1. This paper presents the neurological findings in forty-one patients with rheumatoid arthritis complicated by atlanto-axial subluxation.

2. A method of radiological measurement of the subluxation is described. The extent of neurological involvement was found not to correspond with the degree of subluxation.

3. Fusion of the atlanto-axial complex or of the occipito-atlanto-axial complex is indicated only in patients with progressive neurological signs and in those suffering from acute neurological episodes.

4. Difficulty in obtaining fusion with cancellous bone grafts alone was encountered and we recommend wiring of the laminae C.1 to C.2 in addition.

1. A diagnosis of upward translocation of the dens was made in eight patients with chronic rheumatoid arthritis selected from a group of patients who had radiographic studies of the cervical spine and from whom a number of patients with atlanto-axial subluxation were also identified.

2. Two of the patients presented with an acute neurological syndrome of serious import and required a stabilisation operation. Though this is an uncommon complication of rheumatoid arthritis it seems that urgent neurological syndromes are likely to be more common than in atlanto-axial subluxation.

1. The case is described of an eight-year-old girl with the Morquio syndrome (mucopolysaccharidosis type IV) who died from acute tetraplegia, due to atlanto-axial subluxation which occurred during general anaesthesia.

2. Hypoplasia of the dens of the axis vertebra entails a high risk of vertebral dislocation and spinal cord damage especially in circumstances such as general anaesthesia when excessive movements of the head may occur.

1. This report defines the indications, and describes in detail a technique for atlanto-axial arthrodesis. Open reduction, with wire fixation and bone grafting, achieves the objective of immediate stabilisation of an unstable C. 1-2 articulation.

2. The method is illustrated by fifteen consecutive patients who had atlanto-axial arthrodesis. fourteen of whom had excellent results.

3. When the indications are correct, atlanto-axial arthrodesis by the method described is a safe and effective procedure having an excellent success rate.

1. Ten consecutive cases of acute atlanto-axial fracture dislocation were treated by posterior C.1-C.2 fusion.

2. In eight cases there was significant redislocation warranting further therapy.

3. Operative fusion together with prolonged firm immobilisation are recommended only after a trial of conservative therapy.

1. One hundred and sixty cases of incomplete or complete paraplegia due to extradural malignant tumour have been reviewed. Between 1959 and 1969 laminectomy for decompression of the cord was performed in 154 of these cases as an urgent measure and the results in 129 cases with full records have been assessed.

2. Immediate laminectomy, a palliative procedure, gave worthwhile improvement in 35 percent of cases of incomplete paraplegia; such patients could walk and had satisfactory control of bladder function at least six months after operation.

3. There were no satisfactory results when the paraplegia was complete.

4. The relief of pain following decompression may be gratifying, even if the patient does not improve sufficiently to fulfil the criteria of a satisfactory result.

5. The results emphasise the importance of early diagnosis, myelography and decompression if a patient with incomplete paralysis is to be offered any chance of relief.

1. Nine patients with radiological evidence of narrowing of the lumbar spinal canal, proved at operation, are reviewed.

2. They presented with either a claudicant or a sciatic clinical picture.

3. A classification into primary or secondary spinal stenosis is described. The primary type may be due to a reduction in either the sagittal, coronal or both diameters of the spinal canal.

4. Secondary narrowing of the canal may be superimposed upon a primary anatomical abnormality or may cause narrowing in a previously normal canal.

5. The symptoms are thought to be caused by a further reduction in the size of an already narrow canal, producing traction on the nerve tissue, which is then unable to move freely.

1. The radiographic appearance of normal thoracic and lumbar vertebrae at 15-degree intervals of rotation is described. Each image can be identified by its characteristic features.

2. The appearance on antero-posterior radiographs of apical vertebrae in scoliosis closely resembles the normal at each phase of rotation, on the basis of which an image-matching method is proposed for estimating rotation in scoliosis.

3. The method gives only approximate values of rotation but has the advantage of being able to monitor rotation through 90 degrees.

It is suggested that the operation of partial costectomy is so beneficial psychologically to some young scoliotic patients that it is worth the very small physiological cost demonstrated here in patients who found their "hump" sufficiently embarrassing to curtail their normal social life.

1. Because of the importance of nutrition of the intervertebral disc in relation to its disorders, a detailed study has been made of the neighbouring vasculature of the vertebral body.

2. This has been made possible by an injection technique involving prevention of leakage by freezing with liquid nitrogen.

3. By this method capillary beds are found in the vertebral end-plate cartilage in the adult. A very fine subchondral post-capillary venous network has been demonstrated draining by short vertical tributaries to a much coarser horizontal collecting vein system connecting with the familiar basivertebral system.

4. This arrangement may be of special importance in the nutrition of the intervertebral disc.

1. The case is described of a twenty-nine-year-old man with back pain due to an extensive vascular malformation replacing the major part of a vertebral body.

2. Treatment was by transthoracic ligation of the segmental vessels, with irradiation and spinal fusion later.

3. The importance of demonstrating the origin of the thoraco-lumbar supply to the anterior spinal artery is emphasised.

1. A prospective study of 239 Colles's fractures was made.

2. This indicates that all displaced Colles's fractures should be reduced.

3. After reduction a below-elbow plaster should be used.

4. An above-elbow plaster has no advantages and may have some disadvantages.

1. The clinical, radiological and pathological features of 106 cases of eosinophilic granuloma of bone (solitary and multiple) are reported.

2. Our findings support strongly the concept that eosinophilic granuloma, Hand-Schüller-Christian and Letterer-Siwe syndrome are closely related manifestations of a single pathological disorder, characterised fundamentally by the proliferation of non-neoplastic histiocytes, intermingled with a variable amount of eosinophilic leucocytes and other inflammatory elements.

3. Lipid-bearing histiocytes (xanthoma cells) may be found in variable amounts in solitary and multiple lesions but are more abundant in the more extensive or chronic lesions of Hand-Schüller-Christian syndrome.

4. These entities may perhaps represent some type of immuno-allergic (hypersensitive) reaction to a still unknown infection, possibly viral.

1. Congenital vertical talus is described and the criteria for diagnosis are emphasised. The need for its distinction from other forms of convex pes valgus is stressed.

2. The operative technique of Stone for Lloyd-Roberts (1963) is detailed and the results of seven such operations are examined.

3. Departure from the technique in any respect has resulted in an unsatisfactory outcome, whereas stringent observation of the operative details has resulted in uniformly good results in four patients.

4. Certain aspects of diagnosis, differential diagnosis, etiology, pathology and surgical management are discussed, together with a review of some of the relevant literature.

1. Seventy-four patients over the age of seventy with either subcapital or intertrochanteric fracture have been investigated for evidence of osteomalacia. To establish an index of suspicion the incidence of biochemically defined osteomalacia has been compared with quantitative histology in this group.

2. Whereas no significant difference in the incidence of the disease was noted in the comparison of subcapital with trochanteric fracture groups, there was a high incidence of osteomalacia overall. Furthermore, a subclinical form of the disease appears to exist.

3. The relevance of these observations is discussed with particular reference to the established diagnostic criteria of the condition.

1. Human articular cartilage from normal femoral heads and from cases of osteoarthrosis in subjects of various ages has been examined histologically and by electron microscopy.

2. In specimens from middle-aged and old subjects, peculiar "matrix-streaks" have been observed in the deep zone of the pressure areas as oblique bands extending from the pericellubar halos into the adjacent matrix.

3. Ultrastructurally the streaks are correlated with an undulating pattern of the radially oriented collagen fibres.

4. The streaks are considered to result from a focal lack of acid mucopolysaccharide and from natural forces on the articular cartilage. Their appearance is assumed to be an early sign of cartilage disintegration associated with ageing.

1. Twelve trephine specimens of articular cartilage and subchondral bone taken from six fresh osteoarthritic femoral heads were incubated in a medium containing tritiated thymidine, and autoradiographs were prepared from serial sections five microns thick.

2. Scattered labelling of chondrocytes in sections from four of the six femoral heads was demonstrated. No more than four labelled cells were seen in any one section. About half were found in typical chondrocyte clusters.

3. The implications of this evidence of chondrocyte multiplication with regard to the repair of damaged articular cartilage are discussed.

1. Decalcified lyophilised rat bone matrix prepared by Urist's method acts as an inductor of cartilage and bone when implanted into animals of other species, namely mice, rabbits and gerbils. Induction in rabbits and gerbils was very much weaker than in the mouse.

2. The site of implantation affected the outcome; intramuscular implants induced cartilage and bone more strongly and regularly than subcutaneous or intraperitoneal implants.

3. Rabbit transitional epithelium, growing in cortisone-treated gerbils, caused bone induction, but in general, results with this species suggest that it responds poorly to bone-inducing stimuli.

4. Cortisone, used as an immunosuppressant, did not inhibit bone and cartilage induction.

1. The syndrome here described in six Bulgarian subjects is characterised by partial duplication of the foot or diplopodia, combined with either hyperplasia or aplasia of the tibia. The accessory elements are located along the medial border of the "normal" foot and consist of two or three toes with related metatarsal and tarsal bones. The fibula is not directly involved.

2. No evidence of familial inheritance was found in these cases.

3. Various reconstructive measures and the place of amputation of the whole foot are discussed in the course of the six case reports.

1. The features of ganglia of the flexor tendon sheaths of the hand are described.

2. A high incidence in typists is discussed in relation to etiology and pathogenesis.

3. The suggestion is made that needle rupture is the method of choice, with surgical excision in case of recurrence.

1. A technique for internal fixation of the disrupted symphysis pubis by an angled four-hole plate is described.

2. In five patients in whom internal fixation was used rapid relief of the severe discomfort caused by symphysial disruption was noted.

1. The case is reported of a woman aged sixty-five with widespread osteosclerosis as a feature of IgA myelomatosis.

2. Improvement was noted after treatment by cyclophosphamide and prednisolone.

3. Only two previously reported cases of myeloma with osteosclerosis of comparable extent have been found, but in forty-seven other cases in the literature some sclerosis has been noted.

4. The finding of sclerotic lesions should not rule out multiple myeloma.

1. A case of intraosseous lipoma is reported.

2. The literature on this tumour is reviewed and possible theories as to its pathogenesis are discussed.

3. It is concluded that the lesion is a true benign tumour which cannot be recognised with certainty without operation.

1. Cell differentiation around screws manufactured by two American and two Swiss companies and inserted into seventy femora in forty-one adult mongrel dogs has been observed over periods varying between two weeks and nine months.

2. This study reveals that, despite their excellent holding power, such screws are not everywhere in firm contact with the surrounding bone at the time of insertion. Indeed, only part of the thread surface facing the head of the screw touches the compact bone, all other surfaces being separated by a space up to 150 µ in thickness.

3. These spaces result both from the surgical technique employed and from the inaccurate measurements of drills, screws and taps.

4. Migrating cells invade these spaces during the first two weeks. In the absence of movement, these cells differentiate into osteogenic cells; movement leads to differentiation into fibroblasts, chondroblasts and osteoclasts, and failure of fixation ensues. In contrast, callus formation by osteogenic cells firmly anchors screws in four to five weeks, well before callus uniting the bone fragments has been established.

5. Extremities should be protected from undue stresses during those first few weeks after osteosynthesis, whatever the technique.

6. This study clearly demonstrates the importance oftesting screws in living bone to ascertain their holding power at all stages of fracture healing.

An eight-year-old girl who suffered a traumatic dislocation of a congenitally dysplastic hip is described. No other such case is recorded in the literature.

1. A case is reported of a twelve-year-old boy showing normal stature and severe genu valgum.

2. The radiological and histological features suggested metaphysial dysostosis, possibly of the Schmid type.

1. Three cases of fracture of the neck of the radius with medial displacement of the head are described.

2. It is proposed that such injuries be classified into two types: 1) displacement of the radial head without dislocation of the elbow; and 2) displacement during posterior dislocation of the elbow.