Background

Traditionally, the extended lateral approach (ELA) was the favoured approch for calcaneal fractures, but has been reported to have high incidence of wound complications. There has been a move amongst surgeons in the United Kingdom towards the sinus tarsi approach (STA) due to its minimally invasive nature, attempting to reduce such complications.

We perfused 16 human femora with a 50% barium sulphate suspension and studied the intra-osseous vessels by microfocal radiography and histology. There were few anastomoses between the vessels of the greater trochanter and those of the adjacent cancellous bone of the shaft. Ischaemia of the trochanter may contribute to nonunion after trochanteric osteotomy.

1. The venographic findings in clinical primary osteoarthritis are described.

2. Experimental venous engorgement, of the knee joint and of healing fibular fractures, results in accelerated bone formation and disturbed cartilage formation.

3. Changes in pH, ppCO₂, and PPO₂ are indicated as the chemical means by which chondrogenesis and osteogenesis can be altered.

4. It is suggested that chronic venous stress in joints is a causal factor in primary osteoarthritis.

1. The results of the present investigation indicate that in the foetal rat the juxta-epiphysial vascular bed consists of a dense irregular network of sinusoids in direct contact with the growth cartilage, supplied by end-arteries, and drained by a profusion of metaphysial sinusoids.

2. The circulation is a closed one–that is, the endothelium is unbroken in its continuity and microhaemorrhages do not occur against the cartilage.

3. It is possible that juxta-epiphysial endothelial cells or their derivatives are chondrolytic, and that they participate directly, together with other mesenchymal derivatives, in the removal of cartilage as a preparatory stage in enchondral bone formation.

1. Femoral neck deformities that developed in patients under clinical observation are described.

2. Experiments made on ten decalcified femora produced similar deformities.

3. The two sets of observations are correlated and discussed with reference to the role of muscular imbalance in the causation of deformities of the femoral neck.

1. Twenty-five lower limbs, amputated above the knee for senile atherosclerosis with peripheral gangrene, have been investigated radiologically and histologically to determine the vascular patterns in ischaemic bone with particular reference to the tibia. These have been contrasted with the patterns found in non-atherosclerotic tubular bone.

2. The principal changes are the development of a diffuse vascularisation of compact and spongy bone; a widening of Haversian spaces which come to contain a variable number of sinusoidal blood vessels; and an increasing periosteal participation in cortical nutrition which is related to the severity and chronicity of the ischaemic process.

3. Views on the normal blood supply of long bones are discussed, and evidence is presented for regarding this as discrete and end-arterial in nature; in particular it is suggested that the normal cortex has a wholly medullary, centrifugal, arterial supply.

1. The principal nutrient canal of the femur in day-old rabbits was occluded and subsequent femoral growth observed.

2. An initial shortening is followed by equalisation and a final absolute shortening of the order of 3 per cent in occluded femora as compared with controls.

3. It is emphasised that the medullary arterial system, fed by principal nutrient, metaphysial and epiphysial arteries, is the mechanism for the delivery of arterial blood to long bones, and that the arteries of bone extremities are of overwhelming importance in the nutrition of the long bone as a whole.