1. Volkmann's ischaemia of the lower limb is more common in adults than in children and occurs with sufficient frequency after injuries of the femur, knee and leg to warrant a more determined effort to prevent it.

2. The first and most essential step is to recognise the early signs of ischaemic damage. Incision of the deep fascia may then save the threatened underlying muscle, though it may also be necessary to seek for and evacuate a haematoma beneath the muscle. When the femoral or popliteal artery is injured, exploration and repair may be imperative.

3. The treatment of established ischaemic contracture is by whatever measures are necessary to correct the deformity. These are lengthening of shortened tendons, or excision of them if they are involved in dense fibrosis at the periphery of the ischaemic mass; and excision of all totally destroyed muscle. Amputation may be necessary.

1. Mucopolysaccharides were analysed in the urine of thirteen patients with Morquio's syndrome aged between three and fifty-nine years and of fourteen controls of comparable ages.

2. There were no significant qualitative or quantitative differences between patients and controls.

3. The clinical and radiological findings suggested that these patients did not have the "Morquio-Ullrich" form of the disease, which appears on retrospective assessment of case reports to be more uniform and less diffuse than the Morquio-Brailsford form which may include a number of possibly unrelated diseases.

4. Keratosulphate has so far been demonstrated in the urine only of patients with the "Morquio-Ullrich" form of the disease, although the mucopolysaccharide excretion has been investigated in only a few patients with the Morquio-Brailsford form. The normal mucopolysaccharide excretion of the present series of patients suggests that a normal mucopolysaccharide excretion distinguishes the Morquio-Brailsford from the Morquio-Ullrich form, the latter having a number of features overlapping with Hurler's disease, where large amounts of mucopolysaccharide other than keratosulphate are excreted.

5. Both qualitative and quantitative analysis of urinary mucopolysaccharide are thus necessary to distinguish between Hurler's disease, the Morquio-Ullrich form and the Morquio-Brailsford's form of Morquio's syndrome.

1. Seven cases of massive osteoarticular transplant for conditions affecting major joints are described. In one case the whole femur was replaced.

2. The transplants were well accepted, though there was a varying degree of absorption of bone and necrosis of articular cartilage.

3. The functional results were very satisfactory, and movements of joints were well preserved. 4. In these cases recurrence of the original disease was not seen.

5. Such operations are still in an experimental stage, but they are likely to have a permanent place in treatment in certain carefully selected cases.

1. The results of treatment of 186 club feet have been reviewed.

2. Early strong repeated manipulation and splintage produced correction in all, but only sixty-five out of 186 remained acceptable at three years. The other 121 relapsed.

3. Relapse occurred in the first year in eight, between twelve and eighteen months in twenty-five, between eighteen and twenty-four months in twenty-three, and between twenty-four and thirty-six months in sixty-five.

4. Relapse was slightly commoner when treatment began after the first month of life.

5. Relapse was treated either by manipulation and plaster or by soft-tissue correction, leaving fifty-two out of 121 acceptable at three years and sixty-nine which were not acceptable (this includes those in plaster after soft-tissue correction, necessitated by relapse around the ages of two and a half and three and is thus adversely loaded).

6. The three year results in 186 feet were studied: 63 per cent were acceptable and 37 per cent were not. Five year results in eighty-seven feet were studied: 87·4 per cent were acceptable and 12·6 per cent were not.

7. Soft-tissue correction is described. It produced 89 per cent acceptable feet but 11 per cent relapses in 280 operations.

The management of a personal series of over 500 patients with congenital hip dislocations has been reviewed with special reference to the mistakes that have been made and the safeguards which have now been adopted.

1. A small personal consecutive series of children with congenital dislocation or subluxation of the hip who came for treatment at the age of over three years has been reviewed. The children have been kept under review up to the age of ten years or more.

2. A number of late results are illustrated. They lead to the conclusion that open operation is indicated in all these cases and that acetabuloplasty will effectively provide stability in most, particularly when combined with osteotomy of the femur with adduction angulation and lateral rotation.

3. It is still too early to assess the value of pelvic osteotomy of the Salter (1961) or Chiari (1955) type.

4. Capsular arthroplasty appears from Trevor's (1960) considerable experience to have a valuable place in patients over six years old.

1. Bone changes in the haemoglobinopathies are caused by either (a) chronic haemolysis with marrow hyperplasia, or (b) infarction, when Hb S is present in the red cells in amounts sufficient to allow sickling (and therefore vascular occlusion) in vivo.

2. Marrow hyperplasia produces osteoporosis, widening of the medulla, and thinning of the cortex; it may lead to spontaneous fractures and disturbances of growth. Enlargement of the foramina of the nutrient arteries may be seen especially in the phalanges. Infarcts leading to aseptic necrosis occur in the long bones, and may become infected with Salmonella organisms. The range of radiological lesions caused by these processes is illustrated.

1. Chondrosarcoma is a malignant tumour of bone with clinical and morphological features which distinguish it from osteosarcoma.

2. Cartilage tumours present an unbroken spectrum in their clinical behaviour and histological appearances from the entirely benign to the frankly malignant.

3. A few chondrosarcomata, particularly those in children and young adults, run a rapidly fatal course but in general they metastasise late and some kill by local extension of the tumour.

4. "Secondary" chondrosarcomata arising from a pre-existing osteocartilaginous exostosis or enchondroma are mostly low grade tumours.

5. The first appearance of an osteocartilaginous exostosis after skeletal maturity, renewed growth, or pain unassociated with a fracture, should arouse suspicion of malignancy in any cartilage tumour.

6. Cartilage tumours of the trunk and upper end of femur and humerus are especially liable to sarcomatous change.

7. Although most benign cartilage tumours occur in the hand and foot they rarely become malignant with the exception of those in the calcaneus.

8. If biopsy is necessary it should be of the incisional type, a generous amount of material being removed from the edge of the tumour. Calcified, degenerate areas must be avoided.

9. In low grade tumours microscopic fields judged to be malignant by Lichtenstein and Jaffe's well established criteria may be scanty and many paraffin sections should be examined. Absence of mitotic figures, heavy calcification and poor vascularity are no guarantee of benignity.

10. Information as to the site of the tumour and age of the patient must be available to the pathologist if a useful report is to be given.

11 . In "borderline" tumours or where any difficulty in diagnosis arises the clinical, radiographic and histological features must all be taken into account and treatment based on the most unfavourable features.

12. Chondrosarcoma is a radio-resistant tumour and treatment is by radical excision or amputation.

13. Malignant cartilage cells implanted in the tissues at operation will often continue to grow and in all instances the biopsy wound and surrounding tissues must be removed en bloc with the tumour.

14. Small, low grade, readily accessible, peripheral tumours may be successfully treated by excision with a wide margin of healthy tissue.

15. In the limbs or pelvis large tumours and those of high grade malignancy should be treated by amputation. Since marrow permeation is often greater than the radiograph suggests amputation should, as a rule, not be performed through the bone in which the chondrosarcoma is situated.

16. Recurrence carries the danger that an initially accessible tumour becomes inaccessible and inoperable and, less frequently, a low grade tumour recurs in a metastasising form.

17. Recurrence is frequent after inadequate surgery; it indicates that the tumour is at least locally malignant and a cure can usually only then be achieved by more radical surgery.

Symptoms due to a supracondylar spur of the humerus, although rare, are common enough to make it the subject of routine examination of a patient with pain and disturbance of sensibility of the hand. It can mimic the carpal tunnel syndrome; it may produce ulnar nerve symptoms. Irritation or compression of either the brachial artery or, if there is a high division of it, the ulnar artery, may cause episodes of ischaemic pain in the forearm. The clinical features of a supracondylar spur causing symptoms are: symptoms of median nerve compression; forearm claudication; a palpable spur about two inches above the medial epicondyle; and disappearance of the radial or ulnar pulse on full extension and supination of the forearm.

1. The posterior interosseous nerve of the forearm is vulnerable to constriction in an aponeurotic cleft in the supinator muscle.

2. A case is presented of paresis of the nerve by an intramuscular lipoma which extended into this cleft.

3. A discussion is given of the possible relation of this feature to certain cases of occupational stress–"tennis elbow."

4. An approach is described for decompressing the nerve in the rare cases which do not respond to conservative treatment.

1. A case of posterior interosseous nerve palsy from compression in the supinator muscle by what appeared to be a simple ganglion is described.

2. Surgical decompression led to an effective cure.

3. The course of the nerve through this muscle invites compression.

4. Rotation of the forearm, especially with super-added deformity of the limb, may increase the compresssion.

1. Six patients suffering from spontaneous posterior interosseous paralysis are described.

2. Two were due to benign tumour and four due to traumatic neuritis, three of which were associated with minor hyperextension injuries to the elbow joint and one with long standing cubitus varus.

3. Surgical exploration was performed in each patient with recovery of nerve function.

1. A case of spontaneous posterior interosseous paresis is reported. It is suggested that the cause was replacement fibrosis secondary to local ischaemic damage from unremembered minor trauma.

2. In a patient with a posterior interosseous nerve paresis examination may reveal a space-occupying lesion near the elbow along the course of the nerve thus compressing it. Recovery may be expected after its removal. Consequently the nerve should be explored before resort to tendon transfers.

1. Evidence is presented that the basic lesion in scoliosis is relative lengthening of the anterior components of the spine compared with the posterior elements.

2. The logical treatment is to reduce this relative lengthening either by lengthening the posterior elements or shortening the anterior elements. This may be achieved by anterior lumbar wedge osteotomy or by epiphysiodesis; and correction of lumbar lordosis can improve a thoracic scoliosis.

1. Experiments have been carried out in lambs to determine the source of nutrition of the joint cartilage of an immature animal. A wedge of bone with its overlying cartilage was removed from the knee joint and then replaced in its original position, so that the bone was infarcted but the cartilage remained in normal relationship with the joint.

2. In these circumstances degeneration of the cartilage occurred and proliferation ceased until revascularisation of the bone was established.

3. It is therefore concluded that growing cartilage derives a significant part of its nutrition from the underlying bone. The possibility that it also receives a contribution from synovial fluid has not been excluded.

1. A clinical, radiological and histological description of a patient with fibrogenesis imperfecta ossium is given. We think that this is the first case in which diagnosis has been made during the life of the patient.

2. The disease is characterised by a defect in the formation of the collagen fibres of the bone matrix. There is also a failure of normal calcification of the matrix, giving rise to the appearance of wide "osteoid" seams. When examined with the polarising microscope and when stained with Gomori's reticulin stain the collagen fibres can be seen to be grossly deficient and abnormal.

3. The patient presented at the age of fifty-four years with bone pain and multiple fractures. The only biochemical abnormality detected in the plasma was an elevated alkaline phosphatase. He was also in negative calcium balance.

4. Treatment with vitamin D₂, later changed to dihydrotachysterol, appears to have produced clinical, biochemical and radiological improvement. It appears that a direct action of the vitamin on the abnormal bone collagen must be postulated, in addition to its known actions on the calcifying mechanisms.

5. An unusual feature of the case was the slow development of a total unresponsiveness to large doses of vitamin D₂, in spite of a markedly elevated level of vitamin D in the plasma. There was later a response to a much smaller dose of dihydrotachysterol, which is being maintained to date.

1. Experiments are described in which total infarction of the epiphysis was produced in the metatarsal bones of growing rabbits.

2. After operation both proliferation and normal maturation of the cells of the growth plate were slowed or stopped. Cartilage destruction on the metaphysial side of the growth cartilage continued with consequent thinning of the cartilage. Localised areas of cell death appeared in the growth cartilage as early as the second day after operation. These increased in size and led to revascularisation of the epiphysis by metaphysial vessels which grew through the growth cartilage, reaching the epiphysis seven days after operation. The main, central part of the growth cartilage survived intact and its normal structure was restored after epiphysial revascularisation took place. Vessels growing into the bone from outside also contributed to revascularisation of the epiphysis. After revascularisation occurred, new bone formation led to increased radiographic density of the epiphysis.