1. Sixty myelographs have been obtained in severe traction injuries of the brachial plexus.

2. Seventy-eight traumatic meningoceles were outlined.

3. Multiple meningoceles indicate a gloomy prognosis.

4. In forty patients the results were compared with those obtained with the "axon reflex."

5. Myelography is a valuable aid in obtaining an early prognosis but the results must be correlated with the clinical picture.

1. Four cases of abnormal arrangement of the lower lumbar and sacral nerves within the spinal canal are reported.

2. In all four cases the presentation was like that associated with acute lumbar disc protrusion, though in only two cases was a protrusion found at operation.

3. The significance of the findings is discussed and the findings are compared with those in the eighteen other recorded cases.

1. The treatment of contractures at the hip secondary to poliomyelitis by Soutter's muscle slide or by Yount's fasciotomy gives excellent results. So does high femoral osteotomy, but it is not superior to the other two and should therefore be kept in reserve as a supplementary operation for the completion of correction of a deformity so gross as not to be wholly remediable by division of the soft parts.

2. Subluxation of the hip occurs only if the paralysis comes on during the first eighteen months of life and is a product not of severe paralysis but of unbalanced and often slight weakness of muscles. Correction of the invariable valgus deformity of the femoral neck by osteotomy is followed by relapse; acetabuloplasty too is unreliable. The most promising remedy seems to be some form of acetabuloplasty combined with transplantation of an iliopsoas of adequate strength into the greater trochanter. The indications for arthrodesis are few, but the results of this operation are good.

3. In the few patients with abductor weakness and little else the dipping gait may be abolished by iliopsoas transplantation.

1. In children with cerebral palsy and spastic paraplegia or tetraplegia with no fixed fiexion of the knees, tightness of the hamstrings may limit the stride, restrict passive straight leg raising and cause inability to sit up with the knees extended.

2. Nine such children have been treated by bilateral release of the hamstrings from the ischial tuberosity, with marked benefit in all patients.

1. Previous reports of the role of the quadriceps in producing limitation of movement or dislocation of the patella have tended to implicate one particular part of the complex. Experience gained in thirty-five quadricepsplasties in children has shown that all parts of the quadriceps (except vastus medialis) and the ilio-tibial band also may play a part and that each of these must be attended to if a satisfactory result is to be obtained.

2. A simple technique of operation is described and illustrated.

3. Since this paper was prepared, a patient showing features of particular interest has been seen and treated.

1. Four cases of congenital lateral dislocation of the patella are described.

2. The significance of the associated flexion contracture is emphasised.

3. Early diagnosis and operative realignment of the extensor mechanism is considered to be important because it should avoid the secondary growth changes which can produce serious disability.

1. The literature on pigmented villonodular synovitis has been reviewed and a series of eighty additional cases is reported.

2. The condition usually presents either as a nodule in a finger or knee, or as a diffuse lesion in a knee. The lesions, although benign, sometimes erode or invade the tissue of adjacent bones.

3. Distinction from malignant synovioma can be made on the basis of the macroscopic appearance of the lesion at operation (relationship to joints or tendon sheaths: villonodular appearance: pigmentation), and by histological examination.

4. Treatment of the nodular form by excision is satisfactory but extensive synovectomy for diffuse lesions of the knee gives poor results.

5. The etiology of pigmented villonodular synovitis is unknown, but it appears to be a self-limiting process, possibly inflammatory in nature.

1. Five cases of pigmented villonodular synovitis with associated lesions within bone are recorded, two in the hip, two in the knee and one in the elbow.

2. The mode of formation of these intraosseous lesions is explained and methods of treatment are discussed.

A case of unusually extensive pigmented villonodular synovitis of the wrist with involvement of bone, particularly of the distal end of the radius, is reported. The clinical and radiographic evidence suggested a diagnosis of primary bone tumour, possibly a giant-cell tumour with sarcomatous transformation.

1. The radiological appearances of the fragments in 100 trochanteric fractures have been analysed.

2. A simple practical classification enables the correct method of reduction to be chosen.

3. In Type I fractures the proximal fragment consists of the head and neck alone. In Type II fractures the head, neck and a major part of the great trochanter constitute the proximal fragment.

4. The key role of the greater trochanter in influencing the displacement of the fragments is discussed.

5. For reduction, Type I fractures require rotation of the distal fragment to a neutral position. Type II fractures reduce in some degree of lateral rotation.

1. Distal migration of a femoral intramedullary nail is described in seven patients. Previous reports of proximal and distal migration are reviewed.

2. Factors predisposing to this complication are infection, incorrect nail size, comminution of the fracture and involvement of the medullary isthmus.

1. Seventeen cases of knee injury are described in which the predominant lesion was rupture of the posterior cruciate ligament. Seven were treated conservatively and ten by surgical repair.

2. Most cases occurred in motor cyclists.

3. The extent of the rupture should be determined by examination under anaesthesia.

4. Early surgical repair is indicated for complete rupture.

5. An effective method of repair is described.

1. Two patients with recurrent dislocation of the head of the fibula are described.

2. The difficulties in diagnosis are discussed.

1. A series of six traction lesions of the common peroneal nerve in association with a severe adduction force to knee is described.

2. The reasons for failure of the nerve repair are discussed.

3. A new system of radiological marking of the anastomosis is described.

4. A less pessimistic view of the prognosis is taken than heretofore, and the management of the injury is discussed with a recommendation that a more conservative resection be done three months after the injury.

1. The management of fractures in seven haemophiliacs and one patient with Christmas disease is described.

2. The problems of management are essentially those associated with haemorrhage into the soft tissues.

3. There is no delay in the healing of fractures, which usually occurs with a relative lack of periosteal callus.

4. The principles of transfusion therapy are discussed.

1. Pain at the front of the radial side of the wrist may be caused by various lesions of the tendon and sheath of the flexor carpi radialis tendon.

2. The diagnosis may be established by testing resisted movement at the wrist and by the effect of injecting local anaesthetic into the tendon sheath.

3. In women over the age of fifty the lesion is associated with osteoarthritis of the joint between the scaphoid and the trapezium.

4. Osteoarthritis of the joint between the scaphoid and the trapezium is found in about 25 per cent of women over the age of fifty.

5. If the pain is not relieved by simple conservative measures it can usually be cured by incision of the tendon sheath.

6. The histological changes in the tendon sheath are similar to those found in tenovaginitis of the abductor pollicis longus and tibialis posterior tendons.

The results of using Boplant in a series of thirty-three operations have been very disappointing. Pyrexia of over 100 degrees Fahrenheit followed operation in more than one-third of cases. There was an incidence of at least 36 per cent of failure to achieve the object of operation. Radiographic evidence of failure of incorporation was seen even in a number of clinically successful cases. As a result of this experience and of the experience of other surgeons in Winnipeg the use of Boplant has now largely been abandoned.

1. A simple method of subtalar fusion, suitable for use in children, is described.

2. Although it is intended to provide stability for some years until a complete subtalar fusion can be carried out, further operation may not be necessary.

3. Its use is not advocated over the age of eleven or twelve.

1. The Batchelor method of subtalar fusion by a fibular graft inserted through the neck of the talus is described.

2. The results of the operation appear to be satisfactory.

1. Three cases of severe retroperitoneal haemorrhage complicating fractures of the pelvis are described. In two patients haemorrhage was immediately controlled by ligation of the internal iliac artery. The third patient died before the bleeding could be controlled.

2. Ligature of the internal iliac artery may be a life-saving measure when fracture of the pelvis is complicated by severe haemorrhage.

1. A case of fractured pelvis with massive haemorrhage from the right superior gluteal artery and thrombosis of the right ilio-femoral venous system is reported.

2. The treatment included ligature of the artery and extensive thrombectomy. Ten litres of blood were transfused.

1. A case of hernia of the anterior tibial muscles is described in which repair of the hernia under tension was followed by local muscle necrosis and contracture.

2. This case supports the theory of pathogenesis of the anterior tibial syndrome that increased tension in the compartment embarrasses the blood supply of the contained muscles.

1. Occult fracture-subluxation of the midtarsal joint is described and illustrated by a typical case.

2. Comments are made on the mechanism of injury, diagnostic features and treatment.

1. A prosthesis which is useful in unilateral disarticulations of the hip and highly advantageous in cases of bilateral disarticulation is described.

2. It makes use of the principle of a swing door and makes walking possible with the assistance of elbow crutches in cases of bilateral hip disarticulation and amelia.

1. Experimental epiphysiodesis was performed on either the upper or lower epiphysial cartilage of one tibia of young rabbits, the other tibia serving as a control.

2. Subsequent growth was observed at each epiphysis by radiography.

3. After both operations the normal deceleration of growth rate of the uninjured epiphysis on the experimental side was reduced and this epiphysis made a greater contribution than its control to the final length of the bone.

4. Serial sections of the injured epiphysis revealed that the arrest of growth was due to the formation of a narrow bony bridge between the epiphysial and metaphysial bone.

5. The additional growth of the uninjured epiphysis appeared to have a direct relationship to the deficiency of growth at the epiphysis that had been injured by operation.

6. The results may indicate the existence of a local system of growth control.

1. The use of a protein-free synthetic medium has provided a new technical approach to the study of fracture healing in vitro.

2. The tibiae of fourteen-day embryonic chicks were cut in half in the middle of the shaft, the fragments were placed in apposition and the explants grown in vitro for up to sixteen days. The process of bone repair was studied by means of histology and biochemical estimations.

3. The rate of growth in length of fractured bones was greater in an atmosphere containing 50 per cent of oxygen than in one with 20 per cent oxygen, thus emphasising the importance of an adequate oxygen supply for the regeneration of osteogenic cells.

4. The effect of varying the concentration of glucose in the medium was investigated. Two milligrams of glucose per millilitre was the most favourable for healing; higher levels caused fibroblastic changes in the cartilage cells and inhibited the proliferation of osteogenic cells at the fracture site.

5. Histological examination showed that many of the phenomena that occur in the repair of fractures in vivo can be reproduced in vitro in synthetic medium. Similar results were obtained whether the fracture was made in whole bones or in isolated shafts from which the cartilaginous ends had been removed; the latter are more favourable for biochemical study.