1. A clinical, radiological and pathological study of sixty-nine cases of epiphysial chondroblastoma has been made.

2. The nature of the tumour is discussed and its clinical and radiographic features are described. A special type is described, for which the name "cystic chondroblastoma" is suggested.

3. The results of treatment are described and the generally benign behaviourof the lesion is noted.

4. The occurrence of malignant change is noted and discussed.

1. A review of nineteen cases of malignant spinal tumour treated surgically is presented.

2. Four cases are presented in detail.

3. The results in terms of survival are not assessed, because the effect of operation on survival cannot be estimated in a small series without controls. However, if the patient does survive for a considerable time, the value of operation can be assessed in terms of its contribution to the quality of survival, in relieving pain or improving or protecting neurological function.

4. The limitations of laminectomy are compared with the possible advantages of anterior approaches.

1. Forty patients with solitary eosinophilic granuloma of bone from the Hospital for Sick Children, Toronto, have been reviewed. They had clinical and laboratory findings similar to those reported by others except for the erythrocyte sedimentation rate, which was raised in nearly half the patients tested.

2. Radiographs in all cases showed the lesion to be osteolytic. In the skull and cervical spine there was no bony reaction ; in the thoracic and lumbar spine the typical picture of Calvés disease was produced; in long bones the cortex commonly showed endosteal erosion and periosteal reaction.

3. In one patient the lesion progressed so rapidly that the body of a cervical vertebra was destroyed within ten days.

4. The differential diagnosis includes sarcoma. Biopsy is essential.

5. All the patients improved regardless of the treatment they received. Complications were due either to the site of the lesion or to its treatment.

6. Expansion of the lesion after biopsy indicates a more widespread manifestation of histiocytosis X.

1. Nineteen patients with classical rheumatoid arthritis complicated by severe subluxation of the cervical spine are reported.

2. Thirteen patients had atlanto-axial subluxation. This was the only level ofinvolvement in ten.

3. The next most frequent level to be involved was C.4-5. This occurred in five patients.

4. Eleven patients required surgery for symptoms or signs of spinal cord compression or vertebral artery insufficiency.

5. Operations included six posterior fusions, three anterior fusions and two laminectomies.

6. The differential diagnosis, the radiological findings, the indications for surgery and the results of treatment are discussed.

1. Sixty-three fractures of the femur occurring in forty-eight patients with Paget's disease are presented.

2. In patients with Paget's disease the femur is the bone most often fractured, although the risk of fracture is probably not much greater than that of the normal population.

3. Many femoral fractures in Paget's disease are spontaneous and are preceded by pain. Extension of a stress fracture is the most likely cause.

4. All eleven femoral neck fractures in this series failed to unite; it is suggested that neither operation nor prolonged conservative treatment is indicated.

5. Subtrochanteric fractures, if severely displaced, are best treated by intramedullary nailing.

6. Most shaft fractures may be satisfactorily treated by conservative means. Deformity of the shaft can be corrected in fractures treated by external splintage.

7. The time required for union has been neither unduly short nor unduly prolonged.

8. The long-term results in this series have been acceptable. Sarcomatous change as a complication of fracture was not observed.

1. Seventy-six patients with fracture of the upper end of the femur were examined phlebographically for evidence of thrombosis. The patients were randomly divided into two groups : one was given phenindione post-operatively ; the other acted as a control.

2. Analysis of the select series showed that the incidence of venous thrombosis in the anticoagulation group (19 per cent) was significantly less than that in the control group (48 per cent).

3. However, analysis of the complete series failed to show that the incidence of venous thrombosis in the anticoagulation group was significantly less than in the control group.

4. The number of bleeding complications in the anticoagulation group (47 per cent) exceeded those in the control group (16 per cent). The only life-endangering haemorrhage occurred in a patient who had not received an anticoagulant for five months.

5. We were unable to show that the fracture significantly influenced the site or the incidence of venous thrombosis.

6. No correlation was found between the clinical and phlebographic diagnosis of venous thrombosis.

7. It is concluded that the early use of a prophylactic anticoagulant is an effective means of reducing the incidence of venous thrombosis in patients with a fracture about the hip.

1. Four cases of periosteal ganglion are described. Their relationship to other mucin-filled cysts of connective tissue, both in soft tissues and in bone, is discussed and the fact that they all result from mucoid degeneration of fibrous tissue is emphasised.

2. Treatment is by surgical excision, with removal of a margin of apparently normal periosteum as well as the lesion itself. The lesion may recur, even after apparently adequate excision, by mucoid degeneration taking place in the periosteum immediately adjacent to the operative site or in the connective tissues occupying the surgical defect.

1. Four cases of myositis ossificans circumscripta are presented.

2. It remains an obscure condition but there are characteristic clinical, radiological and microscopical features.

3. While the majority of cases arise as a direct result of injury, these four cases suggest that this is not always so ; the diagnosis from osteosarcoma, bone or joint infection may then be difficult.

4. Noble's classification (1924) of myositis ossificans is adequate and should be accepted. Confusion would be avoided if cases such as those presented here were included in the classification suggested.

1. The treatment of twenty-nine consecutive patients suffering from chronic osteomyelitis is reviewed. With the advent of an antibiotic, Fucidin, which has the ability to penetrate in significant amounts into tissues carrying a poor blood supply, a more limited surgical procedure has become possible.

2. A successful outcome, as judged by primary healing, was achieved in 86 per cent of patients treated with a combination of surgery and Fucidin with penicillin. This compares favourably with the results achieved in a previous series in which more radical surgery was undertaken.

3. Although Fucidin has advanced the treatment of chronic osteomyelitis, it is still essential to use surgery as well.

4. Fucidin caused no toxic effects despite an average total dose of seventy to eighty grammes. Resistance of the staphylococcus developed in vitro in one patient, without affecting a satisfactory clinical outcome.

1. The appearance of arthrographs of healthy and of injured ankles are described on the basis of experimental and clinical studies.

2. Arthrographic appearances have been correlated with findings at operation.

3. Arthrography is a valuable method of investigation for the accurate diagnosis of injuries about the ankle.

1. Complete rupture of the axillary artery caused by dislocation of the shoulder in a man aged seventy-four is reported. There was severe arteriosclerosis and the simple operation of ligation of the artery was performed with success. There was excellent function of the shoulder and hand on review thirteen years later.

2. Previously recorded cases are reviewed.

1. Three cases of the Laurence-Moon-Biedl-Bardet syndrome occurring in a Yemenite family are presented. The parents were first cousins.

2. In two of the patients the complete syndrome, which comprises retinitis pigmentosa, polydactyly, obesity, genital hypoplasia and mental retardation, was found. The patients also had abnormalities of the hips.

1. A case of massive tarsal synostosis with supination of the forefeet, synostosis in the carpus with brachydactylia, clinicocamptodactylia, symphalangism and dysplasia of the elbows is presented.

2. This conforms to the description by Nievergelt (1944) and Pearlman et al. (1964).

An unusual case of median nerve compression within the carpal tunnel ascribed to thrombosis in a dilated artery is described.

1. A case of ossification and partial rupture of the tendo calcaneus is reported.

2. The possible etiology of the ossification and its relationship to the rupture is discussed.

1. Two cases of swelling in the popliteal fossa due to a local hypertrophy of the semimembranosus muscle are described and two further cases thought to be of similar nature are noted.

2. The swelling was soft, not tender, fairly well circumscribed, and without signs of inflammation. Its most characteristic feature was an increase in size and hardening of the swelling during active flexion of the knee.

3. This condition should be considered in differential diagnosis of swellings of the popliteal fossa.

1. A general picture of the histological state of the bone-cement junction, up to seven years after implantation, is presented as a result of the study of twenty-three human specimens.

2. The transmission of load from cement to bone occurs at isolated points through the medium of newly formed fibrocartilage.

3. It is clear that this fibrocartilage has been produced in response to mechanical pressure on fibrous tissue which has undergone compression between cement and underlying bone.

4. Direct contact exists between the surface of the cement and the newly formed fibrocartilage at these sites of load transmission.

5. Load-bearing fibrocartilage frequently shows areas of ossification extending into it from the underlying bone.

6. Where soft tissues in contact with cement are too thick or too delicate for load transmission a thin layer of giant-cell cytoplasm coats the cement surface.

7. No collections of giant cells to form granulomatous or caseating areas have been seen.

8. Fat storage, indicating the absence of chemical irritation, can occur within ten microns of the cement surface.

1. Forty-seven tibial nerves of rabbits were stretched, twenty-four gradually by the Instron machine and twenty-three suddenly by dropping a load. The stretched nerves were examined histologically throughout their length.

2. Nerve trunks possess a high degree of elasticity, which is mainly a feature of the epineurium.

3. The initial elongation of the nerve is due to extension of the epineurium and straightening of the funiculi and of the nerve fibres. Such elongation is "physiological" in the sense that it does not affect the nerve fibres.

4. The first structure to be ruptured during stretching is the epineurium ; this occurs when the nerve trunk has reached its limit of elasticity.

5. Before rupture of the epineurium the damage to the nerve fibres is either neurapraxia or axonotmesis, because the endoneurial sheaths and Schwann tubes remain intact.

6. Beyond the limit of elasticity very severe damage of the nerve trunk occurs; all elements of the nerve may be ruptured. If less violent force is applied, some funiculi may survive. The longitudinal extent of the lesion is always great, reaching 2 to 5 centimetres in the rabbit.

1. Fluorotic bones and exostoses obtained from the skeletons of two subjects with advanced fluorosis have been examined microscopically.

2. The cortical bone showed normal, regular Haversian systems with normal canaliculi and lacunae. The exostoses also exhibited normal, regular Haversian systems but at places the reabsorption tunnels were large.

3. Special stains failed to show osteoid tissue either in the fluorotic bones or in their exostoses.

1. The uptake of S³⁵ labelled sodium sulphate has been studied autoradiographically in the intervertebral disc of the young rabbit.

2. The sojourn of the isotope in the tissues includes an intracellular phase of approximately twenty-four hours, followed by an extracellular phase.

3. The cells exhibiting by far the greatest affinity for the sulphate ion are the peripheral groups of cells of the nucleus pulposus, while the chondrocyte-like cells of the cartilaginous segment of the annulus fibrosus are also fairly active. The central cells of the nucleus and the fibroblasts of the outer one-third of the annulus have a much lower uptake.

4. By analogy with similar studies on hyaline cartilage, and on the basis of correlation between the alcinophilia of the tissues and the concentration of the label, both before and after hyalase digestion of the tissue, it is considered that in the young rabbit disc, as in articular cartilage, the sulphate is incorporated primarily into chondroitin sulphate.

5. The elimination of the isotope from the nucleus at twenty-four days and the persistence of the label in the annulus fibrosus at thirty-two days tends to suggest that the metabolic turnover of acid mucopolysaccharide is considerably slower in the annulus than in the nucleus.