An operation is described for mobilising the whole extent of the cervical part of the spinal cord into an enlarged spinal canal in cases of spondylosis with myelopathy. The procedure is indicated to relieve symptoms and arrest their progress, and it has proved effective in practice.

1. The gravity of thrombo-embolic complications in orthopaedic and accident surgery has stimulated us, since 1951, to devise a means of prevention which comprises: a) the use of anticoagulants, the mode of administration of which has been determined by an experience of over 5,000 cases; and b) a method of selecting those patients most threatened by thromboembolism.

2. Although there could be no absolute guarantee of protection, these measures offered a considerable reduction in the risk of thrombotic complications.

1. Fracture of the neck of the femur in childhood and its complications are discussed.

2. The high incidence of these complications is not generally appreciated–in this series of twenty-four patients only eight achieved normal hip joints.

3. The complications are due to the arrangement of the blood supply to the head and neck. Avascular necrosis is unavoidable in a high proportion, and is not directly related to any particular method of treatment.

4. Extreme care and gentleness in handling the injured limb will help to reduce the incidence of deformities; internal fixation is not suitable for the very young as it may predispose to necrosis or may damage the epiphysis. In older children it can be used with care.

5. Where growth is still taking place in the limb the retention of the angle between neck and shaft is most important, as this will prevent coxa vara and progressive shortening with the consequent unsightly Trendelenburg limp.

1. A collected series of forty-seven traumatic dislocations of the hip in children is reported and reviewed in detail.

2. All were simple hip dislocations, and no child was included in whom there was any other injury to the affected joint.

3. All were posterior dislocations.

4. No anatomical predisposition was observed.

5. Significant complications occurred in fourteen children: avascular necrosis of the head of the femur in four, degenerative joint changes in three, premature epiphysial fusion in one and overgrowth of the femoral head in six. Study of the children with these complications revealed no common cause except the dislocation itself.

6. The injury responsible was often trivial.

7. The results suggest that it is harmless to bear weight four weeks after reduction.

1. Nine cases of traumatic dislocation of the hip in children have been reviewed.

2. There was one instance of avascular necrosis of the femoral head, which became apparent six months after injury.

3. In one case fracture of the femur on the same side led to four days' delay in recognition and treatment of the dislocation.

4. At the time of review all patients were free from symptoms.

1. The case history of a seven and a half-year-old boy who developed increased radiographic density of the femoral capital epiphysis after traumatic dislocation of the hip is presented.

2. The authors have been able to examine the case reports of thirteen similar cases presented in the literature.

3. The case presented is felt to be of interest because avascular necrosis was diagnosed early, and the radiographic appearance of the hip became normal five months after the injury.

1. A brief summary is given of the literature on patients with a dislocated hip and a fractured femur on the same side.

2. One further patient is reported, treated by closed reduction of the hip and the fracture.

3. A warning is given on the frequency with which the dislocation is not diagnosed in this double injury.

1. Almost all patients with osteoarthritis of the hip who consult the surgeon do so because they wish to be relieved of pain. They all have limitation of movement in varying degrees but most of them will be either unaware of it or will have accepted it. What is more important, they would not have sought medical advice because of stiffness if there had been no pain. The primary objective of operative treatment must therefore be to relieve pain.

2. Displacement osteotomy will give substantial relief from pain in a high proportion of cases and the relief is lasting. Perhaps that explains why this operation, advocated by McMurray and Malkin twenty-five years ago, is being practised more widely than ever to-day while its competitors (neurectomy, capsulectomy, arthroplasty) have steadily diminished in popularity.

3. The disadvantages of the operation are all related to post-operative immobilisation in plaster, which may induce further stiffness of the hip, even to the extent of ankylosis, or stiffness and pain in the knee. These disadvantages may be overcome to a considerable degree by internal fixation followed by sling suspension and early active movement. But when, under anaesthesia, the range of hip flexion is reduced to 45 degrees or less, the operation is always liable to result in ankylosis, and it is wise in these circumstances to take this possibility into account and warn the patient beforehand.

1. Nine patients treated for osteogenic sarcoma by elective radical irradiation are reviewed. Five of the nine patients have survived for from three to fourteen years, but one patient has metastases.

2. These results are compared with those from primary amputation.

3. The importance of histological grading in prognosis is emphasised.

4. It is concluded that radical irradiation should be considered in place of primary amputation for osteogenic sarcoma in the upper limb.

1. A case of cryptococcosis (torulosis) of bone is described.

2. The diagnosis was established by microscopical examination of pus and culture of the organism.

3. The literature is briefly reviewed.

1. The natural history of cryptococcal infection is discussed in relation to the findings in a woman of fifty-six with lesions in the right radius and right fourth metatarsal. A diffuse lesion found in the right lung with a calcified gland at the right hilum was believed to represent the initial site of infection.

2. There was a general tendency for normal bone architecture to be restored after the destructive phase of the disease had finished.

3. Specific treatment with the fungicide amphotericin B had to be stopped because of severe systemic reaction.

4. The significance of the rare association of Boeck's sarcoid with torulosis is discussed.

1. An unusual congenital anomaly of the cervical spine is described. This lesion caused a localised cervical kyphosis and resulted in the development of a mild tetraparesis.

2. The case reported is believed to be the first on record in the English literature of multiple posterior hemivertebrae in the cervical region.

3. The neck deformity was associated with an unusual combination of developmental anomalies–namely, brachyphalangy and bilateral congenital optic atrophy.

4. The importance of differentiating between congenital and acquired causes of kyphosis is emphasised.

5. The radiographic appearances of posterior hemivertebra are described, and the differential diagnosis is considered.

6. The development of the vertebral body, and the relationship between coronal cleft vertebra and posterior hemivertebra, are discussed. The possible role of a disturbance of vascular supply in pathogenesis is mentioned.

7. This report augments the growing literature on congenital skeletal anomalies occurring in combination with isolated congenital ocular defects.

1. Three cases are described of a calf swelling occurring in rheumatoid arthritis.

2. This condition has been described by Baker, though many of his patients had tuberculous infection of the knee.

3. The diagnosis may present difficulty because of the distance of the swelling from its origin in the knee joint.

4. Excision of the cyst is advised when it causes pain, but recurrence is likely if disease of the joint remains active.

1. The symptoms, signs and treatment of three patients with a posterior dislocation of the clavicle are described.

2. The value of tomography in confirming the diagnosis is outlined.

3. Certain experimental work has been done in an attempt to determine the factors necessary to produce this dislocation.

1. A child is described in whom an acute osteitis was produced by some organism which could neither be identified nor cultured in vitro, and which provoked a violent general reaction but which also showed a distinct affinity for the central nervous system.

2. This organism survived in a cavity in the femur for four months; it preserved its pathogenic properties, and could only be cultured in living tissue.

3. A twice repeated passage through animals increased the toxicity of this organism and proved its affinity for the central nervous system.

4. This organism may have been a virus similar to those producing encephalitis. A final answer may be obtained by further attempts to provoke experimental osteitis with live cultures of viruses in animals.

1. Tennis elbow is largely an affliction of middle age, and it is believed that degenerative changes in the orbicular ligament may underlie its pathology.

2. It has been shown that most patients may be relieved by either extra-articular or intra-articular injection of hydrocortisone, and operative intervention is required only in a minority of cases.

3. Contraction of the extensor carpi radialis brevis is considered to be the principal pain-producing factor, and Z-lengthening of the tendon of this muscle has been found to relieve the symptoms when conservative measures have failed.

4. The late results in fifty patients have shown that this operation causes diminution neither of the power of wrist dorsiflexion nor in the efficiency of the grip. The operation may therefore be undertaken with every prospect of relieving the discomfort of tennis elbow without inviting alternative disability.

1. Two boys complaining of pain in the ankle were shown to have centres of separate ossification for the medial malleoli. These were present bilaterally, but discomfort was unilateral.

2. In one, followed for fifteen months, the extra centre became wholly incorporated into the normal lower tibial epiphysis.

3. in a series of 100 children between the ages of six and twelve, without any known disease or injury of the ankles, radiographs showed that 20 per cent had a separate medial malleolar centre on one side. In 13 per cent this finding was present bilaterally. In one child a separate lateral malleolar centre was also found.

4. The significance of this finding is discussed, and it is considered to be a normal variant.

5. Occasionally one of these centres may remain unfused into adult life. Attention is drawn to the possible implications of this persistence.

Radiographic examination of a giraffe-necked woman shows that there is no true elongation of the cervical spine. The apparent lengthening of the neck is due to incorporation of part of the thoracic spine and thorax in the neck.

1. By unilateral resection of the posterior ends of the sixth to eleventh ribs including the costal parts of both costo-vertebral joints, progressive scoliosis can regularly be provoked in young rabbits. Rotation of the vertebrae is prominent in the experimental deformity.

2. Although severe progressive scoliosis can be provoked by a surgical procedure we do not yet know the deforming forces which are released by the operation, but the way lies open for accurate studies on these factors.

3. It seems possible that studies on experimental progressive scoliosis may provide us with new methods to counteract or cure scoliosis in children. The goal is a means to reverse the deforming forces during growth so that the child's spine is straight when growth ceases.

1. An experimental study of the effects of nerve and muscle lesions upon the growth of bone has been made. In each case animals were subjected to unilateral lesions in the hind limb, the other limb serving as a control. The growth of the tibia was measured by calculating the difference between the length of the bone on a radiograph at the beginning of the experiment and the length of the dried bone after necropsy. The weights of the dried bones were compared.

2. In the young rabbit simple exposure of the common peroneal nerve, or division of the sural nerve, produced no change in the growth rate of the tibia. Division of both peroneal nerves, producing paralysis of the muscles below the knee, led to lengthening of the affected tibia, and this lengthening persisted until maturity several months later. A similar lengthening was seen after division of the tendons around the ankle. In spite of this lengthening the tibia on the side of the operation was almost always lighter than its fellow.

3. In the puppy division of the anterior nerve roots supplying the hind limb produced a significant lengthening of the tibia of the affected limb three months after operation. No significant changes in limb length occurred after lumbar sympathectomy in the puppy.

4. The significance of these experimental nerve lesions has been considered together with recent observations upon the growth of bone in the presence of lower motor neurone lesions in the child. From this analysis it is suggested that the initial effect of paralysis is to produce lengthening of the affected bone. This lengthening is probably due to the hyperaemia of disuse. In the presence of persistent paralysis the growth of the limb is ultimately depressed. This depression is rarely seen in the experimental animal because the growing period is relatively short. The possible causes of this secondary depression of bone growth have been considered.

Two groups of intervertebral discs, one normal, as obtained from the post-mortem room, the other prolapsed, as removed at operation, have been compared by chemical analysis of their principal constituents. There is a progression of chemical changes associated with the ageing of the normal disc. This shows not only the expected slight increase in collagen as age advances, but also, surprisingly, that the polysaccharide content rises to a maximum in the fourth decade, in the same way as does polysaccharide in costal cartilage. In prolapsed discs the ageing process is superseded by a different and distinctive progression, which advances, not according to age, but according to the duration of the prolapse. There is a critical level to which the polysaccharide content must apparently fall, irrespective of the normal level for the patient's age, before a prolapse occurs. Normal ageing probably consists in the breakdown of a particular polysaccharide/protein linkage, with coincident "maturation" of collagen. In the prolapsing disc multiple, and possibly different, linkages are rapidly broken down. This depolymerisation of a gel structure must be presumed to be the basis of the decreased imbibition capacity of the nucleus pulposus, and to be the source of the hydrostatic abnormalities which result in disc prolapse.

In both normal and prolapsing discs the products of mucopolysaccharide breakdown appear to participate in the metabolism of collagen.

1. Cancellous bone cubes from calf and man were deproteinised with hydrogen peroxide and with ethylenediamine.

2. Long bones were removed aseptically from sheep, stored in the bone bank and used for cancellous homografts.

3. Holes were drilled in the upper part of the tibia or ulna or in the lower part of the femur of sheep. Some were left empty; others were filled with plugs of the deproteinised heterogenous bone, with autografts, or with homografts.

4. Histological appearances were studied after seventeen and thirty-six days.

5. At seventeen days repair was more advanced in the plugged holes; the biological result was better with the ethylenediamine-treated than with the peroxide-treated material. After thirty-six days repair was at an advanced stage. As much new bone had been deposited on the trabeculae of the deproteinised heterografts as on those of the homografts.

6. There was no evidence of metaplastic bone formation; new bone seemed to form from endosteal osteoblasts.

7. Certain clinical implications are briefly discussed.

1. Linear fractures of the shaft of the long bones are divided into four basic types: 1) transverse; 2) oblique transverse; 3) spiral; and 4) oblique.

2. The mode of production of these fractures is deduced on the grounds of simple mechanical theory: 1) transverse fractures are a result of angulation; 2) oblique transyerse are the result of angulation with axial loading; 3) spiral fractures are the result of axial twists with or without axial loading; 4) oblique fractures are the result of angulation and axial twisting in the presence of axial loading.