1. The results of treatment have been compared in two unselected series of patients with unstable fractures of the thoraco-lumbar spine accompanied by paraplegia.

2. One group had been treated by conservative or " postural" methods while the others had been subjected to open reduction and internal fixation with double plates.

3. No difference in the amount of neurological recovery could be detected between the two groups but while a number of conservatively treated patients had significant residual spinal deformity and subsequently developed serious pain, this did not occur in any of the patients treated by plating.

4. It is concluded that open reduction and internal fixation are indicated in displaced fractures in the interests of long-term spinal function.

1. Thirty-nine patients with synovial sarcoma have been reviewed.

2. The average rate of five-year survival was 45 per cent; of ten-year survival, 30 per cent; and of survival for more than ten years, 10 per cent.

3. The only important factor influencing the long-term results was the method of treatment; primary amputation was by far the best.

1. Tendon possesses an active potential for repair and remodelling.

2. Large defects made in the flexor tendons of rabbits showed tenoblastic activity and repair without the formation of adhesions.

3. The failure to show this intrinsic ability for repair in previous studies may have been influenced by adverse factors introduced in order to hold the cut tendon ends together.

1. Evidence is presented which suggests that after total joint replacement bone necrosis and consequent loosening of the prosthesis may be due to the development of sensitivity to the metals used.

2. Nine patients, from a total of fourteen with loose prostheses, were found to be metal sensitive by skin-patch testing. In twenty-four patients with intact prostheses no sensitivity was demonstrated.

3. In material from the joints of sensitive patients the metal content was raised.

4. Examination of this material showed necrosis of bone and soft tissue following obliterative changes in the vascular supply.

5. Similar reactions were found following the injection of cobalt into a sensitive patient.

6. The release of metal around a prosthesis is greatest where metal rubs against itself.

7. We conclude that prostheses in which metal articulates with polyethylene should be preferred; that any patient in whom loosening or fragmentation occurs should be patch tested; and that if sensitivity is found the implant should be removed.

1. The management of fractures in five patients with haemophilia is described: two patients had antibodies to antihaemophilic globulin.

2. The principles of management of injured haemophilia patients are described, as are the special problems in patients with antibodies to AHG.

3. Stability of the fragments must be achieved to prevent the hazards of displacement of the fracture, recurrent bleeding and pseudotumour formation which may threaten viability of the limb.

4. Stabilisation of potentially unstable fractures can be achieved at the onset by internal fixation. Plaster casts should be reserved for stable fractures or fractures occurring in young children.

1. A review of 193 African and Indian children suffering from spina bifida has been made. Forty-three were seen on the first day of life and the remainder during subsequent weeks of life.

2. For the baby with mild or moderate paralysis and an open spinal lesion early closure was of value in preventing progressive neural damage.

3. For the baby with severe paralysis and an open myelomeningocele early operation was not of value in preventing further neural damage, and all remained severely paralysed. immediate operation to close the spinal lesion is not justified in babies with severe paralysis: survivors may be treated by later operation to prevent recurrent meningitis.

1. Passive straight-leg raising may induce pain in the back or leg or a combination of both in patients with acute lower lumbar disc lesions. Clinical, myelographic and operative observations were carried out prospectively in fifty such cases to investigate the relation of the pattern of pain on straight-leg raising to the site of the protrusion.

2. In patients with central protrusion straight-leg raising induced mainly back pain. In patients with intermediate protrusion, lying in contact with both dura and nerve root, a combination of back and leg pain predominated. Patients with lateral protrusion usually experienced only pain in the leg. This correlation was found in 80 per cent of cases.

3. Production of pain in the leg by straight-leg raising is of practical significance in lateral protrusions where myelography may be normal.

4. Pain in the back and pain in the leg on straight-leg raising may be related respectively to dural and nerve root sensitivity.

1. The treatment is described of a consecutive series of fourteen patients suffering from rheumatoid arthritis causing a slip of the cervical vertebrae, mainly at the C.1-2 level, and a cord lesion.

2. The importance of a change of symptoms and signs in these patients, especially the occurrence of the so-called "alarm signs", is stressed.

3. In twelve patients the combination of this kind of cervical instability with a cord lesion was treated by fusion, most frequently of occiput to C.2 and 3.

4. In the eleven patients who survived the operation the results with a follow-up period of one to eight years are considered highly gratifying.

5. Technical details and various problems associated with treatment are discussed.

1. The aetiology of a destructive lesion through a former interspace in a spine fused by ankylosing spondylitis is reviewed.

2. From the findings in three patients treated by anterior spinal fusion, evidence was obtained to show that a stress fracture, originating posteriorly between two fused spinous processes, leads to a pseudarthrosis between two vertebral bodies that may simulate a tuberculous lesion.

3. If spinal fusion is indicated, the anterior approach is recommended, both for direct observation of the lesion and to achieve sound union.

1. Attention is drawn to the danger of avascular necrosis developing in the capital femoral epiphysis as a complication of osteomyelitis in the intertrochanteric region.

2. This necrosis is commonly aseptic. It is believed to be caused by compression or thrombosis of the epiphysial vessels.

3. The situation will be aggravated if infection spreads to involve the joint.

4. We believe that prompt decompression of both the joint and the bone is indicated in order to reduce the incidence and severity of these complications.

1. Senile subcapital fractures in osteoporotic patients are due to fatigue, not to the impact of a fall, since they are preceded by the local accumulation of isolated trabecular fatigue fractures.

2. One pathological significance of the isolated trabecular fractures described by Todd, Freeman and Pirie (1972) has been demonstrated.

1. A case is reported of a girl aged fifteen with growth hormone deficiency who developed a slip of the left femoral capital epiphysis at the age of seventeen during human growth hormone therapy.

2. The epiphysiolysis is regarded as iatrogenic.

1. Fourteen patients whose Kienböck's disease was treated by prosthetic replacement, and who have had an acrylic lunate prosthesis in place for periods of eight to twenty years, have been reviewed.

2. In most patients pain, weakness and limitation of movement are less than they were before operation. Four wrists are completely painless and the other ten have only occasional slight pain. The average range of antero-posterior movement is 100 degrees.

3. Radiological signs of osteoarthritis are either absent or slight in ten wrists: this is considered to be due to the success of the prosthesis in maintaining the carpal architecture, even after prolonged heavy use.

1. Exercise ischaemia in athletes with chronic pain over the postero-medial border of the tibia is described.

2. Fasciotomy of the compartment of the deep flexor muscles as a treatment of "shin splints" is recommended.

3. In eleven patients the symptoms were completely relieved and the athletes were able to start effective training within four weeks.

1. Electro-physiological studies have been made in a case of "tourniquet paralysis" of the upper limb produced by the application of a pneumatic cuff.

2. The results indicate that an important part of the persistent paralysis was caused by local conduction block at the level of application of the cuff.

3. The value of electro-physiological studies in such cases is stressed.

1. The dominant role of pathogenic staphylococci in surgical infections has been confirmed by positive isolations in 89·9 per cent of a wide variety of lesions in a hospital infective unit. Of 150 staphylococci isolated, 147 were sensitive to fusidic acid, two were slightly sensitive and only one was resistant.

2. Fusidic acid was administered as sodium fusidate to 100 patients with staphylococcal infections (including seventy-two with chronic post-traumatic osteomyelitis). Sterile swabs were achieved in seventy-seven of these patients and in the remaining twenty-three a change of flora was detected.

3. Bone samples were taken at operation from twenty-nine patients with chronic osteomyelitis who had been treated for at least five days with fusidic acid. Depending on dosage, the mean fusidic acid concentrations were 7·3 and 9·8 micrograms per gram. Corresponding levels in non-inflammatory bone samples from thirty-one patients were, depending on the duration of treatment, 12·3, 2l·3 and 25·4 micrograms per gram. The fusidic acid levels in cancellous bone were almost twice as high as those in compact bone.

4. The relevance of these findings to the use of fusidic acid therapy as an adjunct to surgical management of chronic osteomyelitis is discussed.

1. In a series of 129 tibial fractures treated by compression plates, a high incidence of complications causing delay in healing was found in alcoholics and persons with abnormal personality traits.

2. The healing time and time off work for these people were about doubled.

3. The indications for internal fixation in such patients should therefore be sharply defined and, if used, added protection should be given by institutional care and by well controlled plaster casts.

Two cases of adamantinoma of the tibia are reported. The first patient has survived twenty years after above-knee amputation and shows no sign of recurrence. The second patient shows no evidence of recurrence two and a half years after amputation through the knee.

The clinical picture of the tumour is described and the theories of histogenesis are outlined.

1. The cases of four children who presented with bowing or pseudarthrosis of the fibula only, are described.

2. There is a gradation in the severity and significance of this condition. There may be fibular bowing without fibular pseudarthrosis; fibular pseudarthrosis without ankle deformity; fibular pseudarthrosis with deformity but without the late development of tibial pseudarthrosis; or fibular pseudarthrosis with the late development of tibial pseudarthrosis.

3. Proper management is dependent on a knowledge of this range of conditions.

1. The case is reported of a girl born by normal delivery whose right lower limb showed reduplication of the femur below the single femoral head.

2. The tibia was absent but the ossific centres in the foot appeared to be normal. We are grateful to Processor Robert Roeaf for permission to publish details of this patient.

1. Three typical cases of recurring digital fibroma of infancy are reported, with a follow-up of three to four years. In each case excision of the tumours during the first year of life was followed by recurrence and then by some degree of slow spontaneous resolution, in one case complete.

2. A strictly conservative approach is recommended for three reasons : the difficulty of complete excision, the tendency to spontaneous regression and the facts that no case of metastasis and no case of persistence into adult life have yet been reported.

3. Cytoplasmic inclusion bodies could not be demonstrated in the biopsy material from these cases, nor any virus.

1. An investigation of interdigital clavus or corn does not support the opinion that it is found most often in the web of the fourth interspace.

2. Most occur in that interval, but less than a third involve the web.

3. The commonest site is the area of impingement of the distal interphalangeal joint of the fifth toe on the proximal interphalangeal joint of the fourth.

1. As previous experiments with autogenous transplantation of epiphysial growth plates have given limited success, a study was carried out on two groups of rabbits, one of which was given hyperbaric oxygen post-operatively in an attempt to improve the results.

2. Sixty-four New Zealand white rabbits had the distal ulnar growth plate transplanted from left to right and vice versa, giving a total of 128 transplants.

3. In the group of thirty-two rabbits given hyperbaric oxygen 48 per cent of the transplants were regarded as successful when examined histologically six weeks after operation, while in the control group the figure was 28 per cent.

4. This investigation suggests the clinical use of hyperbaric oxygen to improve the results of transplantation of growth cartilage.

The immigrant Asian population of Bradford has a relatively high incidence of bone and joint tuberculosis, which now accounts for most of this disease in the city. One hundred and seventy-six cases of skeletal tuberculosis are reviewed and indigenous and Asian disease compared. The disease in Asians is more acute with greater systemic disturbance. The abscess is often warm, larger and quicker to develop and there is more likely to be multiple site involvement. Tuberculosis is particularly seen in the knee and cervical spine in the Asian as compared with the hip and lumbar region in the indigenous population. The course of the disease is shorter and there are fewer recurrences in the Asian patient.