1. Some problems in the early diagnosis and management of congenital dislocation are discussed.

2. In a well-staffed maternity unit one dislocation completely escaped early detection in every 8,000 births over the period 1962 to 1968 inclusive.

3. The complications of early treatment on a Malmö splint are initial failure to obtain reduction, failure to maintain reduction, deformity of the upper femoral epiphysis or metaphysis, and persistent anteversion of the femoral neck.

4. Arthrography suggests that failure of early splintage and deformity of the upper femur are due to attempted reduction in the presence of an inverted limbus.

5. A trial method of treatment of frank displacement in the first year of life has been carried out by combining excision of the inverted limbus with a period in a frog position plaster to correct anteversion. This method avoided changes in the upper femur but failed to correct anteversion in four out of eighteen cases.

1. In Northern Ireland a campaign to eradicate congenital dislocation of the hip by neonatal demonstration of abnormal laxity and early splintage has been reviewed. The number of live births in the area covered is approximately 30,000 per annum.

2. The results to date suggest that the problem has been greatly over-simplified. The number of established dislocations has not fallen appreciably.

3. Failures have occurred both in early diagnosis and in early treatment.

4. To help close the diagnostic net all children should be screened again during the first year. Infants born by breech presentation and infants with a family history of dislocation should have radiographs taken in the early months, even if clinical tests are negative.

5. With regard to neonatal treatment, early splintage has failed to prevent established dislocation in about 2·4 per cent of the hips so treated. How to detect such resistant cases is an important problem.

1. A scheme was started in 1960 with the object of ensuring that the hips of all babies born in the North-Eastern Region of Scotland were examined shortly after birth.

2. 1,671 children with suspected abnormalities have been seen during the ensuing ten years, and the findings are discussed.

3. Clinical examination is essential. Radiographic examination of the newborn is not necessary and may be misleading, but it does prove that some hips with limited abduction but no instability are in fact dislocated.

4. Treatment is not started when the diagnosis is made shortly after birth. The children are re-examined at three weeks, when spontaneous recovery has occurred in about half. The others, whether they show instability or only limitation of abduction of the hips, are treated in a simple splint until they are three months old. Any residual stiffness is an indication for further splintage.

5. The first radiographs are taken when the children are three months old, and no child is discharged until the radiographs show that the upper femoral epiphyses have appeared and are in normal position.

6. We appreciate that we are treating some children who would have recovered spontaneously, but we do not know how to distinguish them. There is no evidence that splintage harms a hip.

7. Eighty-six children (5 per cent of the total) needed operation usually because the diagnosis was missed at birth.

8. Children with familial joint laxity or genu recurvatum should be examined especially carefully for associated hip abnormality.

9. The incidence of abnormality of the hips at birth is about one in fifty live births.

1. There is an increasing prevalence in the evidence of prenatal extended knee postures in the legs of newborn, from normal births to breech deliveries and to babies with hip displacements. The extended knee postures are also commoner in female births.

2. Babies with reducible hip displacements appear to be born more often in summer as the result of winter conceptions. Spontaneous recovery is very high, with or without splintage.

3. Irreducible hip displacement does not respond to splintage during the first six months of life. Even with adductor tenotomy, there is a great risk of acetabular and femoral epiphysial damage. This is thought to be due to incarceration of the limbus, present at birth.

1. The etiology and natural progress of lumbar kyphosis in children from three to twelve years of age with myelomeningocele are reviewed.

2. The indications for operation have included intractable or recurrent skin ulceration, inability to wear calipers for walking, inability to sit in a wheel-chair and inability to perform ileal conduit operations.

3. The technique of osteotomy-excision of lumbar vertebrae used in eighteen cases is described.

4. The results in fourteen children are described. The primary aims of operation have been achieved in all patients.

5. A comparison is made with the results of neonatal osteotomy-excision of the spine in the newborn. Recurrence of deformity, but at a much reduced rate, must be anticipated after either operation.

1. The results have been reported of total hip replacement by a low-friction technique using high-density polyethylene for the acetabular component in 379 primary interventions, performed between November 1962 and December 1965 and followed for between four and seven years.

2. Apart from failures due to infection, the rate of which in the era under review was 3·8 per cent, late failures from mechanical causes were unusual after total hip replacement by this technique. When the socket was cemented in position, which is now routine, the late mechanical failure from all causes was only 1·3 per cent in 210 cases.

3. As regards the quality of the results and their maintenance over the years, the results were so good (Table X) that it was unnecessary to distinguish an intermediate class of "improvement" between success and failure.

4. As regards relief of pain and ability to walk, the average final rating, on a scale numbered 1 to 6, was 5·9 for both, indicating 90 per cent of patients in Grade 6 (excellent) and only 10 per cent in Grade 5 (good).

5. The average recovery of movement was not as spectacular and was influenced considerably by the pre-operative range, but in all cases that range was improved on. Even starting with the stiffest of hips about one patient in four regained a right angle of flexion movement. There was no tendency to lose movement with the passage of time.

6. As regards late infection (2·2 per cent out of a total of 3·8 per cent), the various findings tend to exonerate cement as a cause.

7. The mechanical details of the technique became stabilised in the period 1959 to 1962 in the Teflon era, and with the exception of improved methods of reattachment of the greater trochanter, they are identical with our current practice in 1971.

1. Two hundred and seventeen low-friction arthroplasties performed between November 1962 and April 1969 in 203 patients with failed previous operations have been analysed.

2. The technical details of operation in relation to these conversion problems have been outlined.

3. The quality of the results in relation to pain, mobility and ability to walk has been assessed before operation and one year afterwards, with small numbers at three and five years.

4. Pain was completely relieved or was minimal in 96·3 per cent of the patients, and in no case was the pain worse.

5. The total range of movement was 100 degrees or more in 98·5 per cent. No hip lost movement after conversion.

6. The failures were principally due to infection and to technical difficulties. There were no mechanical failures without a technical or radiological explanation.

7. Low-friction arthroplasty is an excellent salvage procedure, especially for failed cup arthroplasty.

1. A chrome-cobalt hinged prosthesis has been specially designed for total replacement of elbow joints disorganised by rheumatoid arthritis, and has been used in twelve patients over the last two years.

2. The technique of insertion includes fixation of the two main portions in the humerus and in the ulna by acrylic cement before they are joined by an axis pin.

3. Ten of the twelve patients obtained 90 degrees or more of painless movement and good muscle control of the artificial joint.

4. The results to date suggest that the prosthesis and surgical technique have a wider application than for rheumatoid arthritis.

1. The results have been reviewed of forty-two traumatic dislocations of the knee in forty-one patients, twenty-six of which were treated conservatively.

2. Primary operative repair was carried out in only three cases, although a further ten had operative intervention for various complications.

3. It was not possible to compare the results of operation with those of conservative treatment, because the operative procedures were so diverse in nature.

4. The conservative treatment of twenty-six dislocations yielded surprisingly good results with regard to stability, absence of pain, and range of flexion movement.

5. In general, immobilisation for long periods, like operative repair, led to reduced movement.

6. In the absence of complications, conservative treatment is the method of choice.

1. Semitendinosus tenodesis with adequate lateral release for recurrent dislocation of the patella has a high success rate and a low complication rate.

2. The technique of operation is simple.

3. Its particular application is in the young patient before epiphysial closure, although it can give good results in the older patient.

1. In twenty-five patients with rheumatoid arthritis of the knee examined by contrast arthrography certain typical features were encountered. These consisted of enlargement of the suprapatellar pouch and loss of the normally smooth outline of the joint cavity because of nodular filling defects. In some cases less definite filling defects were seen, due to loose fibrinous deposits, particularly in popliteal cysts.

2. This method of assessment of the results of synovectomy of the knee correlated well with the clinical findings. The more satisfactory the clinical result the more normal the arthrograph. Patients who had recurrence of pain, swelling and tenderness in the knee showed arthrographic findings similar to those before operation.

1. A series of patients with recent ligamentous injuries of the ankle is presented. Stress radiography and arthrography were carried out in all cases, with surgical exploration where indicated. The findings are correlated.

2. Both stress radiography and arthrography are unreliable in the diagnosis of injuries to the "lateral ligament" of the ankle.

3. Arthrography may be useful in the demonstration of injury of the inferior tibio-fibular joint and of the medial ligament.

1. A case of the scapho-capitate fracture syndrome is described.

2. At operation the proximal fragment of the capitate bone was found to have rotated on a transverse and not on a vertical axis.

1. Secondary tumours in bone are common in Uganda.

2. Of the five tumours which often give rise to bone metastases in Europe—breast, bronchus, thyroid, prostate and kidney—only the kidney is an unimportant site in Uganda, its place being taken by hepatocellular carcinoma.

3. Most primary bone tumours occur around the knee whereas tumours ofthe skull, vertebrae and head of femur are very likely to be secondary. The thyroid was the most likely primary site for secondary tumours in women. In men the liver, bronchus and prostate were common primary sites.

Two cases of neurofibromatosis with gigantism of a lower limb complicated by subperiosteal bleeding, and exuberant subperiosteal bone formation are reported. Both patients were young boys. Five similar cases were found in the literature.

A case of excision of a chondrosarcoma of the upper end of the femur with replacement by a prototype internal prosthesis has been followed for eighteen years.

1. The insertion of skull calipers is not generally known to be associated with any morbidity or mortality.

2. In the past six years the details of three fatal complications have been collected: there was one case each of cerebral abscess, subdural abscess and extradural abscess.

3. Brief notes of eleven other similar cases, five of cerebral abscess and six of osteomyelitis of the skull, have been supplied by colleagues.

4. The implications of these findings are discussed.

1. A case of osteoid osteoma of the skull is reported, with characteristic clinical, radiological and pathological features.

2. Osteoid osteoma of the skull has not previously been reported.

1. Paralysis of the femoral nerve secondary to haemorrhage of the iliopsoas muscle is described.

2. Four cases are presented. None of the patients had haemophilia, but one was receiving anticoagulant treatment–the second reported case in the literature. Only one case in a non-haemophiliac not receiving anticoagulants has been described previously. We have added three more such cases.

3. This condition can usually be managed conservatively because recovery can be expected. We believe that operation is indicated only if the lesion progresses and the symptoms and signs increase.

4. These cases underline the importance of assessing the femoral nerve in patients with hip symptoms after trauma. Iliopsoas haemorrhage should be suspected as the cause of femoral nerve neuropathy in cases of trauma to the back in adolescents or in those receiving anticoagulants.

1. A case of complete sciatic palsy complicating anticoagulant therapy is presented.

2. A brief review of the possible pathogenesis is made and the importance of early recognition and treatment of the syndrome is emphasised.

1. The case of a girl aged sixteen years who avulsed the iliacus muscle from the ilium during a gymnastic exercise is reported.

2. The lesion was complicated by paralysis of the femoral nerve from pressure by the haematoma. Recovery occurred after decompression.

3. Reports of similar cases from the literature are reviewed.

1. A specially designed loading apparatus and dyeing technique have been used to demonstrate the weight-bearing areas in fifty-one normal adult hip joints.

2. Under loads and positions typical of the stance phase of walking the entire articular surface of the acetabulum is involved in weight-bearing. This contact area is reproduced on the femoral head, and its position determined by the attitude of the femur to the acetabulum.

3. With loads typical of the swing phase, the dome of the acetabulum and corresponding areas on the femoral head are not involved in weight-bearing.

4. The results are compared with the conclusions of previous investigators and their possible significance with regard to joint degeneration is discussed.