1. From India a family is reported in which fifteen of fifty-seven were affected by the nail-patella syndrome.

2. Additional coincidental features not described previously were fiexion deformities of both hips and hyperextension of the interphalangeal joints of the fingers.

3. Patients affected by the condition do not always show the same blood group.

1. Fifty-eight major injuries in the region of the talus were reviewed regarding treatment, incidence of complications and long-term results.

2. The prognosis for simple fractures of the head, neck or body was good, as was that for dislocations of the midtarsal and peritalar joints.

3. The prognosis for fracture-dislocations of the neck and body was better than has been frequently reported. It was related to the degree of initial trauma. A good result occurs only if accurate reduction is effected and maintained. Fixation with a Kirschner wire is a useful method of maintaining the reduction after unstable fracture-dislocations.

4. Avascular necrosis occurred only in the more severe injuries and its incidence was related to the degree of initial displacement. The late results were better than have been previously described. The condition is best treated conservatively by protection from weight-bearing until revascularisation is well advanced.

5. A case with an unusual pattern of fracture of the neck of the talus is described following a plantar-flexion inversion injury.

Joint allotransplantation has a place in the treatment of joints destroyed by operation or disease. It is hoped that the results will improve with increasing knowledge of immunological mechanisms and with improvements in methods of internal fixation.

1. The use of metallic internal fixation in the primary treatment of 176 open skeletal injuries is discussed and the results presented.

2. The use of metal (stainless steel) in this type of injury is shown not to have any harmful effects. it can be used with safety and benefit in the primary treatment of open skeletal trauma, especially in the multiple and complicated injuries of war and motor vehicle accidents.

3. The place of antibiotics is discussed and adequate treatment of the soft-tissue wound is stressed.

1. One hundred patients with fractures of the upper end of the femur were investigated clinically and radiographically to ascertain the incidence and site of deep venous thrombosis during convalescence.

2. The technique of phlebography used has its own inherent dangers, but we believe that familiarity with the technique reduces the risk of complications.

3. The investigation revealed thrombi that were clinically unsuspected and indicates a need for further investigation of factors such as manipulation and retraction that may promote deep thrombosis.

4. The study has provided a control series for an investigation of the effect of prophylactic anticoagulants upon the incidence of deep venous thrombosis and pulmonary embolism after fractures about the hip.

1. ¹³³Xe clearance rates as a measure of blood flow were determined in the knees oftwo groups of patients.

2. In the first group eight patients with rheumatoid arthritis were studied before, three months after and one year after synovectomy. Blood flow values were significantly lower three months after operation but the values recorded one year after operation did not differ significantly from those before operation.

3. In the second group (twenty-one patients with rheumatoid arthritis) blood flow values were determined two to three years after synovectomy. The values obtained differed from those obtained in normal joints and fell within the range of values obtained in forty-three patients with rheumatoid arthritis who did not have synovectomy.

1. Acute osteomyelitis is defined.

2. An analysis of 113 cases is given.

3. An effective programme of treatment was evolved from experience over a period of nine years.

4. Recommendations regarding a programme of treatment are given.

1. A technique of closed instillation-suction for the treatment of chronic bone infection is described in which infected bone is first exposed and all necrotic material removed. Three perforated drainage tubes are inserted, and brought out through the skin some distance from the wound. The perforated parts of the tubes are laid close to the infected area and the wound closed in layers. Two of the tubes are connected to a drip bottle containing antibiotic solution, and the third to a continuous suction pump. Closed continuous instillation-suction is thus established, and has been maintained for up to six weeks.

2. The results in twelve cases are presented, two-thirds of which showed clinical resolution of the infection.

1. It is suggested that early weight-bearing on physiologically bowed legs in infants leads to slowing of growth of the tibia and consequent increase of the differential length between fibula and tibia.

2. Such differential growth can produce both varus and medial rotation, leading to established tibia vara or Blount's disease.

3. Stimulation of tibial growth by simple metaphysial forage can correct this deformity if performed at an early age.

A careful study of children with transient synovitis of the hip has failed to establish any connection with infection by staphylococci or streptococci, with allergy, with viral infection and with trauma.

1. Six cases of necrosis of articular cartilage complicating slipping of the upper femoral epiphysis are reviewed: histological examination in one case showed death of the superficial two-thirds of the articular cartilage, with survival of a layer of basal chondrocytes. In all six cases, after severe initial reduction of joint space as seen radiographically, there was gradual return of joint space, suggesting some regeneration of articular cartilage. The prognosis after cartilage necrosis is therefore not always so bad as has been supposed.

2. Various hypotheses concerning the cause of cartilage necrosis complicating slipped epiphysis are reviewed. The precise cause remains unknown, but there is substantial evidence against its being a consequence of ischaemia of the femoral head.

1. The usefulness of the halo method of traction in orthopaedic surgery, neurosurgery and plastic surgery is not widely appreciated.

2. Modifications of the apparatus are described and the technique of application is detailed.

3. Some advantages of the method are discussed.

Two cases of laterally open knee joints with surrounding skin defects are reported. The joints were closed by muscle flaps fashioned from the lateral belly of the gastrocnemius, which was detached distally and folded upwards and forwards to cover the defect. The transposed muscle and the remainder of the wound were covered by free skin grafts. Results were satisfactory.

1. A case of osteoid osteoma which recurred twice after block excision is reported.

2. It is postulated that recurrence is almost certainly caused by incomplete removal of the nidus, either by curettage or by incomplete block excision.

3. Why curettage is successful in most cases but not in others is obscure, but it may be that the arterial supply to the tumour is interrupted.

4. Block excision with adequate radiographic control to ensure its completeness is the treatment of choice.

1. Ten children with scoliosis and cerebral palsy of various types have been reviewed. All underwent operation for correction and stabilisation of the spinal curve, and spinal fusion.

2. Three of the ten patients required supplemental surgery in the form of regrafting, with or without reinsertion of Harrington rods. All have shown considerable correction of the curve, and in all cases the fusion appears to be consolidated. Operation has given these children stable spines which are compensated. Their ability to sit, and in some cases to stand, has improved.

3. In many such cases of scoliosis complicating cerebral palsy Harrington instrumentation and spinal fusion is the only feasible effective form of treatment.

1. Methods of correcting flexion contractures of the knee following poliomyelitis fail if posterior subluxation of the tibia is allowed to occur.

2. Careful serial manipulations will give straight, congruous joints in younger patients. Posterior capsulotomy does not facilitate correction.

3. Supracondylar femoral osteotomy is indicated in children over fifteen and in adults, although sometimes arthrodesis of the knee is necessary.

Two individuals with generalised articular hypermobility are described. There are many affected members in both kindreds, and the pedigrees indicate that the disorder is transmitted as an autosomal dominant trait. Orthopaedic complications and deformities are common in one family but absent in the other. It is suggested therefore that the two disorders are distinct and separate genetic entities.

The findings in a child with bilateral congenital dislocation of the hips who died shortly after birth are described. The only significant abnormality present was redundancy of the capsular ligaments and elongation of the ligament of the femoral head. The relationship between the orientation of the femoral neck and of the acetabulum was within normal limits. The significance of these findings in relation to etiology and management are discussed.

1. The intraosseous and extraosseous circulation of the talus was examined in thirty necropsy specimens.

2. The blood supply to the talus is quite diffuse and arises from the three major arteries of the lower leg.

3. The common patterns of circulation, as well as the variations, have been documented.