1. Linear fractures of the shaft of the long bones are divided into four basic types: 1) transverse; 2) oblique transverse; 3) spiral; and 4) oblique. 2. The mode of production of these fractures is deduced on the grounds of simple mechanical theory: 1) transverse fractures are a result of angulation; 2) oblique transyerse are the result of angulation with axial loading; 3) spiral fractures are the result of axial twists with or without axial loading; 4) oblique fractures are the result of angulation and axial twisting in the presence of axial loading

1. Radiological and histological observations of the tissue changes resulting from the implantation of various metals in the long bones of dogs are recorded. 2. Of the metals employed, tantalum, Vitallium, alloys "C" and "S" and F.M.B. steel were inert; silver and mild steel were reactive; F.S.T. steel occupied an intermediate position. 3. A correlation has been demonstrated between the anodic back E.M.F., the weight loss due to corrosion and the histological changes produced

1. Details of clinical, radiological, biochemical and histological investigations of a case of metaphysial dysostosis are presented. 2. The patient was a boy of seven years, and showed widespread lesions (involving long bones of limbs, small bones of hands and feet, pelvis, clavicles, and ribs) characterised by retardation of growth and ossification with masses of partly calcified tissue in the metaphyses. 3. No radiological, clinical or histological evidence of renal osteodystrophy was found in the case described. 4. Metaphysial dysostosis is discussed in relation to other chondrodystrophies

1. Monostotic fibrous dysplasia in the long bones occurs most frequently in adolescence. In the jaws it is found mainly in early adult life. It presents later in the ribs, probably because it is often asymptomatic in this site. 2. The disease is equally distributed in both sexes. 3. Reactivation may occasionally occur in later life and in pregnancy. 4. Successful surgical treatment is by no means always easily achieved, and requires, in addition to the problems of fracture fixation and the correction of deformity, careful consideration of the age of the patient, the activity of the lesion and the extent to which it involves the cortical bone

A group of patients were studied 10 years after stopping work in a high-pressure environment. Radiographs of their long bones showed little change during the period, but only two of 12 scintigrams were normal. The 10 abnormal scintigrams contained 18 "hot-spots" which were not always associated with an abnormal radiographic appearance; the findings suggest that some lesions may never become visible on a radiograph. A reactive or repair process associated with these lesions may be prolonged and may not be beneficial, as structural failure of the joint may subsequently occur. Prognosis should therefore be guarded

The method of producing osteogenic sarcoma in rabbits by the injection of beryllium in the form of "zinc beryllium silicate" is presented. In five of ten animals which had such injections, osteogenic sarcomas developed several months later. There was new bone formation in the medullary cavities of the long bones before malignant changes were apparent. It is of particular interest to note that there was atrophy of the spleen in those animals in which bone tumours developed, whereas the spleen seemed to be quite normal in the rabbits which did not develop bone tumours. The tumours usually developed in the metaphysial regions. More than one tumour often developed in the same animal

1. Bone changes in the haemoglobinopathies are caused by either (a) chronic haemolysis with marrow hyperplasia, or (b) infarction, when Hb S is present in the red cells in amounts sufficient to allow sickling (and therefore vascular occlusion) in vivo. 2. Marrow hyperplasia produces osteoporosis, widening of the medulla, and thinning of the cortex; it may lead to spontaneous fractures and disturbances of growth. Enlargement of the foramina of the nutrient arteries may be seen especially in the phalanges. Infarcts leading to aseptic necrosis occur in the long bones, and may become infected with Salmonella organisms. The range of radiological lesions caused by these processes is illustrated

1. The occurrence of multiple centres of ossification in the epiphyses of the long bones of the hand and foot is shown to be frequent, and in the first metatarsal and first proximal phalanx of both hand and foot in both sexes the normal pattern of epiphysial ossification must be regarded as taking place in this way. 2. Multiple centres of ossification are shown to occur simultaneously in several epiphyses of the same hand or foot. 3. There seems to be a relationship between the shape of an epiphysial area and the pattern of ossification occurring within it. 4. Care should be taken to avoid confusing these normal patterns of ossification with radiological appearances caused by pathological changes

We reviewed 275 cases and calculated the prevalence of bacteriologically or radiologically confirmed acute haematogenous osteomyelitis in children under 13 resident in Greater Glasgow during 1970 to 1990. In the 20-year period there was a fall of over 50%, mainly involving cases of long-bone infection, and those due to Staphylococcus aureus. There was a reduced incidence of complications. The proportion of cases involving long bones decreased from 84% to 57%, and those of Staphylococcus aureus infection from 55% to 31%. These changes, in what is becoming a rare disease, need to be known to ensure early diagnosis and adequate treatment, particularly of subacute non-staphylococcal infection at unusual sites

The level of bone resection for osteosarcoma depends on the pre-operative evaluation of the extent of intramedullary tumour. We compared the accuracy of magnetic resonance imaging (MRI), computerised tomography (CT), and isotope bone scanning with the actual extent of the tumour in the resected specimens from 34 patients with primary osteosarcoma of a long bone. The extent of medullary tumour was defined accurately in 23 of 24 MRI scans (96%) and 24 of 32 CT scans (75%). A flexion contracture of a joint close to the tumour was an important cause for inaccurate measurements from both MRI and CT scans. Isotope bone scanning was inaccurate: its role is now confined to detecting skeletal metastases and skip lesions

The clinical and pathological features of six cases of desmoplastic fibroma of bone are presented. Desmoplastic fibroma is rarely seen as a primary tumour of bone; when it does occur the sites of predilection are the long bones, but other sites such as the scapula and os calcis can be involved. Radiographically the lesion tends to expand the bone from within; it is well-demarcated and lytic, often with a trabeculated soap-bubble appearance. The cellular structure and the morphological arrangement are similar to those of aggressive fibromatosis of soft tissues. Differential diagnosis from malignant spindle-cell lesions of bone is important because the treatment of choice for desmoplastic fibroma of bone is simply excision with a thin layer of healthy tissue

We compared the results of primary ultrasonographic examination of 163 children with 224 suspected fractures with the subsequent radiological findings. The aim was to assess the value of ultrasound in the diagnosis of fractures in children. We found a good correlation for fractures of the long bones of the upper and lower limbs. Ultrasound was most reliable for the detection of simple femoral and humeral diaphyseal fractures and fractures of the forearm. It was less dependable for compound injuries and fractures adjacent to joints, lesions of the small bones of the hand and foot, non-displaced epiphyseal fractures (Salter-Harris type 1) or those with a fracture line of less than 1mm. We were able to distinguish several types of fracture in which the use of ultrasound alone gave reliable information and further radiography was unnecessary. We discuss the advantages and disadvantages of skeletal ultrasonographic studies in children

A 13-year-old girl presented with a two-year history of pain in the right thigh and right forearm. Engelmann's disease was diagnosed on the basis of radiological appearances and histological examination of the bone. Her symptoms subsided after biopsy of the bone, but two weeks later she developed severe pain in the left tibia and was unable to walk. Radiological features of Engelmann's disease were found in the left tibia and other long bones although these bones had been radiologically normal one month previously. Treatment with prednisolone gave rapid relief of pain and allowed the patient to become mobile again. Four months later the radiological appearances showed significant improvement. The use of corticosteroids in this disorder is discussed

Experience in the management of fourteen children with melorheostosis has been reviewed. The principal and presenting clinical features were unilateral soft-tissue contractures associated with inequality of limb length. In contrast to the disease in adults, pain occurred infrequently and was never intense. The average interval between the discovery of the clinical features and the correct diagnosis was six years. The distinctive radiographic feature in the child was an endosteal pattern of hyperostosis marked by streakiness of the long bones and spotting of the small. This differs from the usual subperiosteal or extracortical pattern of hyperostosis seen in adults. The surgical treatment of the contractures proved difficult and recurrence of the deformity was the rule. Distal ischaemia occurred when the chronically contracted and flexed joint was rapidly extended

1. Problems of management of a pathological fracture of a major long bone through a metastatic cancer deposit are outlined. The relatively short life expectancy of these patients is stressed. 2. The results of treatment of thirty-six consecutive fractures of this type by internal fixation and radiotherapy, and of similar treatment used "prophylactically" on seven occasions, are reviewed. 3. Four-fifths of the patients with lower limb fractures became ambulant with crutches and were able to return home. 4. "Prophylactic" internal fixation and radiotherapy appear to be helpful in selected cases. 5. The theoretical dangers and difficulties of the technique are discussed. They are easily surmountable and have probably been over-emphasised in the past. 6. It is concluded that this is the best method at present available for dealing with this difficult problem

1. The so-called adamantinoma of long bones is a clinico-pathological entity, the pathogenesis of which is still in doubt. The case for its being a synovial sarcoma showing epithelial differentiation is in our view unconvincing. 2. The tumour is slowly growing, and of low grade malignancy. Apparent cure has been effected in a third of the total cases recorded by amputation or resection of the diseased bone. 3. These means, however, have not prevented metastases to the lungs and skeleton in a similar number. 4. A case is presented in which a metastasis appeared in the chest twenty-two years after amputation of the leg. This was sensitive to telecobalt irradiation, and is the first case in which a distant metastasis has been proved microscopically

1. A case is described of the marble bone disease of Albers-Schönberg in a woman of forty-one who died from subarachnoid haemorrhage. Several congenital abnormalities were present. 2. No significant abnormality of the chemical composition of the bones was discovered. 3. The long bones were more resilient, stronger, softer and of higher specific gravity than normal and the abnormal compact bone of the skull was less resilient, weaker, harder and of about the same density as normal bones. 4. The simple investigation of determining the breaking strength of cortical bone yielded results similar to the more complex investigations and if applied to a larger series of cases could provide sound data on which to base speculations about this condition

1. An experimental study of the healing mechanism in circumscribed defects in femora of albino rats of the Wistar strain is described. 2. Only the outer one-fifth of the defect is repaired by subperiosteal bony callus, the rest of the defect being repaired by endosteal callus. 3. Subperiosteal callus does not bridge the defect until endosteal callus is developed fully. 4. As peripheral callus matures the greater part of the endosteal callus is resorbed, with the exception of trabeculae attached to the margin of the defect. 5. The resorbed area in the medullary part of the defect is gradually obliterated by deposition of inner circumferential lamellae. 6. There appear to be differences between the mechanism responsible for repair of fractures of a long bone and that which heals circumscribed bone defects

An experimental study performed in 16 mongrel dogs is presented, which shows that when venous stasis is combined with the local injection of non-esterified fatty acid an intense thrombosis results. This response is not produced by venous stasis alone, nor by the combination of venous stasis and triacylglycerol. Histologically it is quite different from the response produced by an inert intraluminal foreign body. It does resemble venous thrombosis described experimentally and in patients. The clinical relevance of these findings is that during accidental or operative trauma to a long bone, fat is commonly forced into the local venous circulation. If this event is combined with venous stasis or a tourniquet is used, then the circumstances of this experiment are reproduced. It is suggested that the venous thrombosis which commonly complicates long-bone injury or operation is in part caused by the thrombogenic nature of the introduced fat