1. Seventy-five patients sustained fractures of the pelvis with associated soft-tissue complications. Twenty died, and of these, thirteen died within forty-eight hours of admission to hospital.

2. The initial resuscitation and clinical assessment of these patients are discussed, and attention is drawn to the significance of the concomitant retroperitoneal haematoma as a cause of oligaemic shock, and as a dissembler of internal visceral injury.

3. The morphological fracture patterns are classified into six categories, but the fracture patterns are not correlated with specific visceral injuries.

4. Forty-six patients sustained urinary tract injuries. Of these, nineteen had suffered rupture of the urethra; fourteen had rupture of the bladder; two had both urethral and vesical disruption, and one patient had a torn ureter. The diagnosis and management of these injuries is discussed.

5. Twelve patients had a traumatic laceration or perforation of the ano-rectum. Nine of these patients had associated urethral or vesical injuries.

6. Four patients were involved in accidents and sustained pelvic fractures while in the last three months of pregnancy. The tragic outcome of this combination of circumstances is noted.

7. Attention is drawn to peripheral nerve injuries in association with pelvic fractures, and the difficulty of localising these lesions is stressed.

8. Eight instances of damage to the abdominal parietes are recorded. Four patients suffered skin and soft-tissue loss, two patients had diaphragmatic disruptions and two patients had abdominal wall dehiscences.

9. Major accident victims frequently have multiple injuries. This series of patients has been analysed to draw attention to the association of pelvic fractures with bizarre visceral injuries.

1. Thirteen cases of occipito-cervical fusion performed in the past fifteen years at the London Hospital are described.

2. Seven of the patients had congenital anomalies in the region of the foramen magnum, six had spontaneous atlanto-axial dislocations, and in one case the operation was performed prophylactically to stabilise a severely disorganised cervical spine.

3. Nine of the patients had evidence of neurological involvement before operation due to pressure on the spinal cord or nerve roots.

4. Operative fusion was successful in all cases and there was no operative mortality.

5. The clinical results were good in eight cases and four patients were improved. The condition of one patient, in whom progressive disseminated sclerosis was also present, deteriorated.

6. The technique of operation is described, and it is recommended that it should always be performed as a combined orthopaedic and neurosurgical procedure.

1. Four patients with tetraplegia from rheumatoid subluxation occurring in the lower cervical spine are described and the common features are noted.

2. Compression appeared to be responsible for the cord damage, although it was not necessarily directly related to vertebral subluxation. The lesions causing the compression were varied.

3. Forcible attempts to reduce vertebral subluxation may be harmful. Two patients were improved by posterior decompression.

4. A suggested programme for the treatment of such patients is outlined.

1. Clinical and histological features in ten patients with smooth muscle tumours of the limbs are described.

2. Severe pain and tenderness and the radiographic demonstration of calcification are useful pointers to the diagnosis.

3. Local recurrence of the tumour occurred in four patients despite apparently adequate excision. In three of these the tumours were shown histologically to be benign.

1. In congenital absence of the fibula, the fibrous strip that replaces the bone, abnormal insertions of fibular muscles, and disturbances in the formation and growth of the tarsal bones all go to cause the valgus deformity of the foot and the complete or partial dislocation of the talo-tibial joint.

2. Conservative treatment is justified only for children less than a year old and then only as preparation for operation.

3. Between the second and seventh year of life operations upon the soft tissues are indicated, to eliminate the contractures occurring on the posterior and lateral sides, to restore the proper position of the foot in line with the axis of the tibia, and to restore the normal shape of the foot and muscular equilibrium. At the same time favourable conditions are created for operative reconstruction of the lateral malleolus.

4. Arthrodesis of the talo-tibial joint or reconstruction of the lateral malleolus by a bone graft with the aim of stabilising the foot in the axis of tibia is not advisable in the growing limb.

5. The results obtained in three cases described support the conclusion that the bifurcation operation recommended by Gruca produces a new lateral malleolus with an epiphysis that grows at the same rate as the remainder of the lower epiphysis of the tibia, does not affect the rate of growth of the tibial epiphysis, prevents the recurrence of the deformity, and preserves the mobility of the talo-tibial joint.

6. In early cases this reconstructive operation may be done at the same time as soft-tissue deformities are corrected and subluxation reduced.

7. It is probable that the bifurcation operation should be done on children aged between two and seven years in order to give the limb the best chance to develop normally.

1 . A classification of Madelung's deformity on an etiological basis is suggested.

2. Seven patients with "idiopathic" Madelung's deformity and one occurring in association with Turner's syndrome are discussed.

3. Cytogenetic studies of five patients are recorded and their significance discussed.

4. Arthrodesis of the radio-carpal joint by the "wedge" technique is preferred for those patients whose symptoms warrant treatment.

1 . A series of twelve patients with solitary lung metastases from primary tumours of bone is reviewed. There were seven osteosarcomas, two chondrosarcomas, two fibrosarcomas and one malignant chondroblastoma. In each patient the lung desposit was resected.

2. Four patients have so far died from the disease. The average survival of the others since pulmonary resection is six years and seven months.

3. It is suggested that the results of pulmonary resection in carefully selected patients with solitary pulmonary metastases fully justify the procedure.

4. Careful investigation to ensure as far as possible that the metastasis is solitary, and a "waiting period" in case others should develop, are essential if unnecessary surgery is to be avoided. A waiting period of three months is recommended.

1 . A ten-year study of fifty-four operations for transplantation of the hamstring muscles in thirty-one spastic patients has been made.

2. Twenty-one patients were improved after operation, six were not improved, and in four the duration of follow-up was too short for proper assessment. One patient died from other causes.

3. Greatest benefit was not obtained until one year after operation.

4. The results varied considerably in different grades of spastic patient. Important factors affecting the results were age, sex, personality, balance and function of arm and hip. Hand and major hip operations should be carried out before hamstring transplantation.

5. The objectives of operation are discussed. These were most consistently achieved in older, more ambitious or more responsible males with good balance and with good arm and hip function.

6. Factors which were of less direct importance were mental capacity, minor degrees of limb length inequality, and foot deformities.

7. Operative correction of foot deformities should not be done before hamstring transplantation.

8. Serial plaster correction of the knee flexion deformity before operation is preferred to division of the patellar retinacula.

9. Transplantation of the hamstrings to the patella in spastics is under trial.

1. The tarsal tunnel syndrome is a clinical entity and is probably more often encountered than is recognised.

2. The cause is unknown but is probably like that responsible for the carpal tunnel syndrome. Experimental evidence suggests that the sensory symptoms in both these conditions are due to localised ischaemia of the nerve within the fibro-osseous tunnels, and that later structural changes are responsible for motor paralysis.

3. Relief of symptoms is complete if decompression of the posterior tibial nerve is performed before the onset of motor involvement.

1. A modification of the Grice extra-articular subtalar arthrodesis is described.

2. The results of this operation are presented.

1. A simple cone arthrodesis of the metatarso-phalangeal joint of the big toe based on the Rose and Mann operations is described.

2. New instruments have been devised to simplify the procedure.

3. Thirty-one operations have been performed on twenty-three patients. Bony fusion has occurred in all but one case. There have been no complications.

1 . Thirty-four cases of Perthes' disease followed into adult life were reviewed twenty-five to forty years (average thirty years) after diagnosis.

2. Rather more than one-third of the patients developed hips which were good, an equal number were considered fair and about one-quarter were poor.

3. Four out of five patients were fully active and free from pain but only two out of five had hips which were radiologically good.

4. Clinical and/or radiological deterioration had seldom occurred in the last twelve years.

5. A good result in childhood is likely to be maintained with no pain and good function up to the age of forty years and perhaps longer.

1 . Two cases of osteochondritis dissecans after Legg-Calvé-Perthes' disease observed for thirty years are described.

2. Osteochondritis dissecans of the hip can remain in an apparently unchanged state for many years and in these two patients is associated with excellent function, not requiring surgery.

Five knees with congenital dislocation were explored. The cruciate ligaments were found to be absent or hypoplastic. The results obtained by reconstructing an anterior cruciate ligament appear to be good. On the basis of dissections of foetal knees we believe that the cruciate ligaments are the main structures preventing an anterior dislocation of the knee in early foetal life; this deviation from the adult pattern is due to the bony configuration of the foetal knee. We therefore postulate that the basic defect in congenital dislocation of the knee is an absence or hypoplasia of the cruciate ligaments.

1. Thirty-two infants with genu recurvatum congenitum are reported.

2. Fifteen infants responded completely within eight weeks with conservative treatment; the remaining cases were recalcitrant.

3. The etiology, pathology and treatment of the two groups are discussed.

4. The prognosis is adversely affected by delay in treatment by the presence of certain associated deformities and by generalised joint laxity.

5. Indications for operative treatment are suggested.

1 . A case is described in which complete transposition of the latissimus dorsi muscle with its neurovascular pedicle was performed to compensate for complete paralysis of the triceps and partial paralysis of the posterior part of the deltoid muscle.

2. Muscle necrosis did not occur to any significant degree.

3. Strong substitute triceps function was achieved.

1 . A case of haemangioma arising in the tendons of the extensor pollicis longus and extensor pollicis brevis muscles of a twenty-seven-year-old woman is described.

2. The etiology of the lesion is discussed, together with a brief review of the literature.

1 . Normal and diseased bone was obtained by biopsy from five patients suffering from Paget's disease. The tissue was studied by histology, microradiography and quantitative fluorescence microscopy using tetracycline markers. Study of the morphological changes showed that two of the biopsies could be regarded as normal, while one was osteoporotic; two biopsy specimens were in the porotic phase of Paget's disease and the remaining five were in the sclerotic phase.

2. The tetracycline markers were used to measure the linear rate at which bone was deposited on individual surfaces (appositional growth rate) in µ per day and the percentage volume of new bone added to the total volume of bone per day (bone formation rate). The values obtained for appositional growth rate in all the biopsies were of the order of 1 µ per day, but slightly higher values were obtained in the diseased tissue of each individual. The bone formation rate in normal bone from the proximal femur was about 0·04 per cent per day, about 0·13 per cent per day in the porotic phase, and about 0·4 per cent per day in the sclerotic phase of Paget's disease.

3. Although these values must be accepted with some reservation, there seems to be no doubt that there is an upper limit of about 1 µ per day to the rate of deposition of bone on an individual bone surface; this suggests that in Paget's disease the osteoblast behaves as a normal cell.

1. The distribution of isotope following a single injection of either Ca⁴⁵ or C¹⁴-proline has been studied in young rats in which one tibia had previously been removed, killed and reimplanted.

2. The dead tibia took up about 25 per cent as much Ca⁴⁵ or C¹⁴ as did the living tibia and the possible processes by which this occurred are discussed.

3. Determination of the "accretion rate " by kinetic analysis of the Ca⁴⁵ data showed that this was much too high unless the physico-chemical process of uptake of isotope by bone was taken into account.

4. Under the conditions of the experiment it was not possible to estimate the rate of bone matrix formation using C¹⁴-proline as a tracer.

1 . Necropsy and dissection findings of a man of fifty-two who died from nail-patella syndrome are recorded.

2. The significance of the iliac horns are discussed and the literature concerning their development is reviewed.

3. Other anomalies are reviewed and the incidence of hereditary nephropathy is discussed.

4. The genetic origin ofthe syndrome is outlined but the involvement of such varying tissues remains unexplained.

1. The age changes in the articular cartilage of the elbow joint are presented from a study of twenty-eight necropsy subjects aged eighteen to eighty-eight years. During early adult life those areas of cartilage which do not usually articulate with opposed cartilage always show some degree of chondromalacia.

2. Evidence is presented that the almost inevitable degeneration of the radio-humeral joint in old age is related to the combination of rotation and hinge movements that occur at that joint. This is in marked contrast with the relative immunity of the humero-ulnar articulation which has hinge movement only.