1. The clinical, histological and radiological findings in 129 cases of histiocytosis X have been reviewed and the natural history of the disease is discussed.

2. Certain clinical and histological factors emerge as having prognostic significance.

3. The treatment in thirty-four personally reviewed cases is discussed and some suggestions are made as to the treatment of particular types of case.

1. Twenty-eight patients with pyogenic infection of the spine are reported.

2. Diagnosis was by clinical, radiological and bacteriological means. Investigations of the spinal lesions by needle aspiration or open operation was needed in four patients.

3. Treatment consisted primarily of antibiotics and rest.

4. Twenty-five patients were fit and well after follow-up of one to fifteen years. Three deaths occurred, but only one was directly connected with the infection ; urinary infection with paraplegia and haemophilia were the cause in two others.

5. The relatively benign course is stressed, as are some of the diagnostic pitfalls in the early stages, particularly with thoracic lesions.

1. Thirty-seven cases of fracture of the dens have been studied.

2. The incidence of non-union was high: 64 per cent after apparently adequate closed treatment.

3. Possible causes of the high incidence of non-union have been studied : attention is drawn to the effect of displacement and to that of posterior displacement in particular.

4. Non-union of the dens with potential instability at the atlanto-axial joint is not acceptable in a patient who expects to lead a normal active life.

5. Atlanto-axial fusion is the method of choice in the treatment of instability ; once that has been secured, pseudarthrosis of the dens is no longer significant.

1. In a previous investigation, approximately 40 per cent of so-called "primary" degenerative disease or osteoarthritis of the hip appeared to have been the result of an abnormal joint mechanism caused by minimal epiphysiolysis in adolescence. Males were affected much more commonly than females. The residual abnormality of this disturbance, recognised radiologically, was termed the "tilt deformity" of the femoral head.

2. Three groups of young adult males, with different athletic backgrounds, have now been examined to assess the incidence of this abnormality and its relationship to athletic regimes. The condition was found to be more common in subjects who had been engaged in more active regimes and was also related statistically to a history of "growing pains". The deformity is compared with the gross disturbance of adolescent epiphysiolysis or slipped epiphysis, which is believed basically to be caused by chronic stress.

3. Degenerative disease of the hip of this type has a geographical and racial distribution corresponding to the degree of interest in and encouragement of competitive athletic activities. Many cases are therefore postulated to be the direct result of a minor and usually asymptomatic disturbance of this type, attributable to excess activity during adolescence.

1. A method of internal fixation for the supracondylar fracture of the femur in the elderly patient is presented.

2. The fixation obtained allows the unsupported use of the limb and early partial weightbearing. Convalescence is thereby considerably shortened.

3. The disappointing results of internal fixation previously reported can be largely related to poor methods of fixation.

1. A review of ten cases of T-shaped intercondylar fractures of the humerus treated with a sling and early movement is presented.

2. The method and the results are discussed and some comparison is made with other series.

3. This method of treatment has certain advantages and the results are reasonable in comparison with those of other methods.

1. Thirty-four cases of displaced fracture of the neck of the radius in children are reviewed with special reference to elbow and forearm function.

2. There were eight poor functional results-four after eighteen closed reductions and four after sixteen open reductions.

3. The causes of the poor functional results are recorded and the complications discussed. Union in a displaced position was the main cause of restricted movement. Deformity of the radial head due to avascular necrosis, and fibrous adhesions between the neck of the radius and the ulna, were other factors.

4. Fractures that were held reduced by Kirschner wires had better results than comparable fractures treated by closed reduction or op en reduction without fixation.

5. It is concluded that all fractures, whatever the age of the child, with angular displacement exceeding 15 degrees need accurate reduction. Closed reduction is not easy, and repeated check radiographs are needed to ensure maintenance of reduction. Certain of these fractures are unstable and require internal fixation with Kirschner wires.

1. One hundred patients with osteochondritis dissecans of the knee have been reviewed. Sixty-eight were male. Unilateral lesions were found in seventy-four. The average age at onset of symptoms was eighteen years.

2. The outstanding etiological feature was found to be direct injury to the joint surface (46 percent), repeated injuries sustained in first class athletics and field sports, and mechanical abnormalities of the knee.

3. Osteochondral fracture was found in seven cases.

4. The results of various types of treatment are described and a plan of management outlined.

1. In sixty mature rabbits osteochondral fractures of various types were made in the medial femoral condyle.

2. The fractures or fragments which remained stable united but those in which movement occurred progressed to non-union.

3. An ununited osteochondral fragment resembled osteochondritis dissecans in the human both radiologically and histologically.

4. Experiments in the cadaveric knee show that the patella articulates with the classical site on the intercondylar aspect of the medial femoral condyle in full flexion of the joint and here an osteochondral fracture could be sustained.

5. It is concluded that the fragment in osteochondritis dissecans follows an osteochondral fracture which remains ununited.

1. The pathological anatomy in a case of convex pes valgus in a patient with myelomeningocele is described.

2. A neuromuscular imbalance between the tibialis posterior and the evertors of the foot is suggested as the underlying cause of this type of foot deformity.

1. A conservative approach to the varus deformity of anaesthetic feet in infants with myelomeningocele is advocated. Thirty-three of thirty-five varus feet treated by this method, supplemented when necessary by a minor operation to correct equinus, responded satisfactorily in this prospective study of twenty-four infants treated from birth.

2. A rotation flap incision has proved of considerable advantage in the rare instances when an extensive medial release is required.

1. The indications for talectomy in the treatment of equinovarus deformity in arthrogryposis multiplex congenita and spina bifida are discussed.

2. The technique of the operation is described, with variations which may be necessary in special circumstances.

3. The results of forty-one operations are analysed.

4. It is concluded that the operation has a useful place in the management of equinovarus deformity in arthrogryposis multiplex congenita and spina bifida, especially between the ages of one and five years.

1. Twenty cases of tarso-metatarsal joint injury have been studied with regard to the mechanism of injury, and experiments have been done on cadavers to confirm clinical impressions.

2. Injuries of the tarso-metatarsal joints occur by direct and indirect mechanisms, the latter being more common.

3. Indirect injuries occur in at least two ways-namely, acute abduction of the forefoot and plantar-flexion of the forefoot.

4. Most of the indirect injuries occur when the ankle joint is in a plantar-flexed position.

5. Whereas this foot injury once gained prominence on the field of battle amongst cavalrymen, it is currently associated with the motor car, the step ladder, the toboggan, the joy-rider, and commonly the simple misguided step.

1. Eight patients are described in whom the patellae subluxated laterally on every extension of the knee. This is an unusual type of recurrent subluxation. It may recover completely, or remain symptom-free for many years, or increase in severity so that the patient seeks treatment for relief of pain and joint effusion, or progress to frank dislocation.

2. Each patient was examined and the probable causes were analysed. The bayonet deformity was present in twelve of the sixteen knees. A new observation is made on the relationship of tibial crest and tubercle in this condition.

1. Destructive changes in a knee joint, eventually requiring arthrodesis, are reported in a patient who had undergone renal transplantation.

2. The underlying pathology was avascular necrosis with separation of large osteochondral fragments.

3. The pathogenesis is discussed.

1. A family is reported in which tibial aplasia with polydactyly of hands and feet and absent thumbs occurred in a father and daughter.

2. The evidence suggests the existence of an autosomal dominant mutant gene that causes absent thumbs and manual polydactyly, with or without varying degrees of tibial hypoplasia and pedal polydactyly.

1. Three cases of paralysis of the radial nerve after intensive muscular effort in extension of the elbow are described. Clinical and electrophysiological evidence is recorded.

2. There was motor and sensory affection of varying degree and extent in the distribution of the radial nerve.

3. The type of lesion in each case was that of neurapraxia, and rapid spontaneous recovery occurred in each case.

4. The level of the lesion was in the arm, below the origin of the branches to the triceps.

5. The cause of the lesion was thought to be compression by a fibrous arch related to the lateral head of the triceps.

6. The cases are discussed in relation to other instances of compression of nerves by fibrous arches, and an explanation is advanced for spontaneous recovery.

1. Eight patients with rheumatoid arthritis had an intra-articular nodule in one or both knees causing mechanical symptoms.

2. The nodule was on the lateral side of the knee and interfered with walking. It caused a click and painful instability of the knee at about 15 degrees of flexion.

3. Surgical excision of the nodule, which was attached to the synovial membrane, abolished the symptoms.

1. A case of bilateral spontaneous and simultaneous rupture of the quadriceps tendons is described.

2. The underlying cause was found to be gouty affection of the tendons.

3. So far as is known, a similar case has not previously been recorded.

1. The hyaluronate of synovial fluid is an acidic linear polymer which can effectively resist the diffusion of other macromolecules into its domain. Gelatin was used as an experimental model for hyaluronate, to investigate its effect upon the diffusion of protein-polysaccharides from cartilage slices.

2. The concentration of protein-polysaccilaride in the extracting medium was quantitated by uronic acid estimation and liquid scintillation spectrometry of ³⁵sulphate-labelled proteinpolysaccharide.

3. Concentrations of gelatin in excess of 20 per cent (W/v) significantly retarded diffusion of protein-polysaccharides out of cartilage slices, but evidently not the movement of these molecules within cartilage.

4. It is suggested that disaggregation of both the protein-polysaecharide molecules of cartilage and the hyaluronate of synovial fluid contribute to cartilage breakdown.

1. The processes of repair and union were studied in six fractures of the lower end of the radius, ranging in age from ten days to five and a half months.

2. The major pathway to union is medullary, through the proliferation around the fracture of vascular granulation tissue with osteogenic power. This invades and then bridges the fracture and is followed by the laying down of trabeculae of new bone.

3. Success depends on the growth of new capillaries across the fracture line, some of which mature and re-establish the meduilary circulation.

4. Indriving of the lateral cortex of the proximal fragment into the distal spongy medulla at the time of injury (in Colles's fractures) permits bridging between proximal periosteal and distal meduliary callus. Otherwise periosteal proliferation plays only a subsidiary role in union.

5. Fissure fractures of the lower articular surface were frequent and they also healed by the invasion of granulation tissue proliferating in the medulla nearby.

1. The effects of frozen irradiated homogenous bone grafts on the healing of circumscribed defects in the mandibles and femora of forty albino rats have been studied.

2. The grafts were well tolerated by the host animals and did not appear in any way either to stimulate or to inhibit osteogenesis. The rate of healing of the defects containing the homografts compared favourably with that of the control defects.

1. The utilisation of labelled proline in normal and injured mature rabbit articular cartilage has been studied and compared simultaneously in one phase of the study with radiosulphate utilisation. The morphologic features of lacerative injury paralleled those reported previously.

2. Labelled proline is actively utilised by mature articular cartilage and can be recovered in time from the matrix as labelled hydroxyproline. This is taken as evidence of collagen synthesis.

3. Evidence is presented to suggest that the rate of formation of labelled hydroxyproline may be augmented after lacerative trauma.

4. Parallel utilisation of radiosulphate and labelled proline suggests that the synthesis of chondromucoprotein and collagen are closely related and that the continual synthesis of both moieties is necessary for the maintenance of normal matrix.

5. Despite evidence of increased chondromucoprotein and collagen synthesis no significant contribution is made to the healing of lacerative defects in mature rabbit articular cartilage.