1. A technique for bridging bone defects in the forearm with massive iliac graft and medullary nailing is described. 2. The results of fifteen operations are reviewed

We have compared the rates of infection and resistance in an animal model of an orthopaedic procedure which was contaminated with a low-dose inoculum of Staphylococcus epidermidis. We randomised 44 Sprague-Dawley rats to have bone cement implanted subcutaneously containing either gentamicin or saline (control). The wound was inoculated with a dilute solution of gentamicin-sensitive Staphylococcus epidermidis. At two weeks the cement was retrieved and microbiologically tested. A lower overall rate of infection was seen in the gentamicin-loaded cement group, but there was a significantly higher rate of gentamicin-resistant infection in this group (Fisher’s exact test, p < 0.01). Antibiotic-impregnated cement has an optimum surface for colonisation and prolonged exposure to antibiotic allows mutational resistance to occur. Gentamicin-loaded cement may not be appropriate for revision surgery if it has been used already in previous surgery

After the simultaneous administration of radiocalcium and radiophosphorus to young rats the rate of deposition of calcium and of phosphorus in various skeletal parts was computed. Agreement was found between the two sets of data. No difference was thus found in the metabolism of the calcium and of the phosphorus of the bone salt

We performed curettage and bone grafting of amyloid cysts of the femoral neck in five patients on long-term haemodialysis. All had had hip pain on weight-bearing. The duration of haemodialysis before the operation averaged 15 years and the average age of the patients was 53 years. All the large cystic lesions were located in the anterosuperior quadrant of the femoral neck. At operation, they were found to consist of fibrous tissue containing amyloid deposits. Postoperatively, all five patients had painless hips and the grafts had incorporated into the bone defects

We have reviewed 13 operations on 11 patients using curettage and polymethylmethacrylate cement for giant-cell tumour of bone (GCT) to assess the value of radiology in the early detection of recurrence. There were four recurrences, the most specific radiological sign on plain radiography was lysis of 5 mm or more at the cement-bone interface. This preceded clinical signs by a mean of four months and was identified at a mean of 3.75 months after operation. There was not always a complete sclerotic margin around the cement, but when it was present, there was never evidence of recurrence. MRI was helpful in assessing cases with evidence of recurrence. Frequent surveillance with plain radiography should continue for one year after operation irrespective of clinical signs of recurrence. When the appearance of the plain radiographs suggests recurrence, MRI should be performed and followed by image-guided needle biopsy

The clinical and radiological features in three cases of cystic angiomatosis of bone are reported. Although these features are generally diagnostic except from histiocytosis X, the definitive diagnosis must be established by a pathological study, preferably of a segment of an involved rib or fibula. The prognosis varies according to the type of clinical presentation-in particular upon whether the lesions are solely skeletal or whether there is extraskeletal visceral involvement. Whereas these last cases may often prove fatal, those with only skeletal involvement have a favourable prognosis: indeed, the cystic bone lesions may regress without any treatment, as occurred in some cases reported in the literature and in two of our three cases

The statistical quality of 103 original articles published in The Journal of Bone and Joint Surgery (British Volume) in 1984 was assessed. Some papers were found to be deficient: thus, it was not always clear how series were selected and sometimes neither the data nor the results were clearly presented. Sample sizes were frequently inadequate for the conclusions reached and statistical techniques should have been used more frequently. A majority of papers were descriptions of case series for which no comparative data were made available. It is suggested that collaborative research would best advance knowledge about the relative benefits of various managements, and that statistical advice could make a substantial contribution

Two cases of skeletal amyloidosis are described. In one the disease existed for many years, progressively destroying several vertebral bodies. There was no evidence of chronic infection, myelomatosis or cancer. In the other case myelomatosis was the primary disease but the first manifestation was a cystic tumour of the humerus. Not until several years later did typical bone lesions and Bence-Jones protein reveal the true nature of the disease.

A case of intramedullary neurilemmoma of the terminal phalanx of the right index finger is reported, and the cases previously reported are briefly reviewed.

A study was made of the clinical course of 102 cases of fibrosarcoma of long bones. Of these, 55 were predominantly fibroblastic or pure fibrosarcomata while 47 contained extensive areas resembling so-called malignant fibrous histiocytoma (MFH). Treatment was similar in the two groups, and the five-year survival was the same, 34%, in both groups. Lung metastases developed in 63% of the fibroblastic sarcomata and 59% of the MFH-like tumours. Our study indicates that there is no significant difference in behaviour in fibrosarcoma with or without marked MFH features. The histological grading of both groups of fibrosarcomata together was of prognostic value; five-year survival was 64% in 14 Grade I tumours, 41% in 32 Grade II tumours and 23% in 56 Grade III tumours

A saw blade was made from two standard oscillating blades which were fixed to each other with channels between, so that cooling fluid could be directed to the saw teeth. The blade was connected to a standard arthroscopy pump which delivered a flow of 80 ml/min through the blade. The performance of this blade was compared with that of a standard saw blade, cutting ox-bone in the laboratory. Irrigation of the standard saw blade with saline delivered by a syringe only slightly diminished the maximum temperature. Pumped irrigation was more effective but required large volumes of fluid. The heat generated by the internally cooled saw blade was negligible and the temperatures achieved (19 degrees C to 34 degrees C) fell well below the critical level for bone death (44 degrees C to 47 degrees C)

1. Into osseous defects cut in the pelvis of rats, Kiel bone grafts were implanted after impregnation with the animals' own fresh bone marrow, obtained by femoral puncture. Unimpregnated Kiel bone grafts and Kiel bone grafts impregnated with an antibiotic solution were implanted as controls. 2. Histological examination of the implant area showed that in the marrow-impregnated grafts new bone formation could be observed after twelve days, and that during an observation period of 135 days after implantation bone formation occurred in thirteen out of nineteen rats. In four of these cases a continuous bony bridge developed over the defect. 3. In the unimpregnated grafts no more than a small amount of new bone was seen in only one of seven rats. In the antibiotic-impregnated grafts no bone formation was found in six rats during the same period of observation