1. A radiographic investigation of a group of 241 men who had worked in compressed air at pressures up to 35 pounds per square inch gauge on the construction of tunnels under the River Clyde showed that forty-seven men (19 per cent) had one or more lesions of aseptic necrosis of bone.

2. The radiological lesions have been classified as juxta-articular, which may lead to pain and limitation of movement, and head, neck and shaft lesions, which are usually symptomless. In 10 per cent of the men the lesions were juxta-articular and therefore potentially disabling. The treatment ofjuxta-articular lesions is described and reviewed.

3. The environmental factors associated with the occurrence of aseptic necrosis of bone, the radiological and histological appearances, and the pathogenesis of the lesions are discussed. Bone lesions were found to be related directly to the number of times a man had been decompressed, to the height of pressure at which he had worked and to attacks of bends for which treatment was given.

4. When the histological and radiographic appearances of aseptic necrosis of bone in compressed air workers are compared it is clear that a radiograph may not always reveal the full extent of the lesion, and some lesions may not show up at all. The cause of the necrosis is obscure because experimental and direct evidence of bone infarction by gas bubbles is lacking.

5. The currently accepted decompression procedures and treatment of bends used in civil engineering practice, do not prevent the occurrence of aseptic necrosis of bone in compressed air workers.

6. It is suggested that periodic radiological examination of the bones of compressed air workers should be carried out and the results correlated with other information about the men and the contracts on which they have worked in order to elucidate the causative factors in aseptic necrosis of bone. A central registry has been set up by the Medical Research Council in the University of Newcastle upon Tyne to fulfil this function.

1. The early results of thirty Austin Moore arthroplasty operations with acetabular reaming in twenty-five patients with advanced osteoarthritis of the hip have been investigated.

2. The radiological changes after insertion of a prosthesis have been studied.

3. There was a variable degree of improvement in all patients. There was a worth-while improvement in function and relief of pain. Stability, however, was disappointing in more than half (and in all the bilateral cases). An average of three-quarters of an inch of shortening was found in the unilateral cases.

4. In such advanced cases the results of Austin Moore arthroplasty are probably of the same order as for cup arthroplasty, and in many cases they show no more than marginal improvement over pseudarthrosis.

5. It is concluded that at the present stage of progress in the development of arthroplasty the use of the Austin Moore prosthesis with acetabular reaming has very limited indications.

1. The various surgical procedures in common use for the treatment of the osteoarthritic hip are briefly reviewed and compared with the operation of replacement of both the acetabulum and head of the femur by a metal prosthesis, that is, a complete artificial hip joint.

2. The development, description and technique of insertion of this artificial hip joint are given in detail.

3. The results of the first fifty cases of this operation show a success rate of over 90 per cent. The few failures are analysed in detail. The revision procedure has been the insertion of another artificial hip joint.

4. The essential details necessary for success are stressed and the indications and aims of the operation given.

1 . The results of compression arthrodesis of the hip have been studied in fifty-six patients. There was one post-operative death from pulmonary embolism on the tenth day.

2. Bony union for the whole series (fifty-five patients) was achieved in 76·4 per cent. Sound fibrous ankylosis, indistinguishable from bony union clinically and functionally, was achieved in 10·9 per cent. Residual movement occurred in 12·7 per cent.

3. Thirty-five patients were treated by the standard technique of eight weeks in plaster, followed by full weight bearing, irrespective of whether any movement was detected on clinical testing. 82·8 per cent achieved sound bony union; 5·7 per cent achieved sound fibrous ankylosis, and residual movement occurred in 11·4 per cent.

4. Ten patients were treated without plaster protection; six achieved bony union; three had sound fibrous ankylosis and one had residual movement. Healing was delayed in this group and there was more residual deformity.

5. 67·5 per cent of all patients recovered full knee range. Only one patient with reduced range had knee flexion of less than 90 degrees. Twenty-four of the thirty-five patients treated by the standard technique of eight weeks in plaster were examined. Fifteen had full knee movement; in only four was knee flexion less than 120 degrees and in no case was it less than 90 degrees.

6. Return to full activity was rapid. Sixty per cent of patients returned to work within six months and 80 per cent within nine months of surgery. Five of the six patients examined with residual movement in the hip joint were back at work within six months of surgery.

7. This study lends support to the view that arthrodesis of the hip, in the presence of normal function in the opposite hip, is compatible with vigorous and full activity.

1. Phlebography has been done on seven hips showing no radiological evidence of osteoarthritis. The findings largely confirm the work of previous authors.

2. Thirty-seven osteoarthritic hips have been examined in the same way. As the degenerative process worsens radiologically so the pattern of venous drainage deviates further from the so-called normal.

3. An attempt is made to explain the phlebographic findings in the light of known facts of the pathology of the disease.

1. Septic arthritis of the hip in adults is not common and the diagnosis can be difficult. The value of diagnostic aspiration is emphasised.

2. Predisposing causes in fifty patients are analysed and the possible relationship to pelvic infection is discussed.

3. Loss of joint space is occasionally seen within one week of the onset of the infection.

4. A method of treatment is suggested and the value of decompression by arthrotomy is discussed.

1. The hypothesis is advanced that the fundamental lesion of epiphysiolysis is a slow posterior growth migration of the head on the neck.

2. It is suggested that this is unrelated to the erect posture or to any abnormality of the growth cartilage.

3. Sitting stresses are measured and are postulated as the likely cause of the growth deviation.

4. The result of the deviation is an increase in the shear stress component; in the erect posture clinical epiphysiolysis is regarded as a simple fracture occurring in a proportion of deviated cases when the increased shear component exceeds the critical level appropriate to the individual.

5. It is suggested that this hypothesis explains the age and sex incidence, the left predominance, the reduced epiphysial angle found on the uninvolved hip and the clinical and radiological evolution of the disorder.

1. On the basis of, first, a mathematical analysis of the age-specific and sex-specific prevalence of Dupuytren's contracture; second, the genetical aspects; and last, the pathology, it is concluded that Dupuytren's contracture is probably a spontaneous disturbed-tolerance auto-immune disease.

2. The proportion of predisposed individuals at birth is about 20 per cent of males and females in the population studied by Early (1962), although it differs between populations and races.

3. The disease is probably initiated by four random, dependent-type, autosomal somatic gene mutations in a stem cell of the lymphoid system. With the accumulation of the fourth and final somatic mutation, a "forbidden-clone" of lymphocytes is probably generated. There is a latent period between the occurrence of the last initiating event and diagnosis.

4. In men the average latent period is about fifteen years, in women it is about thirty years.

5. The target tissue primarily attacked by forbidden lymphocytes is unknown, although proliferating fibroblasts are evidently a consequence of the auto-immune attack.

1. Three patients with enchondromata of the metacarpal bones are described.

2. The nature of the enchondromata in all three patients was confirmed by histological examination.

3. Treatment was by radical excision and bridging of the gap by a cortical bone graft.

4. There has been no impairment of function in the hands. No patient complained of pain after the operation.

5. Radiographs taken one year after operation in two patients showed that the flat bone grafts had become cylindrical and that medullary canals had appeared.

1. A simple calculation for the timing of epiphysial arrest to correct leg length discrepancy is described. An assumption is made that growth ceases at a constant chronological age of sixteen years in boys and fourteen years in girls. It is further assumed that the lower femoral epiphysis provides three-eighths of an inch and the upper tibial epiphysis one-quarter inch of growth each year.

2. Whilst the assumptions made are known to be approximations, analysis of the results of fifty-three epiphysial arrests in forty-four children shows that the errors cancel themselves sufficiently to make this method accurate. The simplicity of the calculation makes it useful to confirm or modify the timing of arrests calculated on the basis of skeletal age, or as an alternative method.

1. Recurrent dislocation of the elbow is caused primarily by collateral ligament laxity with secondary damage to the capitulum and head of radius.

2. The pathological changes resemble those of recurrent dislocation of the shoulder.

3. Subluxation or instability of the radial head is often associated with capsular ossification and deserves wider recognition because it may be confused with osteochondritis dissecans.

4. A simple method of soft-tissue repair has successfully prevented redislocation of eight elbows.

The treatment of juxta-epiphysial fractures of the terminal phalanx is discussed. It is submitted that a simple form of conservative treatment gives the best results.

1. Five cases of Salmonella osteomyelitis in infants without red-cell sickling are reported.

2. All these cases occurred in children under eighteen months of age and within a period of five months of time, suggesting a seasonal incidence.

3. Only one strain of Salmonella was isolated–Salmonella typhimurium.

4. There was complete healing in four of the cases.

5. In one case there was destruction and complete absorption ofthe upper humeral epiphysis.

We conclude that conservative excision of the nail bed gives satisfactory results–89 per cent in this series. Recurrence is common but rarely causes symptoms. No patient had symptoms without recurrence. We think that recurrence is related to technique and to infection. Syme's terminal amputation is recommended for troublesome recurrence because repetition of Zadik's operation proved unsatisfactory.

1. A patient with macrodactyly of the middle finger of the left hand was followed up from birth until the finger was amputated at the age of three.

2. The affected finger, besides showing gigantism at birth, grew at a faster rate than the normal fingers. The degree of bone maturation (as judged from the appearance and size of the phalangeal ossification centres) proceeded at a faster rate than the normal fingers. No vascular abnormality which could account for the gigantism was detected either radiologically or microscopically. The affected finger showed histological abnormalities of both bone and soft tissues.

1. Three patients with backache and spinal cord or cauda equina compression due to Paget's disease of the vertebrae are reported; all three were relieved by laminectomy.

2. One case is of particular interest because it is only the second one reported where compression was due to a single affected vertebra.

Incorrect dates were given on page 199 of the February 1966 issue for the Fifteenth Annual Congress of the South African Orthopaedic Association. These should have read October 12-15, 1966.