1. Four cases of vascular injury during lumbar disc removal are reported, and the literature is reviewed. One of the cases is unique in that the inferior mesenteric artery was transected.

2. Clinical syndromes associated with various vascular injuries are discussed.

3. The possibility ofvascular injury should always be kept in mind during lumbar lam inectomy for disc prolapse. Unexplained hypotension is strongly suggestive of a vascular catastrophe. The advent of high output cardiac failure in the patient who has recently undergone lumbar disc removal is almost diagnostic of traumatic arteriovenous fistula.

1. Fifty cases of fibrosarcoma from the records of the Bristol Bone Tumour Registry are reviewed. They present further clinical and radiological evidence supporting the concept of fibrosarcoma as a distinctive type of bone tumour.

2. The radiographic appearances have often been those ofan osteolytic lesion totally enclosed by reactive subperiosteal new bone.

3. Included in the group are eleven cases with Paget's osteitis deformans, three cases in which the sarcoma was associated with calcified cartilage and one case that is regarded as a post-irradiation sarcoma.

4. Several clinically differing modes of presentation are described.

5. Fibrosarcoma in bone has often been said to be "central" or "medullary" but because the present series includes tumours with eccentric origin and unilateral cortical destruction this description is inappropriate.

6. The histological differentiation from other fibroblastic lesions is briefly discussed.

7. The five-year and ten-year survival rates were respectively 28 per cent and 1 2 per cent, with an average survival oftwenty-four months in the thirty-six patients who died. Among the long survivors were two patients with Paget's disease.

1. A review of fifty-eight posterior dislocations or fracture-dislocations of the hip is presented.

2. With few exceptions, patients were treated by immediate reduction of the dislocation under general anaesthesia, traction for six weeks and avoidance of weight-bearing for a further six weeks.

3. The results are discussed with reference to the age of the patient, length of follow-up, side affected and type of dislocation.

4. As a result ofthis review, we propose to reduce the period oftreatment in Type I dislocations (posterior dislocation without fracture) and to continue a conservative policy in respect to treatment and reconstructive hip surgery in Types II and HI fracture-dislocations.

1. A study is presented of 286 extra-articular subtalar arthrodeses done during the years 1958 to 1965 on 258 patients with pes calcaneo-valgus, pes planovalgus, pes varus or flail foot.

2. Certain changes in the surgical technique originally presented by Grice have been made. We have applied the arthrodesis not only to valgus feet but also to varus feet, and we have described the details of the surgical technique as used on the varus foot.

3. In none of our cases was there failure of fusion or reabsorption of the graft. The unsatisfactory results (239 per cent) were caused by residual varus or valgus deformity of the foot.

1. A method of arthrodesis of the ankle is described which combines the compression principle of Charnley with the medial approach to the joint described by Pridie.

2. Fusion occurred promptly in seventeen out of nineteen cases. In one case fusion was delayed, and in one case there was failure of fusion.

1. Talipes equinovarus is a specific type of club foot which has a genetic basis. Its occurrence along with certain neurological disorders has been noted.

2. An investigation of its incidence in 1,447 mental defectives, excluding those with cerebral palsy, revealed an incidence of 228 per 1,000, which is about ten times that for the general population.

3. There may be an upset early in embryonic development to account for the co-existence of both mental deficiency and talipes equinovarus.

1. A series of 102 cancellous strip grafts for delayed union of long bone fractures has been reviewed.

2. Half of the initial injuries were open.

3. Half of the fractures were butterfly or segmental lesions or were comminuted.

4. After strip grafting 84 per cent of the fractures were united within sixteen weeks, and only four took longer than twenty weeks.

5. Complete failure of union occurred in only one case, a tibial fracture complicated by low-grade pyocyaneus osteomyelitis.

6. A more aggressive attitude to the problem of delayed union is advocated.

1. Stainless steel mould arthroplasty of the knee is described and a ten-year follow-up study of sixty-two operations is reported. Fifty-four were for rheumatoid arthritis and eight for osteoarthritis.

2. Forty-nine of the sixty-two joints retained mobility, six had become ankylosed and five were later arthrodesed ; two limbs were amputated. The forty-nine mobile knees included twenty-seven which were painless at all times, and fourteen in which only an occasional twinge was felt.

3. The range of movement was increased in twenty-two joints as compared with the state before operation, diminished in twelve and unaltered in five. In ten knees measurements before operation were not available.

4. Flexion deformity, swelling, stability and function were improved in a significant number of joints.

5. Patients suffering from active rheumatoid arthritis often found that the joint operated upon no longer took part in generalised flares of the disease.

1. If osteoarthritis of the knee is confined mainly to one tibio-femoral compartment and the range of flexion is 90 degrees or more it can be treated safely and reliably by proximal tibial osteotomy.

2. The operation relieves pain in a large proportion of cases while retaining a useful range of knee flexion.

We are grateful to Miss H. M. Briggs, Research Secretary at Harlow Wood Orthopaedic Hospital, for secretarial assistance.

1. High tibial osteotomy-above the tibial tubercle-gives good results in elderly patients disabled by arthritis of the knee.

2. A technique of operation is described in which fixation is secured by four pins gripped in compression clamps.

3. No other fixation is needed, and knee movements and walking are encouraged within a few days of operation.

4. The early results warrant further trial of the method.

1. The danger of fracture and subsequent pseudarthrosis in congenital anterior bowing of the tibia is emphasised. The fate of seven such patients is described.

2. With the object of preventing fracture, early and urgent bone grafting is advocated.

1. Congenital coxa vara and infantile coxa vara must be separated as distinct entities.

2. Infantile coxa vara is likely to be due to distal movement of the head fragment relative to the shaft and neck. This can result either from severe trauma in normal bone or from shearing stress on an abnormal femoral neck.

3. There is no justification for considering infantile coxa vara as congenital, developmental or due to interruption of ossification. The nature of the pathological lesion at the epiphysial line in some children is unknown.

1. The background to the work of Australian medical teams in South Vietnam is described.

2. The types of limb wounds seen among the Vietnamese civilian population are classified and described, and the methods of treatment used are reported.

1. Five cases of avulsion fracture of the calcaneus are reported.

2. The "beak" fracture of the calcaneus is thought to be a variant of the avulsion fracture and not a separate entity.

3. The variable attachment of the calcaneal tendon to the calcaneus is described, and its relationship to the different forms of avulsion fractures discussed.

4. Operative reduction and fixation are appropriate for young and active patients in order to restore full heel-cord function.

5. Attention is drawn to the risk of pressure necrosis of skin overlying a displaced fragment. Early operative correction may be required to prevent skin damage.

1. A case of ischaemic necrosis of the peroneal muscles (peroneal compartment syndrome) is described. Recovery or regeneration of a seemingly necrotic peroneus brevis was noted.

2. The similarity between peroneal compartment syndrome and the anterior tibial syndrome is noted.

3. Treatment by early fasciotomy is advised.

A long-term follow-up of a patient with melorheostosis and arteriovenous aneurysms confined to the left side of the body is reported. The patient was earlier investigated and shown at the Royal Society of Medicine by Murray in 1951.

1. An unexplained case of extensive subperiosteal haematoma of the tibia is reported.

2. The radiological and biochemical findings are described.

A case of paraplegia presumed on clinical grounds to be due to bilharziasis is reported. The patient was treated with antibilharzial drugs and steroids. She has been followed up for eight years and has recovered almost completely.

The literature is reviewed, and the incidence and types of spinal lesion, the possible routes of infection and the diagnosis and treatment are discussed.

1. The source of nutrition of articular cartilage still remains a subject of controversy.

2. Experiments are described in which an attempt to demonstrate the direct transfer of fluid from the subchondral bone has been made using 355 and an autoradiographic technique. These experiments were based on ones originally performed by Ekholm (1951), except that two distinct groups of animals were used : immature rabbits and adult rabbits whose skeletons were mature.

3. The transfer of fluid to the cartilage could be demonstrated only in the immature rabbits.

4. It is suggested that some of the conflicting opinions which have been advanced on this subject stem from a failure to distinguish between mature and immature joint cartilage. Subchondral nutrition is a feature only of the immature animal.

1. Experimental fracture callus in rats contains mast cells as a normal morphological element.

2. The mast cell count undergoes peculiar variations in the normal course of events in experimentally delayed or accelerated bone repair.

3. A hypothesis is presented in which the tissue mast cell granules are regarded as calcium transporters in the mineral phase of callus formation, a process probably corresponding to Selye's concept of "mastocalciphylaxis" and "mastocalcergy."

1. Evidence is given of successful direct implantation of a motor branch of the ulnar nerve to the denervated flexor carpi radialis muscle in the dog with the formation of new motor end-plates.

2. A method is described of measuring four muscle parameters-volume, myoneural delay, rate of contraction and greatest developed tension-which allows a quantitative comparison of the muscle in its original state with that after it has been changed experimentally.

3. By use of this method it was found that the direct implantation of a new motor nerve restored the denervated muscle volume in twenty weeks and that at least 50 per cent of its original strength was recovered.

4. The success of motor nerve transplantation is likely to be influenced by the length of time lapsing between denervation and implantation, by the number of functioning motor fibres in the transplanted nerve, and by the amount of recovery achieved in the afferent and spindle efferent systems.

1. An investigation was made of the tolerance of the cells in the femoral head in rabbits for ischaemia brought about by transecting the ligament of the femoral head and applying a ligature around the femoral neck. The animals were killed two, six, twelve, twenty-four and seventy-two hours after operation.

2. In the cells of the bone marrow and in the osteoblasts distinct histological signs of disintegration were present six hours after operation. Pyknosis of the osteocyte nuclei was found after twenty-four hours' ischaemia; sometimes vacuolar clarifications could be observed in these pyknotic nuclei. After three days of ischaemia the staining affinity for Feulgen and haematoxylin of a number of osteocyte nuclei had visibly decreased.

3. The Feulgen-DNA content of the osteocyte nuclei-as measured in individual nuclei by means of an integrated microdensitometer-was significantly reduced as compared with similar nuclei from the control side as early as after six hours of ischaemia. This DNA loss was progressive with the period of ischaemia. From these facts, the conclusion was reached that in the femoral head of the rabbit the period of reversible damage for osteocytes must have ended within six hours.