1. The term "observation hip" refers to a form of hip disease affecting children and adolescents, the most significant features being the transient nature of the symptoms and the absence of a bony or cartilaginous lesion on radiographic examination.

2. With a view to determining the possible sequelae of the disorder, twenty-three patients aged between two and fifteen years at the onset of the condition were studied fifteen to thirty years later.

3. Varying degrees of coxa magna, osteoarthritis or simple broadening of the femoral neck in the "observed" hip joint were found in the radiographs of twelve of the twenty-three patients studied.

4. This analysis suggests that the " observation hip" syndrome is the result ofan inflammatory process ofthejoint due to varied etiology, whether from injury or infection. The developmental and degenerative changes which may occur are a consequence of hypervascularisation of the bone. Thus changes may develop without necessarily producing the epiphysial necrosis characteristic of the first stage of ischaemia in Legg-Calvé-Perthes' disease.

5. The persistence of this stage of hypervascularity, and therefore the possible outcome of the transient synovitis, may be conditioned by the age at onset of the pathological process, the severity of the condition, and the duration of the symptoms and signs.

1. Transient synovitis is an acute, and at times exudative, condition of the synovial membrane.

2. There is no particular association with injury or with upper respiratory infection.

3. The course is short and benign with complete resolution. The occasional hip with chronic or recurrent symptoms can be distinguished from Legg-Perthes' disease by the shorter history, normal radiographs and the complete resolution.

4. There is no evidence that transient synovitis leads to avascular changes in the femoral head.

1. The results of ischio-femoral arthrodesis for tuberculous arthritis of the hip in thirty-five adults and in twenty-nine children are reported. The "blind" technique of Brittain was used in thirteen patients and the open technique in fifty-one.

2. Bony fusion was obtained by the first operation in thirty-three out of the thirty-five adults and in twenty-three out of twenty-nine children. In children strikingly better results were gained from the posterior open technique than from the original "blind"technique of Brittain.

3. There was no evidence that ischio-femoral arthrodesis in children interfered with the growth of the limb.

1. Thirty cases of stiff knee treated by the operation of quadricepsplasty are reviewed.

2. The causes and morbid anatomy are analysed. The operative technique is based on an appreciation of the latter.

3. The after-care must be meticulous and prolonged. Manipulation under anaesthesia was used after operation in over half the cases.

4. The results were most gratifying. There were two technical failures but in the remaining twenty-eight cases the average gain of fiexion was 68 degrees. In twenty-one of these active extension was full and it was only 5 degrees short in another three. Permanent loss of active extension occurred when the rectus femoris tendon had to be divided or lengthened.

Ten cases of Thompson's quadricepsplasty for stiffness of the knee after thigh injuries are discussed, with particular reference to points in the operation and after-treatment.

1 . A method of restoring protective sensibility to the thumb by a neurovascular pedicle graft is described.

2. The pedicle is taken from the dorsum of the index finger.

3. The method has been modified to include a racquet-shaped skin flap to give continuous sensibility from the pulp down the antero-medial border of the thumb.

1. Primary pollicisation of an injured middle finger is described.

2. The value of stellate ganglion block in preserving the blood supply is emphasised.

1. Forty-eight patients with spontaneous rupture of the tendon of the extensor pollicis longus have been studied and the results of forty-four operations by tendon transfer are reported.

2. The etiology and the pathology of the condition are discussed.

3. Transfer of the extensor indicis in general gives a better result than transfer of the extensor carpi radialis longus, but each method has its advantages and disadvantages.

4. The best results are obtained when the suture is done so as to leave the tendon in the fullest degree of tension obtainable.

1. During two years eighty-five children with supracondylar fractures of the humerus were admitted to a children's hospital. This paper is a study of the severe fractures which occurred in twenty-three children of whom fifteen had a deformity at review.

2. The only deformity found after treatment by closed manipulation was an alteration in the carrying angle. It is considered that cubitus varus was caused by medial angulation of the distal fragment.

1. Open osteotomy near the tuberosity of the radius to enable correction of fixed supination deformity of the forearm in children is an alternative to Blount's closed osteoclasis of both bones.

2. In five out of six cases with residual obstetrical palsy substantial correction of the deformity was maintained.

3. The cosmetic result was impressive, especially in girls, but an improved function was also observed. If the hand is paralysed, correction of supination facilitates reconstruction.

4. Complications such as angulation, displacement, delayed union and synostosis of the proximal radius and ulna did not affect the final results.

5. With the method described a more or less permanent "blocking" of rotatory movement in the forearm was observed but this did not seem to impair the functional result.

1. Stress fractures are described in children. The fibula and tibia are most often affected.

2. Stress fractures of the humerus are described in two boys aged fifteen.

3. Stress fractures are described in the pelvis in children.

1. Fifty-two patients with chronic tendovaginitis of the tendon of the tibialis posterior have been reviewed. With one exception the changes were regarded as non-specific.

2. Twelve patients in whom conservative treatment failed were treated by division of the tendon sheath, with complete relief in eleven.

1. The mechanism of injury in tarso-metatarsal dislocation and fracture-dislocation has been investigated by experimental studies in the cadaver. Two distinct types of injury were observed.

2. Five cases of simple tarso-metatarsal dislocation and seventeen cases of fracture-dislocation are reviewed.

3. The treatment of the injury is discussed.

1. An oblique displacement osteotomy of the distal third of the first metatarsal is described for the correction of adolescent hallux valgus.

2. No fixation of the fragments is necessary, stability depending upon displacement in the over-corrected position for two weeks.

3. A follow-up of twenty-five operations has shown only one failure, from recurrence of the deformity. There have been no complications.

1. The surgical management of two children with congenital hypoplasia of the upper end of the femur is described.

2. Early exploration is advocated to establish the nature and extent of the anomaly and to attempt its correction.

3. The preliminary results are sufficiently encouraging for us to recommend that further attempts at surgical treatment be considered in patients with this disorder.

1. An unusual case of bilateral and symmetrical congenital aplasia of the femur in a man of fifty is described.

2. The literature on the condition is reviewed and discussed.

A case of eosinophilic granuloma of bone in a man of thirty-three, involving the tenth and eleventh thoracic vertebrae, is described. The presenting symptom was pain and he had spinal compression with spastic paraparesis. Improvement followed operation. The operative findings and the histological features are described. The literature and the unusual features of this case are discussed.

1. Four cases of arterial injury complicating meniscectomy are described.

2. The danger of using chisel-type meniscectomy knives, especially when they are incorrectly sharpened, is emphasised.

1. It has been shown that in experimental rickets the well known changes in the epiphysial cartilage which so seriously affect growth are accompanied by severe interference with the progress of the metaphysial vessels into the growth cartilage.

2. Further evidence has been found that, by the repeated increase in their number, the cartilage cells occupying the more distal part of the proliferative segment become more and more affected by their remoteness from the epiphysial vessels, which supply the transudates to these cells. At a given distance these cells are affected and change, becoming hypertrophic, with increasingly large vacuolae, and are rich in glycogen and alkaline phosphatase.

3. The hypertrophic cells alter the nature of the intercellular substance they deposit and this becomes calcifiable. Provided that the metaphysial vessels are situated at an appropriate distance–about three cell capsules away–and that the blood has its necessary components, calcification occurs.

4. Calcification produces the advancing, rigid multitubular structure within which the progressing metaphysial vessels are protected.

5. The interruption of calcification by the withdrawal of fat-soluble vitamins breaks down the whole mechanism of growth and stops the vessels growing into their proper position. The administration of the required vitamins re-establishes the normal sequence of events and allows the vessels to play their decisive role in osteogenesis.

6. Any mechanism which causes the interruption of the vascular progression, whether from metaphysial ischaemia (Trueta and Amato 1960), from severe pressure (Trueta and Trias 1961) or from lack of calcification by withdrawing the fat-soluble vitamins, equally interrupts growth.

Puppies in the second half of their growing period have been observed for one and a half to four and a half months after creation of a superficial femoral arteriovenous fistula on the right side. From measurements of the whole bone and from microradiographic and tetracycline-fluorophore studies of the diaphysial bone, it is believed that the following statistically significant phenomena may be attributed to the influence of the arteriovenous fistula.

1. All bones distal to the fistula are influenced in their growth. The tibia and metatarsals become heavier and larger, but retain normal shape. Although stimulation of longitudinal growth is small, it is significant for the tibiae and nearly significant for the femora in these short-term experiments.

2. The histological structure of the bones remains normal but quantitative changes are induced. The compact bone is more porous because of an increased number of osteones. Haversian turnover itself is affected in that the individual formation time of osteones tends to become longer, especially in the metatarsals.

3. Periosteal new bone formation is immediately stimulated, producing a flare of new bone. This accounts for the increase in diaphysial weight in the tibia but not in the metatarsals, where the same effect results from decreased resorption of old bone.

4. Endosteal new bone formation is depressed, especially in the metatarsals, resulting in an enlarged medullary cavity.

1. The antigenicity of homologous cortical and cancellous bone has been investigated in eighty-four rabbits.

2. The primary immune responses which occur in lymph nodes draining homografts of fresh tissues (Burwell and Gowland 1961, 1962) have been used as a histological indicator of the antigenicity of fresh homologous cortical bone freed from soft tissues.

3. The secondary immune responses which occur in lymph nodes draining homografts of fresh marrow-containing iliac bone (Burwell 1962a, b) have been used also as a histological indicator of the antigenicity of homografts of 1) fresh cortical bone freed from soft tissues, 2) fresh marrow-free iliac bone, and 3) mairow-containing iliac bone treated by boiling, freezi ng, freeze-drying and merthiolate solution.

4. It is found that whereas fresh homologous cortical bone fails usually to produce cytological evidence of a primary response in the regional lymph nodes, fresh homologous cortical bone chips inserted into the drainage areas of lymph nodes sensitised previously to donor ..tissue evoke constantly cytological evidence of a secondary response.

5. Fresh homologous marrow-free iliac bone inserted into the drainage areas of lymph nodes sensitised previously to donor tissue does not produce detectable evidence of a secondary response.

6. Homografts of boiled marrow-containing iliac bone do not elicit a secondary response in lymph nodes previously sensitised to donor tissue.

7. Previous work has shown that homografts of frozen (–20 degrees Centigrade) marrow-containing iliac bone do not evoke a primary response in lymph nodes draining such grafts. In the present work it is shown that similar frozen homografts inserted into the drainage areas of lymph nodes previously sensitised to donor tissue evoked a secondary response in three of six lymph nodes.

8. Homografts offreeze-dried marrow-containing iliac bone fail usually to evoke a secondary response in lymph nodes sensitised to donor tissue.

9. Homografts of marrow-containing iliac bone treated by immersion in merthiolate solution before being inserted into the drainage areas of lymph nodes previously sensitised to tissue from the donor elicited a secondary response in three of five lymph nodes.

10. Knowledge concerning the antigenicity offresh and treated homologous bone is discussed in the light of recent work.