1. Deformities of the foot in children with myelomeningocele are described and classified. The results of a policy of operative correction of deformity in 148 patients all of whom had had at least one operation on the foot between 1947 and 1965 are described.

2. In 241 feet in which there were deformities 433 operations were performed, including tenotomies, soft-tissue divisions, tendon transfers and bony procedures. At the time of review successful correction of deformity had been obtained in 81 per cent with a plantigrade foot that could bear weight safely, and with a distribution of muscle activity that required minimal external support and presented the least liability to recurrent deformity.

3. The management of individual deformities is described and the causes of failure are analysed and discussed.

1. The management of severe kyphosis of the lumbar spine in association with myelomeningocele is discussed.

2. Neonatal spinal osteotomy-resection has been performed in six patients with partial correction of the deformity and a greatly improved ease of closure and healing of the skin defect. The severity of lower limb paralysis has been diminished compared with the complete paraplegia that almost always results from conservative management of closure of the defect without osteotomy.

3. In an older child who has not had the benefit of neonatal osteotomy and who has complete lower limb paralysis, transverse spinal osteotomy or excision of the prominent laminae and pedicles on each side of the midline makes possible the fitting of apparatus for walking and diminishes the liability to recurrent ulceration of the skin.

1. Experience with twelve cases of arterial trauma are presented.

2. Six limbs were amputated and six limbs saved.

3. Delay in effective treatment was the major cause of failure to save the limb.

4. Five types of limb injury involving vessels are described.

1. The types of ischaemia that accompany injuries to a limb are described.

2. The ischaemia may be total or local.

3. Thirty-seven cases of total or local ischaemia of a limb are analysed and conclusions are drawn therefrom.

1. The venographic findings in clinical primary osteoarthritis are described.

2. Experimental venous engorgement, of the knee joint and of healing fibular fractures, results in accelerated bone formation and disturbed cartilage formation.

3. Changes in pH, ppCO₂, and PPO₂ are indicated as the chemical means by which chondrogenesis and osteogenesis can be altered.

4. It is suggested that chronic venous stress in joints is a causal factor in primary osteoarthritis.

1. Forty-five arthroplasties of the knee with the Walldius prosthesis are reported in forty-two patients, thirty-seven with rheumatoid arthritis and five with osteoarthritis.

2. There has been no structural failure of the prosthesis.

3. Sepsis required removal of the prosthesis in three cases, but arthrodesis was obtained in two of the three.

4. Serious loosening of the prosthesis occurred in one case only. Varus deformity occurred in one patient.

5. Radiological evidence of some movement of the prosthesis was present in six other cases but this did not seem to affect function.

6. It is concluded that this operation has a place in the treatment of the more seriously disabled patient, but should not be used when heavy demands are likely to be made on the joint.

1. The history of cytotoxic treatment has been briefly reviewed.

2. The structure and possible mode of action of the various agents have been described.

3. The applications, techniques and complications of cytotoxic treatment have been discussed.

1. Six thousand consecutive newborn babies were personally examined by the author for congenital dislocation of the hip. Twenty-four cases were diagnosed and twenty-three treated.

2. Twenty-two of the twenty-three treated cases had excellent results after treatment in the von Rosen splint.

3. The baby should be five days old before a final decision is made as to whether treatment is necessary.

4. A further twenty-seven babies were found to have unstable hips. Eighteen of these were followed up and all were found to have developed normally without treatment.

5. The technique of examination is simple and quick but it is desirable that it should be carried out in each maternity unit by only one or two doctors.

1. Out of 11,868 children born in one maternity department and examined neonatally three cases (possibly four) of typical dislocation were missed at the first examination but diagnosed and treated with good results within the following few months.

2. One single neonatal examination of the hip is not sufficient. Repeated examinations during the first weeks and months are essential.

3. Treatment with a Frejka pillow is unsatisfactory. The von Rosen splint is preferable.

4. Following the campaign for neonatal diagnosis and early treatment no case of established dislocation has been encountered after the age of six months.

5. Atypical cases present special problems.

1. Twenty-one cases of congenital dislocation of the hip were found on examination of 1,881 consecutive neonates on the first day of life, giving an incidence of eleven per 1,000 live births.

2. Insignificant high-pitched "clicks" were noted in 10 per cent of newborn children.

3. Conversion of half of the patients with hip dislocation to normal occurred during the first post-natal week.

4. Joint laxity was not a feature of the newborn with congenital dislocation of the hip.

5. Oestradiol, oestrone and oestriol were estimated in twenty-fourhour urine samples collected from sixteen patients with congenital dislocation of the hip and nineteen matched controls during the first six days of life. No significant differences in oestrogen output between the two groups were found.

6. The hypothesis that congenital dislocation of the hip is a result of an inborn error of oestrogen metabolism in the newborn is not supported.

1. Seventy patients with impacted fractures of the femoral neck treated from 1953 to 1965 have been reviewed. Forty-seven were treated conservatively and twenty-three by primary internal fixation.

2. The complications of both methods of treatment are recorded.

3. The prognosis following impacted femoral neck fractures is good. Seventy-nine per cent treated conservatively and 96 per cent treated by primary internal fixation had excellent or good results.

4. Primary internal fixation is the treatment of choice.

1. A report is presented of the results of a trial to compare the effects of early and late weight-bearing in patients with a transcervical fracture of the femur treated by reduction of the fracture and internal fixation with a sliding nail-plate.

2. One hundred and twelve patients have been assessed clinically and radiologically three years after operation.

3. Retrospective analysis of factors that affect the outcome of treatment suggests that the two groups were fairly evenly balanced.

4. The results show that full weight-bearing two weeks after operation did not increase the incidence of failure of fixation or of non-union.

5. The higher incidence of superior segmental collapse in patients in whom weight-bearing was deferred for twelve weeks can be explained by the greater number of high fractures in this group and the greater number with a poor reduction.

1. Twelve patients with suspected pseudarthroses in previous spine grafts were subjected to operation.

2. Correction of the curves was produced by Harrington's instrumentation at the sites of pseudarthroses, osteotomies and fractures.

3. A significant increase in stature was produced in all the patients.

4. Harrington's hooks were safely inserted into cavities cut in intact portions of previous grafts.

5. Most patients were able to leave hospital in less than four weeks.

6. Deliberate bending of the Harrington rods has not led to subsequent fracture of the rod.

7. A sliding scoliosis fusion frame is described. It reduces friction during correction and it reduces haemorrhage during surgery.

1. A new method of tendon suture using a barbed wire is described.

2. Experimental evidence suggests that it may prove superior to existing methods.

1. Three cases of traumatic anuria following muscle ischaemia ("crush syndrome") are reported.

2. The pathogenesis and treatment of the condition are discussed.

3. A scheme of management directed to the prevention of renal failure is proposed.

The syndromes associated with a narrow lumbar spinal canal are described and discussed. In thirteen cases two main groups were evident, the larger group having mainly backache and root pain, the smaller group having intermittent claudication. A method of recognising the narrow spinal canal on plain radiographs is described, and a comparison made with normal controls. The findings at operation are reported and the importance is emphasised of making a wide laminectomy for decompression. Our thanks are due to the neurosurgeons of the South-West Neurosurgical Unit, Mr G. L. Alexander, Mr D. G. Phillips and Mr A. Hulme, who kindly allowed us full use of their clinical notes. We would also like to thank Mr G. Banham for the reproductions, Mr E. Turnbull for the drawing and the secretarial staff for their patient co-operation.

1. The syndrome of spinal stenosis is due to compression of the cauda equina from structural narrowing of the lumbar spinal canal.

2. Patients with this syndrome present symptoms of cauda equina claudication or of unremitting bizarre back pain and sciatica.

3. The compression of the cauda equina is always posterior and postero-lateral and is caused by narrowing of the lateral recesses and of the dorso-ventral diameter of the spinal canal.

4. The diagnosis can be made only by myelography. The only form of successful relief of the nerve root compression in spinal stenosis is adequate lateral and longitudinal decompression.

1. The results of thirty-nine operations for correction of drop-foot in thirty-three patients with leprosy are discussed.

2. The procedure used was circumtibial, subcutaneous, two-tailed, tendon-to-tendon transfer of the tibialis posterior to extensor hallucis longus and to extensor digitorum longus and peroneus tertius. The motor slips were inserted into the recipient tendons on the dorsum of the foot.

3. Analysis of the results showed some correlation between the angle of active dorsiflexion and the range ofactive movement ofthe ankle. The angle ofdorsiflexion seemed to determine the range of movement.

4. When contracture of the tendo calcaneus was present, simultaneous lengthening improved the angle of dorsiflexion more than the range of active movement.

5. The causes of failure were sepsis, failure of re-education and unrecognised tightness of the tendo calcaneus.

6. The advantages of the present procedure are mentioned.

1. The complications following standard tendon transfer to provide active correction of drop foot in Chinese patients with leprosy are reviewed.

2. An alternative method of foot drop correction is described in which reactivation of the remaining distal stump of the tibialis posterior tendon is provided to assist in maintaining the stability of the arch of the foot and to help to prevent dropped toes.

3. A review of thirteen patients is given. The indications are that this method is functionally as good as other methods. So far it has shown none of the complications usual in Chinese patients.

1. Two cases of fracture-dislocation of the spine at the lumbo-sacral level are reported.

2. One patient was treated conservatively and survived, with a cauda equina lesion which is now recovering. One patient was treated by operative decompression and died offat embolism.

3. The lumbo-sacral joint is locked in the dislocated position.

1. A case of primary intraosseous liposarcoma is described which was producing tumour bone (osteo-liposarcoma: malignant mesenchymoma) in the right fibula of a boy of fifteen.

2. Death occurred from pulmonary metastases nine months after excision and cobalt teletherapy.

3. Only one similar case has been reported.

1. A case of symmetrical bilateral calcareous bursitis at the elbow is described.

2. Metabolic and neurotrophic factors played a role in its genesis.

3. Chemical analysis showed a similarity between the ratio of calcium phosphate and calcium carbonate in dystrophic calcification and in the fluid in the bursal cavity.

4. An inflammatory reaction was seen around the calcium appearing interstitially: this was probably not a consequence of chemical stimuli.

A case of intra-articular dislocation of the patella is reported. Its special interest lies in the apparent simplicity of both injury and reduction.

During flexion of the joint from the fully extended position the collateral ligaments soon become tight as they pass over the apex of angulation of the side margin of the head and remain tight as they move over more vertical plane of the side of the head.

From measurements on the dissected fingers, from measurements on radiographs and from tracings of photographs of the proximal phalanx it was not possible to draw any definite conclusions about the sagittal cam effect comparable to those relating to the metacarpo-phalangeal joint. A few specimens exhibited some degree of this cam but most did not. This may be related to functional variations of individual fingers and requires more detailed study.

If the joint is immobilised for some time in flexion with the collateral ligaments well below the apex of angulation, the slack volar part of the collateral aspects of the capsule with fibres running to the lateral and palmar tubercies of the middle phalanx and the dorsal fibres of the flexor sheath may become contracted. Shortening of the fibres of the lower part of the collateral portions of the capsule (A) and of the most dorsal fibres of the flexor sheath (B) was a constant finding. Curtis (1964) advocated excision of a portion of flexor sheath over the joint in dealing with flexion contracture.

Dissection of two fingers affected by extension contracture suggests that it takes a long time to produce shortening of the soft and pliable more dorsal part of the capsule.

It appears therefore that if immobilisation of the proximal interphalangeal joint cannot be avoided, it should be for as short a period as possible, with the collateral ligaments just riding over the apex of the side margin on the head when fibres A and B are only slightly slack. The results of immobilising the injured finger with the proximal interphalangeal joint flexed not more than 15 degrees might be compared with those after immobilisation with the joint more flexed. Splintage of the joint in extension was advised by Stewart (1962) on functional and clinical grounds. He noted the importance of flexion of the metacarpo-phalangeal joint and used the position of extension in all cases except those of: 1) gross damage leading inevitably to stiffness; and 2) division of flexor tendons or infection in the tendon sheath.

It is suggested that in correction of contracture of the proximal interphalangeal joint caused by Dupuytren's affection it may be advisable to excise fibres A and B.

1. The claw position of a finger with intrinsic paralysis is caused by the blocking effect of the transverse lamina on the long extensor. This starts as soon as the metacarpo-phalangeal joint is hyperextended, and increases with further hyperextension. Thus the long extensor loses its pull on the interphalangeal joints and allows them to flex. Therefore, in intrinsic paralysis the claw position can be prevented or cured by keeping the metacarpo-phalangeal joint in flexion, however slight, which can be done by splinting, by tenodesis or by capsulorrhaphy.

2. Replacement of the intrinsics by some active element, although it may improve the action of the fingers, is not necessary for the correction of claw finger. The function of the intrinsics in the prevention of claw finger is not to be found in their extending effect on the interphalangeal joints, but in the flexion effect on the metacarpo-phalangeal joint, or at least in preventing its hyperextension. This is in accordance with the fact that loss of intrinsic function is disastrous only in supple fingers, in which the metacarpo-phalangeal joints tend to assume extreme degrees of hyperextension (Riordan 1953, Brand 1958). In such fingers, the wide range of hyperextension available at the metacarpo-phalangeal joints is, of course, part of a generalised laxity of the soft parts of the fingers. These soft parts generally tend to counteract the tendency to clawing; the less their resistance, the more the human finger as a whole will tend to behave like a musculo-articular model, and such a model without intrinsics will always immediately assume the claw position.