1. Senile osteoporosis is one of the common causes of morbidity in old people. Its distribution in European and American populations has been deduced from epidemiological studies of its major complications, such as fractures of the vertebrae and the femoral neck. Although there has been some evidence that different population groups differ in their susceptibility to this condition, no demographic study of its prevalence in the white and Bantu races has previously been made.

2. The present paper describes an epidemiological study of femoral neck fractures in the Bantu population of Johannesburg, covering the years 1957-63. The cases were analysed by age and sex, the type of trauma and the level of the fracture. The number of fractures was related to the population at risk; the fracture incidence was expressed both as an age-specific rate and as a standardised rate and compared with fracture rates in European populations. It was found that the fracture rate in the elderly Bantu is less than one-tenth of that in Western European populations, and that males and females are affected equally. It was concluded that senile or post-menopausal osteoporosis is much less pronounced in the Bantu than in white populations.

3. The relationship of these findings to endocrine changes, calcium balance and racial factors is discussed. It is suggested that senile osteoporosis is not caused by a simple calcium deficiency but may be related to an imbalance between calcium intake, absorption and excretion, or a failure of the complex mechanism which normally controls this balance. Whatever the immediate cause, however, race plays an important part in determining the onset and distribution of the condition.

1. Sixty-nine patients with degenerative disease of the hip joint were treated by intra-articular arthrodesis using secure internal fixation. External fixation with plaster was not used and the patients were mobilised on crutches after a mean interval of 3·2 weeks. Radiologically evident bony union occurred in 87 per cent of cases. Among the nine patients (13 per cent) who failed to show union only three complained of persistence of severe symptoms.

2. The only significant complication was fracture of the upper femoral shaft in three cases (4·3 per cent). However, this has not occurred since a small plate was used in addition to the nail.

3. The disadvantages of the routine use of plaster fixation are discussed and are contrasted with the advantages of early mobilisation without plaster.

4. Whereas this series does not show a rate of fusion as good as that in the best reported series, it supports the view that arthrodesis of the hip offers the most certain, reliable and efficient means of treatment for severe unilateral degenerative disease of that joint.

1. Idiopathic scoliosis is a familial condition.

2. The findings suggest either dominant or multiple gene inheritance, but a larger series is needed before a firm conclusion can be drawn.

3. The infantile and adolescent types of scoliosis seem to share the same basic etiology, because their families contain instances of each.

4. Infants with resolving scoliosis have affected relatives in the same proportions as in the main group, suggesting this is a mild form of the same disorder.

5. In this series all infants seen with scoliosis under one year of age had plagiocephaly, which was usually transient.

6. Mental defect and epilepsy are the commonest findings associated with scoliosis.

7. In adolescent scoliosis the age of the mother is significantly raised by comparison with the expected figure for the normal population.

1. The clinical experience of fourteen cases of traumatic spondylolisthesis of the axis is described.

2. Evidence is presented which suggests that vertical compression and extension forces are frequently involved.

3. Treatment is based on recognition of the deforming force and its extent.

4. Primary treatment of unstable lesions by the coronally placed bone dowel of Barbour allows early stabilisation and long-term security.

5. The increased antero-posterior diameter of the axis explains the low incidence of spinal cord damage.

6. Skull traction is considered illogical in that it runs parallel in effect to the most deadly form of judicial hanging.

7. Secondary stability following injury may allow continuing force to fracture the spine at other levels.

8. The paradox of an extension injury between the second and third cervical vertebrae and a "flexion" injury at a lower level is discussed.

1. Seven cases of non-traumatic anterior atlanto-axial displacement in young people are recorded.

2. Four of the seven patients showed evidence of neurological compression. All cases improved symptomatically with treatment, but five still show persistent radiological displacement.

3. The mechanism of the displacement is thought to be due to acquired insufficiency of the transverse ligament.

4. The distance between the anterior arch of the atlas and the dens in children measured on lateral radiographs of the cervical spine, varies from two to more than three millimetres.

5. Skull traction followed by immobilisation in a collar or Minerva plaster is advised.

6. The place of cervical fusion is discussed.

1. In thirty-six out of seventy-two cases of cervical vertebral interlocking, luxation was still present after two weeks ("old luxation"). The principal reasons for overlooking the diagnosis are lack of familiarity with the radiographic appearances and incomplete or inadequate radiographic examination.

2. Failure to identify luxation probably hardly influences the prognosis of the immediate cord lesion; but recovery from the radicular lesion is unfavourably affected, and a progressive cord lesion may occur later when none previously existed.

3. Reduction is advisable if the luxation is not more than six weeks old. Operative reduction is preferred; manual reduction under anaesthesia and caliper traction with heavy weights are less satisfactory alternatives. Reduction is contra-indicated if the luxation is more than six weeks old.

4. Indications for fixation and the choice between internal and external (plaster jacket) fixation are discussed, and also the treatment of stable lesions which have not been reduced.

1. Thirty-three patients who had had stapling of the lower femoral and upper tibial epiphysis to correct inequality of the leg lengths were reviewed after maturity. The staples were inserted so that correction of the disparity would coincide with termination of growth.

2. The predicted corrections were found to be inaccurate. The error was 47 per cent in girls operated on between ten and twelve and 51 per cent in boys between ten and thirteen. In older children the prediction was more accurate.

3. Despite the inaccuracy of prediction only four patients were left with shortening of more than 3·5 centimetres.

4. Complications of the operation were deformity, ligamentous laxity, subjective symptoms and necessity for further operation.

5. Only one girl had a serious deformity–genu recurvatum of 25 degrees. Half the patients had minor degrees of hyperextension.

6. The causes of the complications are discussed and suggestions made how their incidence might be reduced.

7. It is concluded that the operation of stapling the epiphyses around the knee of the long leg has a small but useful part to play in the correction of inequality of leg lengths. It should be confined to tall boys over thirteen and girls over twelve.

1. Six cases of development of heterotopic bone around joints in association with paralysis from intracranial lesions are presented. It is suggested that such bone may occur more commonly than is realised.

2. The features of these cases are very similar to those seen in association with paraplegia.

3. Extensive new bone is usually associated with fixed contractures.

4. Operation is hazardous in paraplegia but should not necessarily be so in other paralytic conditions.

5. In the presence of returning motor function excision of the bone, allowing correction of the deformity together with some movement, is a worthwhile procedure. In the hip, osteotomy alone usually requires plaster fixation with the attendant risks of venous thrombosis. Previous excision of the bone allows internal fixation of the osteotomy with early mobilisation.

1. Butler's operation for the correction of the dorsally adducted fifth toe is described.

2. It is a simple and safe operation not needing splints, and giving good reliable results.

3. The results of seventy operations performed over ten years are studied.

1. Of forty-seven patients with histologically proven myeloma of the spine, thirty-three had multiple lesions at the time of the first examination and fourteen were solitary.

2. Five of the solitary cases, in which the patients are alive and well without signs of dissemination four to fourteen years after diagnosis, are considered in detail and the differences in clinical presentation and prognosis are discussed.

3. A sixth case, described in detail, showed scattered osteolytic lesions after ten years.

1. The treatment of Bennett's fracture is reviewed and the relative merits of conservative and operative treatment is considered.

2. A closed method of treatment is described and a series of thirty-one patients so treated is analysed. There were twenty-nine successful results.

3. It is urged that conservative treatment is the method of choice, and that operative measures should be reserved for the occasion when closed methods have failed.

Cancellous inlay bone grafting for delayed union or non-union of the scaphoid bone gives good results in most cases (Table IV). The operation is easy, does not require radiological control and does not damage the dorsal arterial plexus. The indications for the operation are twofold: firstly for patients complaining of disabling symptoms in the wrist joint with an established pseudarthrosis of the scaphoid bone, with neither arthritic changes nor severe avascularity of the proximal fragment; and, secondly, for delayed union in recent fractures despite adequate immobilisation. Union may still occur if conservative treatment is continued further, but because this may take up to eighteen months (during which time most patients would be unable to work), operation is a reasonable alternative.

In this series two scaphoid fractures united after operation with some collapse of the proximal fragment. This probably resulted from removal of too much bone (preliminary to inlaying the graft) from an already small fragment with a poor blood supply.

The operation can be performed even in the presence of a small proximal fragment and gave a satisfactory result in two out of three such cases.

1. Operative treatment of scaphoid pseudarthrosis by the Matti-Russe method is a reliable procedure which in our series has given ninety-seven cases of bony union in a total of 100 operations.

2. We do not hesitate to advise operation for this condition as soon as it is discovered, except in cases with severe secondary osteoarthritis. Equally good results have been reported by Murray (1946) from a series of 100 cases treated with cortical grafts from the tibia (blind method) and by Agner (1963) from a series of twenty-four patients treated by Bentzon's operation (interposition of a pedicled soft-tissue flap).

3. In our opinion, Russe's open operation has great technical advantages over Murray's blind method.

4. We have no experience of Bentzon's operation, which seems attractive on account of its technical simplicity and as not more than two weeks' immobilisation in plaster after operation are needed.

5. It would be interesting to see Agner's results confirmed from other sources. It is true that many scaphoid pseudarthroses remain symptomless for years, as London (1961) has pointed out, but many of them sooner or later cause pain, and we do not agree with London's opinion that a few weeks of immobilisation will usually make the wrist painless.

6. Although severe osteoarthritis is very slow to develop in wrists with pseudarthrosis of the scaphoid bone it cannot be denied that these wrists are constantly threatened with suddenly developing pain and by progressive deterioration of function.

7. Therefore, early repair of pseudarthrosis of the scaphoid bone is advisable; it can be expected to save many wrists from progressive loss of function and from final development of severe degenerative change.

1. The clinical, radiological, operative and histological features of twelve aneurysmal bone cysts are recorded.

2. Attention is drawn to atypical features, and the problem of diagnosis is discussed.

3. It is recommended that treatment should be complete excision, except where this would interfere with function.

4. Various theories on pathogenesis are considered and favour given to the view that these cysts result from a local change in haemodynamics occurring possibly in a pre-existing lesion.

1. Epidural abscess should be suspected in patients with lumbar and sciatic pain who have a history of staphylococcal skin infections or of diabetes.

2. The diagnosis of epidural abscess should be considered before that of herniation of a disc if the patient presents an otherwise unexplained pyrexia. The absence of radiographic changes is no bar to this diagnosis.

3. The hazards of lumbar puncture in cases of epidural abscess are obvious.

4. Early diagnosis and operation are essential to control the infective lesion and to ensure recovery of the neural lesion.

1. Three cases of cement injection into the tissues of the thumb and index finger are recorded.

2. This is probably the first description of this type of injection injury.

3. Recommendations are made for the prevention of the injury.

The features of two cases of intraosseous ganglion in the lower tibia are described.

1. Three cases of delayed occlusion of the popliteal artery following trauma are described.

2. The lesion responsible is a partial rupture of the vessel with subsequent thrombosis.

3. All such lesions should be explored and preferably resected.

1. A case of traumatic forward dislocation of the tibialis posterior tendon at the ankle is described.

2. A possible mechanism of the injury is suggested.

1. A lesion of the median nerve after reduction of a dislocated elbow in a boy of nine is recorded.

2. The nerve lesion was progressive, and at operation on the seventh day after injury the nerve was found to be trapped in the joint between the humerus and the ulna.

3. The nerve was freed and gradual recovery occurred.

A variation of the motor branch of the median nerve is described in which this branch arose more proximally and pierced the flexor retinaculum. Its significance during a carpal tunnel decompression is pointed out.

1. A case of massive osteolysis of the right humerus is described. Diseased bone was resected leaving only the lower part of the humerus. The resected bone was replaced by a titanium prosthesis.

2. The diagnosis, etiology, prognosis and treatment of the condition are briefly discussed.

1. Dissections of the newborn child revealed that the psoas muscle is a lateral rotator of the hip in all positions but that this secondary action is much stronger when the limb is abducted.

2. It has also been shown that the iliacus portion of the muscle can contribute towards the completion of abduction movement.

3. An attempt has been made to reconcile these facts with the accepted concept of the action of the muscle in the adult.

4. The clinical significance is discussed.

1. We have shown that the permeability of cartilage is the same in necropsy specimens as in the living animal. We have concluded that studies of material transport into cartilage carried out on necropsy specimens validly reflect in vivo conditions.

2. We have studied the effect of agitation of the fluid in which cartilage is immersed upon the rate of diffusion of substances into cartilage and have found that agitation increases the rate of penetration up to three or four fold. We believe that it may be inferred from this fact that the nutrition of cartilage is partly dependent on joint movement.

3. We have examined the permeability of the bone-cartilage interface to water and solutes and have found that in the adult no detectable material transfer occurs across this zone. In the child on the other hand the bone-cartilage interface appears to be permeable to water and solutes.

4. We have measured the diffusion coefficient of glucose in cartilage and have hence estimated the depth of cartilage which can be adequately supplied with glucose from the synovial fluid in the presence and absence of agitation.

5. We have examined both experimentally and theoretically the possible effect of intermittent loading on the rate of penetration of substances into cartilage. We have concluded that at low pressures intermittent loading contributes little to the material transfer into cartilage. At high pressures intermittent loading does lead to the transport of solutes into cartilage but it cannot significantly increase the rate of transfer above that attributable to normal diffusion. Loading cartilage surfaces for prolonged periods of time without allowing intermittent relaxation would be expected to lead to decreased diffusion, without any absorption of fresh fluid attributable to the action of a pump, and would thus result in an overall decrease in the rate of penetration of substances into cartilage.

1. Hitherto, no study has been reported on the relative quantitative contributions of blood supply by the different arterial systems of long bone. This paper is a report on such a study in the young adult rabbit.

2. The rates and regional distributions of the blood supply of the nutrient as well as other arteries of the femur were studied after ligation of the nutrient artery. The average rates of reduction in blood flow per minute for the first five minutes through the entire femur as well as the shaft, and the epiphysis and metaphysis on each end, were measured and analysed. The bone blood flow was measured by the method of bone clearance of blood strontium 85.

3. The normal average rate of blood flow through the femurs of average weight of 9·38 grammes was 0·90±0·05 millilitres per minute, or 9·60±0·47 millilitres per minute per 100 grammes of bone.

4. The nutrient artery contributed at least 46 per cent of the normal total blood supply of the entire femur and at least 71 per cent of the normal total blood flow of the shaft including its marrow, and 37 per cent and 33 per cent of the normal total blood flow of the upper and the lower epiphysial and metaphysial areas respectively.

5. About 63 per cent, 30 per cent and 67 per cent of the total normal blood flow through the upper epiphysis and metaphysis, the shaft and the lower epiphysis and metaphysis respectively are still intact in the first five minutes after ligation of the nutrient artery, which represent the approximate proportions of the blood supply by the other regional arteries.

6. These quantitative data obtained in this study offer good support to the qualitative observations made by many previous workers.

1. Techniques are described for homografting intact or partly digested hyaline cartilage or isolated chondrocytes on to cancellous bone in rabbits.

2. Material which had been cooled to and thawed from -79 degrees Centigrade either in the presence or absence of the protective substance dimethyl sulphoxide was grafted in the same way. In control experiments samples were boiled before grafting.

3. Necropsies were performed at intervals varying from two to twenty-six weeks later and the graft sites were removed, fixed and decalcified. Paraffin sections were stained histologically.

4. Freshly isolated chondrocytes or chondrocytes which had been frozen in the presence of dimethyl suiphoxide formed new matrix within two weeks and did not succumb to a homograft reaction. By the sixth week they had become aligned in columns surrounded by well stained matrix. There were signs oferosion by invading capillaries and osteoblasts, but no lymphocytes were seen. By the twelfth week invasion by trabeculae of newly formed bone was well advanced and by the twenty-sixth week the grafts were difficult to find although there had been no sign at any stage of an immunological reaction.

5. New matrix was also formed in homografts of hyaline cartilage which had been treated with papain or with papain and collagenase. After freezing in the presence of dimethyl sulphoxide, small areas ofthe grafts seemed to contain living cells which had formed new matrix. Other areas were disintegrating.

6. The homografts of intact cartilage showed a variety of appearances suggesting that the old matrix was gradually leached out and that chondrocytes liberated in vivo formed a new matrix.

7. Intact or partly digested cartilage which had either been frozen without dimethyl suiphoxide or boiled disintegrated and was rapidly replaced by bone after grafting.

8. When specimens of partly digested cartilage or isolated chondrocytes were homografted On to sites denuded of cartilage on the articular surface of the rabbit humeral head, nodules of fresh cartilage were formed. They were embedded in fibrous tissue derived, presumably, from marrow cavities opened up at the time of operation.

1. Isografts of articular cartilage of young rats, with mucoproteins labelled with ³⁵S, extracellular fibrous proteins labelled with ³H-glycine, and nuclei labelled with ³H-thymidine, were transplanted into the anterior chamber of the eye.

2. Thin split-thickness transplants of the cells of the gliding surface of immature articular cartilage induced the formation of fibrous tissue.

3. Thick transplants and subsurface slices of immature articular cartilage, containing germinal cells of the epiphysial cartilage, induced the formation of new bone consistently within 4 weeks.

4. Full-thickness transplants in articular cartilage from senile rats induced only the formation of fibrous tissue.

5. Slices of growing cartilage, devitalised by cryolysis, or extraction of acid-soluble proteins, produced scanty deposits of bone or cartilage, or both, but only infrequently and generally after a lag phase extending from six to twelve weeks.

6. Reduction in the amount of mucoprotein in the cartilage matrix by papain, and suppression of the resynthesis of tissue proteins by cortisone, retarded but did not prevent bone induction.

7. Bone induction is the product of a series of interactions between inducing cells and responding cells by intracellular and intercellular reactions too complex to characterise in physico-chemical terms at this time.