Severe kypho-scoliosis, lateral curvature and lordo-scoliosis are ultimately caused by disturbance of vertebral growth. The results of treatment by destroying the growth potential opposite the area of growth inhibition have been encouraging. When the operation has been adequate further deterioration has been prevented; in younger children there has been improvement with further growth. It is important that the growth arrest should be at the right site and that it should be sufficiently extensive. Accurate pre-operative diagnosis of the type and extent of the curve is important.

1. With the object of perfecting the design of footwear for feet anaesthetic from leprosy, pressures on the soles of feet during walking were measured with transducers sufficiently thin to be worn inside ordinary shoes.

2. It was found that anaesthetic feet without deformity or muscle imbalance did not produce significantly higher pressures than normal feet during barefoot walking on a flat surface. The pressure distribution under drop feet with active posterior tibial muscles differed from normal, with increased pressure under the lateral forefoot and decreased pressures elsewhere.

3. Loss of toes or function of the toes results in high, sharp pressure peaks under the anterior end of the foot during push-off. In deformed feet these pressures are usually concentrated at one or two small areas.

4. In anaesthetic feet the prevention of trophic ulceration largely depends on the even distribution of pressure over the sole of the foot.

5. Moulding by carefully placed arch supports or metatarsal bars effectively redistributes plantar pressure.

6. A shoe with a rigid sole pivoting on a rocker near the centre of the foot most effectively reduces pressures under the forefoot of shortened, deformed feet.

7. We recommend the use of insoles made of microcellular rubber (approximately 1 5 degrees shore).

8. The importance of studying each deformed foot for areas of high pressure before fitting shoes is stressed; a pressure-indicating footprint is satisfactory for this purpose.

1. Neurofibromatosis is a disease involving both neuro-ectodermal tissues and mesodermal elements. In the past it has usually been assumed that the mesodermal abnormalities were secondary to the neuro-ectodermal ones. For example, skeletal deformities were considered to be caused by local neurofibromata.

2. It is becoming increasingly recognised that in neurofibromatosis there may be abnormal development of bone without any local abnormality of neuro-ectodermal origin. Study of our patients confirms this view. Considerable deformity of vertebral bodies was demonstrated at sites where there was no evidence of any neurofibroma or other soft-tissue change. At other sites apparent erosion of bone was associated with the formation of a local meningocele.

3. The findings in this small series of patients with neurofibromatosis suggest that the scalloping of the vertebral bodies, deformity of pedicles and widening of the intervertebral foramina are usually caused by dysplasia of bone and may be associated with a local meningocele.

1. A proven case of typhoid spine in a patient with sickle cell trait (AS) is recorded. It responded well to conservative treatment with chloramphenicol.

2. The literature on typhoid spine is briefly reviewed and the relationship between salmonella osteomyelitis and sickle cell disease is discussed.

The purpose of this report is not to describe a new condition but to remind those who seldom see smallpox of one of its most important and easily recognised complications. Bone infection can be late, almost silent and often most unexpected. It is usually symmetrical and almost always multiple. It does not affect the spine, pelvis and ribs, but does affect the arms, hands, legs and feet. It is destructive, unpreventable and untreatable. It ends with deformity but not with loss of life. The recognition of its etiology will prevent a great deal of unnecessary and unrewarding interference with a self-limiting disease.

1. A child with so-called ischio-pubic osteochondritis is reported from whom the affected ramus was resected. The features observed in the resected specimen were those of a normal closing epiphysis.

2. The literature is reviewed with emphasis on other children who had biopsies and on large scale radiographic surveys of normal children.

3. The conclusions are that the changes in the ischio-pubic synchondrosis cannot justifiably be called osteochondritis, and that they require further investigation, which can most profitably be done at necropsy.

The technique described aims to eliminate the drawbacks of the commonly accepted operative procedures for correction of the spastic "thumb-in-palm" deformity without fusion of the thumb. In all seven patients followed up for one and a half to two years after operation the thumb regained a functional position, being held out of the palm together with the metacarpal without hyperextension of the metacarpo-phalangeal joint.

1. The families of fifty patients with Dupuytren's disease have been investigated for its presence.

2. Familial occurrence has been found to be considerably higher than has been reported hitherto.

3. The findings suggest that genetic factors are of extreme importance in the pathogenesis of the common form of Dupuytren's disease.

4. A single gene, behaving as a Mendelian dominant, is likely to be involved.

5. Dupuytren's disease may not be a homogeneous condition from the pathogenic standpoint.

1. The theories that have been advanced to explain the occurrence of traumatic tetraplegia in patients without evidence of vertebral column injury are reviewed.

2. Traumatic tetraplegia of delayed onset is described in a middle-aged man with ankylosing spondylitis. There was no injury of the vertebral column.

3. The reasons are given for suggesting that the tetraplegia was caused by injury to the arterial supply of the cord.

1. Seventeen children with fracture-separations of the capitular epiphysis are reviewed.

2. Soft-tissue suture was used in eleven and metallic fixation in six children.

3. There was one bad result because of faulty technique but all the other children obtained good results.

4. Soft-tissue suture was found to be a simple procedure with none of the complications of wire fixation.

1. Five cases of greenstick fracture of the upper end of the ulna with dislocation of the radio-humeral joint are described.

2. Although the direction of angulation of the fracture and the corresponding displacement of the upper end of the radius may be lateral, medial or anterior, it is suggested that all five cases form a group in which the mechanism of injury is essentially the same. This mechanism is considered to be a fall on the outstretched hand with the forearm held in supination.

3. The complications of the injury are described.

A method of treatment of Bennett's fracture is described. A Kirschner wire is drilled obliquely through the base of the first metacarpal bone and traction is applied in a distal, ulnar and palmar direction in order to counteract the dislocating action of abductor pollicis longus and the flexor muscles.

The advantages of the method are: 1) It is technically easy and practically without complications. No important structures are liable to be damaged. 2) It can be used in those cases where the palmar fragment is very small. 3) It can be used for comminuted fractures. 4) It can be used in neglected cases where malunion has occurred. 5) It can be used when there are other fractures of the first metacarpal or adjacent bones. 6) It allows exercises of all the finger joints during the whole period of treatment.

1. Twenty-three patients were treated by cross screwing for diastasis of the tibia and fibula in fractures at the ankle.

2. It is suggested that limitation of ankle dorsiflexion after this treatment was caused by the presence of a mechanical block to dorsiflexion by spur formation at the margins of tibia and talus.

3. An ordinary bone screw controlled the diastasis satisfactorily in twenty patients.

4. The screw did not interfere with movement at the inferior tibio-fibular joint because bone resorption about that part of the screw in the fibula allowed a small range of movement.

5. Discomfort from the screw was relieved by its removal.

1. Three cases of recurrent dislocation of the patella due to abnormal attachment of the ilio-tibial tract are described.

2. The nature of the abnormality and surgical management are discussed.

We describe two siblings with congenital growth defects of the distal limb bones and their progress over four years. They bear some resemblances to a boy described in 1958 by Solonen and Sulamaa and to a father and his three sons described in 1944 by Nievergelt.

1. The characteristics of the regenerated knee meniscus are reviewed.

2. A case is reported in which a meniscus twice regenerated and was twice torn.

1. In ten healthy young men an experimental paralysis of the supraspinatus muscle was induced with the aid of Xylocaine injected in or near the suprascapular nerve.

2. The completeness of the paralysis was checked by electromyography.

3. With the supraspinatus muscle completely eliminated, all subjects could move the arm against gravity through its full range in the shoulder joint, though the force and the power of endurance during abduction were diminished.

4. It is concluded that the role of the supraspinatus muscle is of a quantitative nature only.

1. The cause of cyst formation lies in the major overloading of certain regions caused by the unevenness of the articular surface produced by the arthritic process.

2. Photoelasticity investigations disclose an overburdening of the bone beneath the surface of the joint, which in turn markedly resembles the shapes of actual cysts.

3. The results of this investigation fit organically into the logical sequence of processes in accordance with our theory.

4. This theory is further borne out by the successful formation of cyst phenomena in healthy joints by overloading (Trias 1961).

5. Our theory has no immediate practical bearing on the treatment of arthritic cysts. However, it uncovers certain interesting aspects of the behaviour of bone tissues under mechanical overloading above the limits of biological, though below those of mechanical bearing capacity. Conclusions arising therefrom might in many respects be useful in research into the physiology of bone.

1. The relative concentrations of organic material in adjacent microscopic regions of bone have been studied by three methods, and the results suggest that this concentration varies considerably.

2. The variations in the organic concentration in bone have been correlated with the age of the bone and its inorganic concentration.

3. It is suggested that the progressive calcification of bone as its age increases, occurs, to some extent, at the expense of the organic fraction of the tissue.

1. The process of repair after fracture of the humerus of the growing rat has been studied by histological, histochemical and biochemical methods.

2. Both periosteal and surrounding mesenchymal cells take part in the process of repair.

3. The primary framework of collagen bridging the gap is mainly formed by the mesenchymal cells, while calcification and ossification of the framework is largely a function of the periosteum.

4. The mucopolysaccharide content rises rapidly in the first week after injury, and is followed by a rise in the collagen content during the second week. The deposition of calcium phosphate during the third and fourth weeks causes an apparent fall in the collagen content during that period. The collagen content tends to return to normal during the phase of remodelling in the fifth and sixth weeks.

5. The tensile strength of the healing bone bears a close relation to its collagen content.

Study of the morphological pattern of the arteries in the rotator cuff does not produce any evidence that the "critical zone" for ruptures and calcified deposits is much less vascularised than any other part of the tendinous cuff. This work, however, does show conclusively that the "critical zone" of the rotator cuff corresponds to the zone of the anastomoses between the osseous and tendinous vessels. Age does not seem to have a decisive influence on the morphology of the vascular pattern.