1. Forty-six cases of congenital spondylolisthesis (Newman's Group 1) have been studied. The diagnostic criteria were lumbo-sacral subluxation, deficient development of sacral neural arches and superior facets, and attenuation and elongation of the pars interarticularis, with or without a defect in continuity.

2. Intertransverse lumbo-sacral fusion is a safe and reliable method of treatment.

3. Stabilisation is not complete before two years.

4. Spinal fusion is indicated in all patients with significant symptoms during the period of growth, but in adult patients only if conservative treatment fails.

1. In 120 of 740 European patients found to be suffering from spinal tuberculosis the disease was complicated by paraplegia. These 120 patients have been studied.

2. The patients could be divided into two groups: those receiving chemotherapy and those not receiving specific drugs. Chemotherapy improves the patient's general condition and makes operation safer, but does not have any significant effect in preventing paraplegia or in promoting recovery from it.

3. Only twenty-four of the fifty patients treated by closed method made full recovery.

4. The recovery rate after decompression was only 60 per cent. The reasons for this relatively low rate are discussed and the advantages of the postero-lateral approach to the cord, combined with focal operation on the lesion, are stressed.

5. Experience has shown that a policy of early and adequate focal operation can eliminate the risk of this serious complication of spinal tuberculosis.

6. The behaviour of spinal tuberculosis in the European is contrasted with that in the African and Asian.

1. The results of wide laminectomy of the fifth lumbar vertebra and disc excision in 132 patients are reviewed and compared with some published results of the interlaminar operation.

2. There was no significant difference in either the immediate or the long-term results of the two operations suggesting that post-operative morbidity was not related to operative technique.

3. The incidence of post-operative back pain was found to increase with age at operation, duration of pre-operative symptoms and length of follow-up, and supported the impression that backache is predominantly a feature of the underlying degenerative process rather than the incidental operation.

4. The significance of recurrent disc lesions is discussed. Recurrence usually occurred at the previously cleared disc space and was thought to indicate incomplete degeneration of the disc at the time of the original operation.

5. The place of fusion combined with disc excision is discussed. No reliable indications for coincident fusion were found in this series.

6. The value of radiography is discussed. Plain radiographs were essential before operation to exclude other causes of backache and sciatica; otherwise they were of little value. Motion radiographs were no more helpful and myelography was used only when the level of the lesion was in doubt.

7. The risk of an acute cauda equina lesion following manipulation of a prolapsed lumbar disc is noted and the danger of manipulation, unless facilities for emergency surgery are available, is stressed.

1. Anterior transperitoneal lumbar fusion is a successful method of stabilising painful mechanical derangements which have not responded to the usual conservative measures.

2. The operation in this series was done mainly for backache; it should not be contemplated if there is definite evidence of nerve root compression, because sequestrated disc material cannot be removed from the spinal canal from the anterior route.

3. Careful technique has resulted in few complications attributable to the operation.

4. This method is sometimes thought to be inapplicable in cases of spondylolisthesis with a displacement of more than one-third. However, in this series we have seen the block type of graft used with a good measure of clinical and radiological success.

5. There is no doubt that for those patients who have had previous unsuccessful laminectomies or posterior fusions anterior interbody fusion offers an excellent prospect of recovery.

1. Intertransverse fusion in the lumbar spine appears to have many advantages over previously described techniques.

2. The disadvantage of profuse bleeding can be overcome by the use of a Hastings frame and by an operative technique designed to demonstrate constant muscular and articular branches of the lumbar arteries.

3. Coagulation of these vessels by cautery and avoidance of dissection anterior to the plane of the transverse processes ensure that the operative procedure can be carried out with a blood loss averaging less than 500 millilitres.

1. Perthes' disease is an ischaemic lesion of the ossific nucleus of the head of the femur which may vary both in extent and degree. It is probably never quite complete.

2. When part of the ossific nucleus only is affected, as is usually the case, it is almost invariably the antero-lateral part.

3. The process of absorption of the damaged bone is complete radiologically before there is radiological evidence of reossification.

4. Reossification always occurs in Perthes' disease.

5. The aim of treatment must be to see that the mould in which the head is shaped is the right shape when ossification occurs.

6. The deformity of the head of the femur does not occur from pressure alone, but from pressure combined with subluxation. Full unrestricted weight-bearing can be allowed with safety on a femoral head in which there are ischaemic changes provided the femoral head is well contained.

7. The time of treatment can be very greatly reduced by using operation to correct the subluxation instead of relying on external splintage. This can be achieved by subtrochanteric osteotomy with rotation, or rotation combined with varus angulation.

8. Perthes' disease and avascular necrosis of the head of the femur are different conditions with different characteristics.

9. Suggestions are made as to the nature of the disease in relation to absorption, continued growth and reossification.

1. The early signs of Paget's disease of the acetabulum and femur are described.

2. The pattern of arthritis is presented in 199 hips in which Paget's disease of bone occurred in either the femur, the acetabulum or both bones. Distinct patterns of disease occur with different bone involvement.

3. Selective narrowing of the medial segment of the joint is common and is particularly associated with pelvic disease. Why the narrowing occurs here preferentially is unexplained.

4. Protrusio acetabuli occurred in only 25 per cent of hips and usually when both the femur and the acetabulum were involved. This may be due to the presence simultaneously of weakened bone and coxa vara, the latter leading to an alteration in the direction of the resultant force across the hip joint.

5. Degenerative arthritis was present with Paget's disease in 14 per cent of hips but it may be a chance relationship in half of these hips.

1. The results of fourteen intertrochanteric osteotomies in thirteen patients with painful arthrosis of the hip with Paget's disease of the related bones have been analysed.

2. The findings suggest that osteotomy carried out in this condition before the femoral head collapses has much the same prognosis as osteotomy carried out at a similar stage of idiopathic osteoarthrosis.

1. The production of scoliosis in young animals by resection of the posterior ends of the ribs is described and the etiological mechanisms discussed. It is suggested that retardation of posterior rib growth, removal of mechanical support from one side of the spine, and disturbance of proprioceptive impulses are the factors which initiate the deformity.

2. Some or all of these mechanisms may contribute to the production of certain human curves, for instance impaired rib growth and support in post-poliomyelitic deformities, proprioceptive and reflex disturbances in syringomyelia.

3. Therapeutically resection of the heads and necks of the ribs on the concave side of thoracic idiopathic curves is followed by improvement in some cases. Exactly how much improvement, in what proportion of curves, and for how long it will be maintained cannot be defined at present, but therapeutically worthwhile effects have been obtained, especially in children under five years old; even if this improvement is followed by later progression, several years of freedom from bracing may have been achieved, and the operation has not in any way interfered with subsequent correction and posterior fusion if this has seemed necessary. It is thought that this operation may have a small but useful role in the early management of idiopathic scoliosis, especially in a young child who is not responding well to bracing.

1. In the treatment of chronic osteomyelitis the most troublesome factor is the infected bone cavity. This is seldom obliterated spontaneously by bone regeneration. The number of procedures designed to fill the cavity, since the beginning of the century, show how much it troubles the surgeon.

2. The use of bone grafts in the treatment of chronic osteomyelitis has been studied. One hundred and twenty cases are reviewed (the largest series in the literature), the follow-up being between two and ten years. The most common lesion was a bone cavity, with or without a sequestrum.

3. Treatment must include the removal of infected soft tissues as well as sclerosed bone, and must be done under appropriate antibiotic control. The value of cancellous bone grafts in filling infected cavities in the metaphysio-epiphysial regions is especially emphasised.

4. The results were gratifying, only four relapses occurring in 120 cases.

1. Arthrodesis of the first metatarso-phalangeal joint combined with excision of those lesser metatarsal heads with fixed subluxation and painful callosities is an excellent treatment for painful hallux valgus with metatarsalgia.

2. A series of thirty feet in twenty-five patients is reported in which this combined operation was done.

1. Tarsal bone disintegration is a progressive disorder that affects a high proportion of leprosy patients.

2. Early detection and treatment by immobilisation permit healing with minimal deformity or disability.

3. Feet with advanced lesions can be similarly treated with a satisfactory outcome and amputation is not needed.

1. Fifty tibial fractures treated by intramedullary nailing during seven years have been presented. There were twenty-eight closed and twenty-two open fractures.

2. The use of the method for treating open (compound) fractures is discussed.

3. The indications for intramedullary nailing are outlined.

1. Polymyalgia rheumatica is a disease of unknown cause, manifested by severe pain and stiffness of the muscles of the shoulder and pelvic girdles, which may be accompanied by a variety of other systemic symptoms.

2. Twenty-three patients with this condition are reviewed.

3. The difficulties of diagnosis, especially when presenting as an orthopaedic problem, are discussed.

1. Fifty knees affected by rheumatoid arthritis were studied in detail at synovectomy.

2. The destructive lesions found were relatively constant and are described in detail.

3. Cartilage lesions were much more common than was expected radiologically.

4. The pattern described suggests that articular cartilage is destroyed by contact with diseased synovial membrane but protected by contact with another cartilaginous surface.

1. A case of compression of the deep palmar branch of the ulnar nerve by an accessory abductor minimi digiti muscle is described.

2. The morphology of abnormal muscles in the hypothenar region is discussed.

3. Five previously reported cases of ulnar nerve compression at the wrist by an anomalous muscle are reviewed.

4. When symptoms are produced by an anomalous hypothenar muscle, they seem to be related to the anatomical site of the muscle and the presence of muscle hypertrophy. Occupational factors may be important in producing this hypertrophy.

1. Thirteen cases of "pseudorheumatoid" nodules are presented. Eight of these have been observed for three months to eleven years.

2. Histologically the nodules were identical to those that may be associated with rheumatoid arthritis or rheumatic fever.

3. No evidence of systemic disease was found.

4. The etiology is not clear but the prognosis is good.

1. Two cases of iliacus haematoma occurring after injury in otherwise healthy individuals are reported.

2. Both cases were complicated by infection of the haematoma, but both patients made a full recovery after operation.

1. The fibrillar networks of adult human articular cartilage, taken from femoral and acetabular specimens, have been systematically examined by scanning electron microscopy. The internal structures revealed by rupturing the tissue were compared with published findings from transmission electron microscope studies.

2. Though this technique demonstrated the internal fibrillar appearance of cartilage to a remarkable degree, it had several attendant limitations. On final drying, specimens generally exhibited shrinkage which varied within wide limits; this could have altered the internal architecture to some extent. In addition, the rupturing technique, which at the time of this investigation was the only satisfactory method of revealing the fibrillar cartilage structure, may well have had a great influence on the fibril orientations.

3. The fibrils revealed no characteristic collagen periodicity and were considerably thicker than those observed by transmission electron microscopy. It is suggested that a coating of mucin on the collagen fibrils might account for this.

4. At low magnifications the torn layers in the fractured surfaces extended radially from the calcified zone and turned obliquely at or near the articular surface to merge with the distinctly layered superficial zone, thus forming arcade-like structures. That these were not artefacts produced by the fracturing technique was shown by their similarity to the classical arcade pattern of light microscopy. However, the factor which governed the direction of these planes of weakness, be it collagen, mucopolysaccharides or cells, could not be satisfactorily determined.

5. At higher magnifications only three regions of distinct fibrillar organisation could be identified: 1) a surface layer consisting of a random fibrillar network; 2) a superficial zone composed of layers of fibrillar network, intersecting and overlapping in planes parallel to the surface; and 3) elsewhere below the superficial zone a network of virtually random fibrils which extended to the calcified region with apparently little variation in thickness or density. There was little variation from this pattern even in aged fibrillated specimens.

6. At the lower magnification range the scanning electron microscope has revealed the arcade pattern described by light microscopy, while at the higher magnifications the fibrillar organisation as seen by scanning electron microscopy correlated well with the concepts developed by transmission electron microscopy, that is, a random network of fibrils overlaid at the articular surface by a membrane-like system of bundled fibrils.

7. A possible role in the transmission of joint forces is outlined for the above fibrillar organisation.