1. Fifty-one cases of fracture of the odontoid have been analysed. Forty were reported by other surgeons; eleven were new cases first reported by us.

2. Fracture of the odontoid in young children is an epiphysial separation. It occurs up to the age of seven years. As in epiphysial separations elsewhere, it unites readily, and remodelling occurs when reduction has been incomplete, so that normal anatomy is restored.

3. In adults forward displacement is twice as common as backward displacement.

4. Immediate paralysis is commoner if backward displacement occurs, but late neurological disorders are seen only after fractures with forward displacement.

5. Failure of bony healing is not dangerous if treatment has resulted in firm fibrous union, for there is neither excessive abnormal mobility nor progressive subluxation, either of which could injure the spinal cord or medulla. Neurological disorders developing after the fracture are the result of mobility from inadequate early treatment. It is the results of inadequate early treatment which have given this fracture a sinister reputation.

6. The fracture should be reduced by skeletal traction through a skull caliper. The reduction should be maintained for six weeks by continuous traction, and this should be followed by a period of six weeks in a plaster.

7. The increasing definition of the fracture-line seen in the radiographs of some patients indicates non-union.

1. An account is given of fifty stress fractures of the fibula which occurred in athletes.

2. The characteristic symptoms, signs and radiological appearances are described, with details of treatment and prognosis.

3. The mechanism of the injury has been suggested on clinical grounds and supported by experimental methods.

Twenty-one post-irradiation fractures of the femoral neck are reported in seventeen patients who had been treated by radiotherapy for carcinoma of the uterus.

The clinical and radiological appearances are described and the diagnosis, prognosis and treatment of this type of fracture are discussed.

Histological material has been studied in three cases.

It is concluded:

1. That there is a characteristic clinical picture in which premonitory pain is of paramount significance.

2. That when the diagnosis is considered, the likelihood of irradiation damage should take precedence over the remote possibility of metastatic invasion.

3. That the disability varies, but in general the prognosis is favourable.

4. That there is no specific line of treatment applicable to these fractures.

5. That avascularity is not the underlying cause of this lesion.

1. Figures relating to blood loss and post-anaesthetic progress during and after 407 orthopaedic operations performed with the aid of hexamethonium bromide are presented.

2. Two deaths from circulatory failure are examined in detail.

3. The criteria that must be observed to ensure safety are discussed.

4. Measures designed to avoid reactionary haemorrhage are enumerated.

5. Observations regarding contra-indications are presented.

1. An example of haematogenous tuberculous lesion of striated muscle is described.

2. Its rarity is stressed and pathological details described.

3. Some of the theories for the refractory reaction of muscle tissue to tuberculous infection are discussed, and experimental work is reviewed.

4. The prognosis, treatment, and the relationship of the disease to trauma are considered.

1. Three pantalar, one ankle and subtalar, and three ankle arthrodeses have been performed by a technique, the essential step of which is the insertion of a transarticular graft from below. Union has occurred in four to five months.

2. A method is described of determining the degree of equinus before the operation and securing it during the operation.

3. Pantalar fusion by this technique compares favourably with the methods described so far.

1. Idiopathic calcification of articular cartilages is described in a Jamaican woman of thirty-one years who had intermittent joint pains for ten years and who had evidence of past gonococcal infection. She was otherwise normal.

2. The etiology of the condition is unknown.

3. Previous literature is reviewed.

The follow-up of these seventy-three cases suggested the following conclusions:

1. The clinical signs alone are not always sufficient to make the diagnosis of herniated nucleus pulposus with sufficient accuracy.

2. When positive, myelography was reliable as a means of localising the hernia.

3. In doubtful cases in which conservative treatment failed a clearly positive myelography turned the scale for a well-indicated operation.

4. In doubtful cases a clearly negative myelography has often rightly been a contra-indication for laminectomy.

5. No serious complication from the use of water-soluble contrast medium for myelography has been encountered.

1. Cases of hydatid disease causing paraplegia since 1860 in Great Britain have been briefly reviewed and three recent cases have been added.

2. The types have been classified, the clinical pictures outlined and the treatment discussed.

1. The so-called adamantinoma of long bones is a clinico-pathological entity, the pathogenesis of which is still in doubt. The case for its being a synovial sarcoma showing epithelial differentiation is in our view unconvincing.

2. The tumour is slowly growing, and of low grade malignancy. Apparent cure has been effected in a third of the total cases recorded by amputation or resection of the diseased bone.

3. These means, however, have not prevented metastases to the lungs and skeleton in a similar number.

4. A case is presented in which a metastasis appeared in the chest twenty-two years after amputation of the leg. This was sensitive to telecobalt irradiation, and is the first case in which a distant metastasis has been proved microscopically.

1. The prehensile movements of the hand as a whole are analysed from both an anatomical anda functional viewpoint.

2. It is shown that movements of the hand consist of two basic patterns of movements which are termed precision grip and power grip.

3. In precision grip the object is pinched between the flexor aspects of the fingers and that of the opposing thumb.

4. In power grip the object is held as in a clamp between the flexed fingers and the palm, counter pressure being applied by the thumb lying more or less in the plane of the palm.

5. These two patterns appear to cover the whole range of prehensile activity of the human hand.

An experimental method is described which permits observations on the early stages of repair after acute displacement of the upper femoral epiphysis. Because the epiphysis is intra-articular, displacement brings about avascular necrosis which is slowly repaired by ingrowth of callus and blood vessels from the stump of the neck. As the bulk of the epiphysial plate remainsattached to the epiphysis, it acts as a barrier to successful revascularisation. Deliberate removal of the epiphysial cartilage allows earlier revascularisation. It is suggested that in clinical cases reduction be done through the epiphysial plate rather than through the neck, and that it be accompanied by curettage of the remaining part of the epiphysial plate from the under surface of the head.

1. The spinal branches of the vertebral artery were injected with a suspension of barium sulphate and the blood supply of the vertebral bodies of the lower four or five cervical vertebrae investigated radiologically.

2. Beneath the posterior longitudinal ligament there is a free dorsal arterial plexus from which a large branch arises to enter the back of the vertebral body. This vessel terminates abruptly at the centre of the body where numerous, much smaller, branches radiate towards the upper and lower surfaces.

3. The possible significance of the form of the intravertebral arteries is considered in relation to embolic lesion in vertebral bodies.

1. Periosteal bone is supplied by periosteal vessels and endochondral bone by the nutrient artery.

2. In the earliest stages of development the metaphysis is supplied by vessels derived only from the nutrient artery. Later, metaphysial arteries derived from the periosteum take over the supply of its peripheral part, the extent of their area of supply progressively increasing.

3. In injected specimens the blood vessels approaching the epiphysial cartilaginous plate end in saccular dilations. Histological sections show these dilations to be blood-filled cartilage lacunae, with no endothelial lining and into which open the blood vessels approaching the epiphysial plate.