1. Six cases of necrosis of articular cartilage complicating slipping of the upper femoral epiphysis are reviewed: histological examination in one case showed death of the superficial two-thirds of the articular cartilage, with survival of a layer of basal chondrocytes. In all six cases, after severe initial reduction of joint space as seen radiographically, there was gradual return of joint space, suggesting some regeneration of articular cartilage. The prognosis after cartilage necrosis is therefore not always so bad as has been supposed. 2. Various hypotheses concerning the cause of cartilage necrosis complicating slipped epiphysis are reviewed. The precise cause remains unknown, but there is substantial evidence against its being a consequence of ischaemia of the femoral head.
1. The problem of gap defects in the forearm bones and its solution by radio-ulnar fusion is discussed. 2. Seven patients with radio-ulnar fusions are presented. In four patients the operation was done for defects in the ulna, in two for defects in the radius, and in one for non-union of the radius and ulna after fracture. 3. The good cosmetic and functional result after radio-ulnar fusion is emphasised.
1. Avascular necrosis of the bony epiphysis or necrosis of the articular cartilage of the hip joint–without bony necrosis–can occur after a slipped upper femoral epiphysis. 2. In avascular necrosis of the bony epiphysis the prognosis depends upon the degree of revascularisation that occurs and upon survival of the articular cartilage. The articular cartilage can survive and a good functioning hip result especially if aided by mobilisation without weight bearing. 3. The prognosis after necrosis of the articular cartilage is poor. This complication occurs more often when conservative treatment is used. 4. A certain number of hips will show poor results no matter what treatment is used. 5. Nutrition of the articular cartilage is probably by the synovial fluid. 6. Strong traction may damage the soft-tissue structure of the hip joint. 7. It is not advisable to perform an osteotomy soon after a slip of the epiphysis. It is better to wait until good function is assured in the joint.
1. An analysis of 171 cases of compression arthrodesis in the knee is presented. 2. A total success rate of 98·8 per cent was revealed. 3. The average time between operation and walking free of splintage was nine weeks. 4. When the compression was removed, after an average period of four weeks, 88·2 per cent of the knees already showed clinical union.
