1. Tendon grafts, in order to survive, have to develop a blood supply from their immediate environment. This causes adhesions.

2. Their final range of movement is therefore a sum of the length to which these vascular adhesions will stretch, and the range of movement of the normal tissues to which the tendon has become adherent.

3. Thus it is important that the tendon graft should lie in a bed of yielding material, and that no unyielding structures should be divided in the same wound. When possible, blunt tunnelling between short transverse incisions is the method of choice for placement of grafts.

4. The most crippling adhesions are those that grow from an imperfectly sutured cut end of tendon, leaving it unsatisfied. A new method of tendon anastomosis designed to prevent such adhesions is described.

5. A tendon grafting technique for intrinsic paralysis of the fingers in leprosy, using a radial extensor of the wrist as the motor and the plantaris tendon as the graft, is described.

6. A study of 861 fingers after the operation is presented.

7. The importance of re-education after operation is stressed.

1. The success of any method of treating the injured hand is to be measured by the use that is made of the remnant.

2. Careful, prompt surgical treatment of the wound will usually allow prompt healing.

3. Skin-grafts, internal fixation of fractures and the eking out and rearrangement of tissues that have escaped injury have an important place in primary treatment.

4. Many hands so treated are ready for use after one operation and within a few weeks of being injured.

5. Reconstruction in several stages should not be carried out unless it offers a reasonable prospect of improvement that will be useful to the particular patient.

1 . The clinical results in forty cases of repair of the median nerve at the wrist have been examined. Almost half were unsatisfactory.

2. The factors that may have predisposed to failure of adequate re-innervation are discussed.

3. The results might be improved by the use of radio-opaque markers for early detection of separation at the suture line, and by the use of frozen sections to determine the adequacy of resection.

In ten cases definitive loss of sensibility in an important territory of the hand has been treated by a hetero-digital, neurovascular skin island transfer. Operative technique and results obtained are reported. Although not enough patients have been treated to allow us to give precise indications for the procedure, two such indications clearly emerge: 1) the treatment of insensitive digits; 2) the reconstruction of the thumb or fingers. The procedure could probably be used elsewhere than in the hand.

1 . Power and precision grip (Napier 1956) were tested in 154 patients with nerve injuries.

2. The results are described, illustrated and discussed and it is suggested that these tests provide a simple, repeatable and objective method of assessing prehensile function of the hand as a whole.

1 . Thirty-six patients with complete irrecoverable brachial plexus lesions have been studied.

2. Function has been compared after 1) arthrodesis of the shoulder with amputation through the arm, 2) so-called reconstructive procedures, and 3) no operative treatment.

3. The results of reconstructive operations have been so disappointing that we believe that this type of treatment should be abandoned.

4. Amputation-arthrodesis offers a better functional result than either reconstruction or no operation. Its value depends to a considerable extent on the manual dexterity of the patient.

5. A clerical worker who is not mechanically minded is less likely to use an artificial limb, and in this type of patient operation is perhaps best avoided.

1. Regional osteoporosis is a common finding in osteoid osteoma. It may in fact be a constant feature because it was present in all the patients reported in this paper and was suspected in others who have not been included in this report because of insufficient information.

2. Five of our six cases showed osteoporosis about the hip. Osteoporosis is more likely to be noticed in this region than in other parts of the extremities because both hips are usually radiographed on one film. We have seen several instances in which we suspected generalised osteoporosis of an extremity but Case 5 was the only one in which comparable radiographs had been taken of both feet.

3. When there is osteoporosis in the region of a joint with symptoms referred to that joint an osteoid osteoma may be the cause. The nidus may lie at some distance from the joint surfaces and may not be seen in standard radiographs of the joint (Case 4). Additional radiographs including a wider area than usual may be necessary to show the lesion, and tomography is sometimes required.

1. A study has been made of the treatment of recurrent dislocation of the patella in 106 knees in seventy-six patients.

2. In young adults in whom degenerative changes in the knee were not severe at the time of operation transplant of the tibial tubercle gave the best results.

3. In older patients and in those in whom osteoarthritic changes were present in the knee transplant of the tibial tubercle was unsatisfactory, but patellectomy with rerouting of the quadriceps mechanism gave fair results.

4. Tibial tubercle transplant is contra-indicated in children because it may give a recurvatum deformity.

5. When the dislocation is permanent, operation may be unnecessary, but if it becomes inevitable simple patellectomy is the best procedure.

6. The results of plastic operations on the quadriceps expansion and of supracondylar femoral osteotomy are bad.

7. No operation can give consistently good results because the knee is usually congenitally weak, often as part of generalised ligamentous laxity.

1. The problem of instability of reduction in congenital dislocation and congenital subluxation of the hip has been studied and it has been concluded that the basic cause of this instability is the abnormal direction in which the entire acetabulum faces.

2. An operation, innominate osteotomy, has been designed to correct the abnormal direction of the entire acetabulum in children over the age of eighteen months. The principle of innominate osteotomy is redirection of the acetabulum so that the reduced dislocation or subluxation, which previously was stable only in a position of abduction and flexion, is rendered stable in the functional position of weight bearing.

3. The operative technique, and the pre-operative and post-operative management are described.

4. The indications for innominate osteotomy are outlined and the advantages of the operation are enumerated.

5. The early results of innominate osteotomy are very encouraging.

1. Compression stress fractures are described.

2. These fractures have all been previously described in various bones but have not been associated as a clinical or radiological entity.

3. The greyhound suffers a compression stress fracture of the navicular bone. This is described with certain deductions therefrom.

1. The trends in treatment of cervical dislocation are reviewed.

2. Seventeen patients treated by manual reduction under general anaesthesia are reported.

3. The evidence is that reduction in this way is not dangerous and has advantages over other methods.

Six children who complained of pain and stiffness in the back had been treated with lumbar punctures between six and ten years before they came under observation. They were found to have intrathecal epidermoid tumours in the lumbar region which are presumed to have arisen from implanted skin fragments. The main evidence for this assumption is that since 1956 sixteen patients with lumbar epidermoid tumours in patients who had had previous lumbar punctures have been reported, in contrast to the five patients with lumbar epidermoid tumours recorded before that date. This suggests that there is an additional etiological factor.

1. Three patients are described in whom forward dislocation of the peroneal tendons was associated with a chip fracture of the lateral malleolus and forward dislocation of the tendons through the fracture.

2. This injury differs from the more usual simple anterior dislocation of the peroneal tendons in which rupture of the superior peroneal retinaculum allows the dislocation to occur.

3. A simple operation is described which succeeded in holding reduced the dislocated tendons by suturing the fractured small chip of bone back to the lateral malleolus.

The subtalar joint is not easy to visualise by standard radiographic methods. Several projections are described including medial and lateral oblique axial views to demonstrate the three compartments of the joint. It is suggested that when visualisation of the subtalar joint is required these views should be routine.

Various conditions affecting the subtalar joint and their demonstration by these oblique axial views are discussed.

Many analyses of the geometric arrangement of trabeculae in the proximal end of the femur have accepted and perpetuated the theories of Ward (1838), Culmann (1866) and Meyer (1867), and have contributed to the belief that the structure of the femoral neck embodies mechanical principles which are foreign to bony formations elsewhere. This isolated departure from the normal pattern of skeletal behaviour is considered to be most unlikely, and an attempt has been made to show that the structure of the femoral head and neck departs but little from the normal anatomy of the long bone.

From a developmental point of view, the proximal end of the human femur is believed, in its simplest interpretation, to represent an upward continuation of the original shaft which has undergone rotation and expansion. The cancellous arrangements of the internal weight-bearing system are likewise believed to represent the expanded and rotated lamellae of the neck as they are presented radiologically or on coronal section.

The forces acting upon the proximal end of the femur are considered to be mainly compressive in nature, and both crane and street-lamp bracket theories have therefore been rejected. The spiral conformity of the proximal end of the femur has been related to the spiral disposition of the soft-tissue structures that surround the hip, and in the interpretation of hip joint mechanics the principle of the screw has been preferred to the principle ofthe lever.

Calcified matrix that is being absorbed has a characteristic appearance. At the junction of the epiphysis and metaphysis in the rat tibia this appearance can be seen near capillary endothelium as well as under osteoclasts. It is concluded that absorption can take place under the walls of capillaries without the presence of osteoclasts.