1. The results of posterior spinal fusion for paralytic scoliosis in 118 patients have been reviewed after growth had finished. The criteria for skeletal maturity were both clinical and radiological, with emphasis on ossification of the iliac apophyses.

2. The age of onset of anterior poliomyelitis and the age at which scoliosis was first noticed, as well as the extent of the muscle weakness and the curve patterns, all have a bearing on the severity of the deformity and the indication for operative treatment.

3. The method of treatment including operation is described and the complications detailed. The use of a tibial strut has now been abandoned and Harrington instrumentation has become routine.

4. There were five deaths in the series, three early and two late.

5. The difference in height, changes in respiratory function and eventual functional capacity have been analysed.

A method of repairing the defect in spondylolisthesis by internal fixation with screws and bone grafting is described. Sixteen patients have been operated upon with only one failure. In two cases the spine was re-explored for incidental complications and the defect was found to have fused solidly.

1. A small series of fourteen pollicisations has been studied.

2. The keyword, so far as the operation is concerned, has been simplicity.

3. It has been appreciated that a transposed finger can never become a thumb, and it may not be wise to strive too har1d by means of transplants to emulate the perfection of the normal thumb, especially if this is done at the expense of one of the fundamental priorities.

4. Nevertheless, if sensibility, good position and proximal stability are achieved, pollicisation can provide a useful addition to hand function and a reasonably satisfactory appearance.

1. An unusual case of haemangiomatosis in an adult is presented. The association of angiomatosis with massive osteolysis and With extensive soft-tissue destruction is discussed.

2. The extensive vascular involvement of skin, soft tissues and bone strengthens the idea that massive osteolysis results from vascular proliferation or angiomatosis.

Two cases of massive osteolysis of the lower extremities are reported. In one case a second lesion occurred in the opposite tibia and the process stopped after early total resection.

1. Thirty-nine displaced fractures of the lateral humeral condyle in children are reported. In one-third of the children the injury was accompanied by postero-lateral dislocation of the elbow. In some cases there was evidence that dislocation had occurred even when there was little persistent displacement of the condylar fragment.

2. All the fractures were treated by internal fixation with a specially designed screw. Thirtyfive children attended for review.

3. lt is concluded that all displaced fractures should be treated by internal fixation and that the method described is simple and reliable. Undisplaced fractures, or those with little displacement, may be treated conservatively when there is no evidence of associated dislocation of the elbow.

1. A case of cervical cord compression due to a congenital anomaly of the arch of the axis, treated successfully by decompressive laminectomy twenty-six years after the onset of symptoms, is described.

2. The significance of bony abnormalities of the cervical spine as a treatable cause of spastic tetraparesis is stressed.

1. In unreduced congenital dislocation of the hip in adults, causing severe symptoms, it seems that there is a place for a calculated abduction type of femoral osteotomy, which should "defunction" a painful false joint. Care should be taken to avoid excessive angulation, which may lead to painful symptoms from contact of the osteotomy apex to the area of the true acetabulum. Genu valgum and lateral rotation deformity are complications, as is failure of union at the osteotomy site.

2. A series of eleven hips in seven patients is reported, in which such an abduction type of osteotomy has been done. Six of these hips have been highly satisfactory. Three have required subsequent operations to correct deformity. Only one has ended up with arthrodesis. In three, results have been only fair. The use of a reversed nail-plate to secure internal fixation is described.

1. A regime of treatment for acute suppurative arthritis in childhood has been proposed. This consists of: urgent arthrotomy of the affected joint, if possible within five days; skin closure without drainage; antibiotics; and immobilisation of the joint for six weeks.

2. Fifty hips have been treated by this regime: all are clinically and radiologically normal The failure to achieve these results with other forms of treatment is due to delay in diagnosis, inadequate drainage together with lack of immobilisation of tile affected joint, and inadequate treatmellt with antibiotics.

3. Early diagnosis determines the ultimate prognosis. It is suggested that in doubtful cases exploratory arthrotomy is indicated. Eleven hips were found to Ilave some other cause for the signs and symptoms, but the children have suffered no ill effects from the arthrotomy.

4. Diagnostic aspiration is an unsatisfactory method, especially ill the case of tile hip, and should be avoided. Incision is preferable.

5. Acute suppurative arthritis of infancy is a serious condition. Diagnosis is difficult and is often delayed, so that the affected joint may be destroyed. In this small series of nine, seven affected joints were destroyed.

1. Eighty-two patients out of 114 with arthrogryposis seen at the Hospital for Sick Children, Toronto, during the period of 1950-65 have been studied, and the literature has been reviewed.

2. Arthrogryposis is considered to be caused by a failure of normal development.

3. Respiratory infection in the first five years is the major hazard to life. If these children survive the first five years, the expectation is that they will reach maturity and find a place in the community.

4. Children with upper limb involvement develop remarkably good function which can be improved by carefully planned operations.

5. Operation has a much larger place in the treatment of affected lower limbs.

6. Three out of four children with lower limb involvement can be enabled to walk if tile need for repeated operation is accepted.

7. Excision of the talus is a useful operation in the management of club foot ill arthrogryposis.

8. Early treatment is more effective than late ill controlling deformity and improving function.

1. We have reported our experience in fifty-two patients with arthrogryposis multiplex congenita.

2. The nature of the disorder, its possible cause, the clinical features and differential diagnosis are discussed.

3. Early management is described with special reference to the infant, his parents, and general principles of selection and timing. The treatment of the individual deformities which commonly occur is outlined.

4. We have emphasised that lower limb deformities should be treated vigorously in the first year, whereas in the upper limb treatment is better delayed until an accurate assessment can be made.

5. Correction in the young child should be by soft-tissue release rather than by osteotomy.

6. Prolonged splinting after operation is necessary.

7. Severe weakness may dominate the problem and make operation unrewarding.

8. The intelligence, determination and adaptability of these children flatters even modest surgical success.

1. A study of fifty femoral heads removed at operation for primary prosthetic replacement showed a remarkable constancy of the fracture line.

2. It is suggested that two sub-groups of this fracture-subcapital and transcervical-have been described as a result of radiological interpretation without consideration of the effects of varying degrees of rotation.

1. Two patients with bilateral pes cavus and lymphoedema are reported. Lymphography confirmed the existence of lymphatic insufficiency in both cases. In both there was evidence of hereditary factors in the etiology.

2. This familial syndrome appears not to have been previously reported.

A case of posterior fracture-dislocation of the shoulder is reported, and the method of closed reduction is described.

1. A radiological study of the acromio-humcral interval in sixty normal shoulders and in fifty-nine shoulders with known tears of the rotator cuff is reported.

2. The normal acromio-humeral interval was found to be seven to fourteen millimetres, a range that is consistent with previous observations.

3. Narrowing of this interval is a frequent concomitant of a tear of the rotator cuff.

4. An interval of five millimetres or less should be considered compatible with a tear of the rotator cuff until proven otherwise.

5. An explanation of the pathomechanics of the observation has been proposed.

A case of a ganglion arising from a distal lumbar articular facet joint associated with low back pain and sciatica is reported and the pertinent literature reviewed.

Two brothers with osteochondrosis of the phalangeal epiphyses in the hand (Thiemann's disease) are described and the condition discussed.

1. The principle of the vacuum splint is described.

2. A simple, cheap operating splint has been found useful to replace sandbags and other supports.

3. Applications to commonly practised orthopaedic operations are discussed.

1. The avascular zone in the tendon of the supraspinatus near its insertion was not seen in the other tendons comprising the rotator cuff, except for the superior portion of the insertion of the infraspinatus which, on occasions, showed a small avascular area. The biceps tendon, however, also showed an avascular zone as it coursed over the head of the humerus. It is suggested that the anatomical disposition of these tendons makes them subject to constant pressure from the head of the humerus, which tends to wring out the blood supply to these tendons when the arm is held in the resting position of adduction and neutral rotation.

2. Although this study did not produce any evidence that the relative avascularity of the tendons over a prolonged period could be indicted as the sole cause of the degenerative changes that so commonly occur, it was noted that the degenerative changes occurred first and that they were always most extensive in the areas of avascularity. It was also observed that the zones of relative avascularity preceded, and were not the result of, the degenerative changes.

3. With the onset of tendon degeneration, secondary vascular phenomena were observed. Firstly, there was a reaction that appeared to be a foreign body inflammatory response with the development of vascular tufts of granulation tissue. It was thought that these vascular changes were secondary to the breakdown in the tendons and were not the cause of the breakdown as previously suggested by Anderson and Moore. it was noted, moreover, that with the progression of degenerative changes in the supraspinatus tendon, the tendon became much attenuated and, as it did so, the zone of relative avascularity appeared to extend. This secondary shut-down of the vascular bed might well be caused by an increased tension in the tendon. In those tendons in which spontaneous rupture had occurred, it was noted that the major part of the tendon proximal to the rupture was avascular and showed evidence of much degenerative change. This study therefore suggests that in the operative repair of such lesions it is necessary to excise the degenerate avascular tendon in order to effect a sound repair. It is also suggested that detachment of the supraspinatus muscle from the supraspinous fossa in order to advance the whole muscle belly is the only technique possible to enable the surgeon to replace healthy tendon directly into bone, as suggested by Debeyre and his colleagues.

1. Serial slices of articular cartilage obtained at necropsy from apparently normal femoral condyles of individuals between the ages of twenty-six and sixty were examined chemically, by electron microscopy and for permeability.

2. The most superficial layer was shown by chemical analysis and electron microscopy to have the highest collagen content, which fell sharply with distance from the articular surface. On the other hand the glycosaminoglycan content was very low in the superficial layers but increased with depth. This variation was found in all specimens tested but the absolute levels of collagen and of glycosaminoglycans were widely different. There was no correlation of chemical composition with age.

3. Collagen fibrils in the superficial layer were of much smaller diameter than in the deeper zones.

4. Hydraulic permeability was shown to depend more on glycosaminoglycan than on collagen content, although it varied inversely with both these factors.

5. The results obtained demonstrate clearly the close relation between the physical properties of cartilage and its chemical composition.

1. The orientation of collagen fibres of the menisci of the knee has been demonstrated by polarised light microscopy.

2. As might be supposed from its fibre structure, the ultimate tensile strength of the meniscal tissue is dependent upon the axis of loading.

3. The tensile strength of the meniscus is similar to that of articular cartilage.

1. The epiphyses of the metatarsal heads of 250-gramme rabbits were separated at the zone of cell columns, stripped of perichondrium, labelled with tritiated thymidine and transplanted into the back muscles of the same animals.

2. Endochondral ossification started in the grafts at four days, was well established by seven days and progressed until fourteen days, the end of the study.

3. Progressive passage of the label down the zone of cell columns and into the hypertrophic zone was observed.

4. The tritiated-³H thymidine label had disappeared from the cartilage cells by ten days. No labelling was observed in the bone cells at any stage.

5. It was not possible to demonstrate from the experiment that growth plate chondrocytes are precursors of osteoblasts in the process of endochondral ossification in rabbits.