examined with a polarising microscope, and/or by reticulin methods.

4. As a result of the defect in the bone matrix this fails to calcify, or calcifies imperfectly, showing wide osteoid borders as in severe osteomalacia. But the fibre defect separates it quite clearly from osteomalacia, in which the fibre structure of the osteoid tissue is normal. Moreover neither the biochemical findings (Case 2) nor the radiographic appearances correspond with those of osteomalacia.

5. The collagen fibre defect is confined to the bone matrix; no defect was found in the soft tissue collagen, and even the periosteum shows a normal fibre structure.

6. Both the clinical and the histological evidence indicate that the disease is not congenital, but was, in these two patients, apparently acquired during middle age. There was no family history of bone disease.

7. The cause of the condition is quite obscure. It is not inflammatory or neoplastic, nor is there histological or clinical evidence of a toxic origin. If it is a deficiency disease it is unlike any known vitamin or other chemical deficiency.

1. The bone changes in four autopsied cases of Cushing's syndrome are described. The changes take the form of osteoporosis, which is most marked in the spine and the ribs.

2. The osteoporosis results from impaired osteoblastic bone formation in the presence of a normal degree of osteoclastic bone resorption.

3. Histological abnormalities of fracture callus in Cushing's syndrome indicate interference with the proliferation of osteoblasts and cartilage cells and with the formation of new tissue by these cells.

4. The bone changes in Cushing's syndrome are comparable with those produced in experimental animals by the administration of A.C.T.H. or cortisone.