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1. Eleven cases of tuberculosis of the pubis are described.
2. The disease is often of insidious onset, and symptoms vary from vague discomfort to incapacitating pain in the region of the symphysis and the groin.
3. Abscess formation is common and was present in nine of the eleven patients when they first attended.
4. The lesion has a good prognosis and responds well to simple curettage.
5. In this series operation, without bone grafting, has not been followed by pelvic instability or back pain.
1. The results of treatment of 115 patients with Pott's paraplegia during a six and a half year period are reviewed.
2. The indications for operative interventionâin particular antero-lateral decompressionâ according to the duration, grade and type of paraplegia, are discussed.
3. No attempt has been made to justify the treatment of individual patients in the series, some of whom would undoubtedly have benefited from earlier operation; but lessons are pointed and conclusions drawn from the results, good and bad.
1. In Nigeria, among the sites affected by tuberculosis of bones and joints there is especial frequency in the lumbo-thoracic junction from the tenth thoracic to the fourth lumbar vertebrae.
2. Outstanding in the pattern of the disease in adults is a tendency in certain patients to ossification of the spinal ligaments.
3. An ambulatory out-patient reÌgime is described. So far it has promised well.
1. The clinical and radiological features of thirty-two feet with congenital vertical talus are described and subdivided into groups determined by the presence or absence of associated abnormalities.
2. The differential diagnosis of congenital vertical talus from flat foot, talipes calcaneus and uncorrected club foot is discussed.
3. No benefit came from either non-operative treatment or tenotomy of the tibialis anterior.
1 . A series of 343 tibial shaft fractures proceeding to sound union in adults, and 192 fractures in children, was studied. Groups of fractures differing from each other only in the one particular variable under consideration were compared.
2. The severity of the injury (as assessed by the degree of displacement, of comminution and of compound wounding) was found to be an important determinant of speed of fracture union and of incidence of delayed and non-union. A simple classification of severity of injury is described.
3. Distraction delayed healing. Traction which avoided distraction had no effect on the rate of union of fractures of moderate severity compared with cases of similar severity of injury treated by immobilisation only. Major fractures subjected to traction did take longer to unite on the average, but there was no increase in the incidence of delayed or non-union.
1. Neuroblastoma is a disease that may concern the orthopaedic surgeon closely.
2. Six such cases are reported.
3. Early diagnosis may be difficult, but can be achieved if the condition is suspected and an adequate investigation is carried out on suspicion alone.
4. The prognosis in these patients is still poor, but might be improved by a vigorous combination of surgery, irradiation and chemotherapy. The recent advance in treatment with vitamin B 12 may improve the prognosis substantially.
1. Two cases are reported in which hyperkalaemia was a prominent feature in acute renal failure and in which obvious sources of excess potassium were apparent.
2. The literature pertaining to potassium in acute renal failure is briefly reviewed.
3. A return to the surgical elimination of large and expendable tissue sources of potassium in the management of acute renal failure with hyperkalaemia is suggested.
1. A case of hypophosphatasia in a boy who sustained a fractured left femur is described.
2. The literature is reviewed, and the reported cases are found to fall into severe, moderately severe and mild forms.
3. The diagnostic features of the disease are the radiological picture, which resembles that of rickets, very low serum alkaline phosphatase, and excessive phosphoethanolamine excretion in the urine.
4. Other clinical features may be a failure to thrive in early infancy, premature loss of deciduous teeth, hypercalcaemia and renal damage.
5. The function of alkaline phosphatase in bone metabolism in relation to this disease has been discussed.
1. Seventy-seven operations on the patella have been reviewed.
2. There is no evidence that arthritic changes in the femoral condyles are an inevitable sequel of complete excision of the patella.
3. There is a direct relationship between the severity of symptoms after complete excision of the patella and the extent of ossification in the quadriceps tendon.
4. Patello-femoral arthritis after partial excision of the patella may be due to faulty realignment of the patellar ligament and consequent tilting of the patellar remnant towards the femoral condyles.
An anomaly is reported in a girl aged eight years in which an outgrowth from the left radius articulated with a hollow in an eminence on the corresponding ulna. The histological findings are described and the significance of this unusual malformation is discussed.
1. Familial metaphysial dysplasia occurring in two families is recorded.
2. One case with unusual skull changes and webbing of the digits is described in detail.
3. The similarity between the shape of the bones in familial metaphysial dysplasia and other bone disease is discussed.
The intermittent administration of cortisone in both the young and the mature rabbit is associated with appositional bone growth on the periosteal surfaces of the cranium, premaxilla and middle of the shaft of the femur; each new layer of bone is separated from the next by a darkly haematoxylin-staining "reversal" line. The internal architecture of the bone also changes in consequence of the repeated waves of resorption and deposition of bone round vascular spaces.
Cartilaginous growth at the epiphysis in the young rabbit is also affected. The long columns of metaphysial cartilage are replaced by a layer of new bone which partly seals the epiphysial cartilage from the marrow spaces.
1. The methods by which epiphyses receive their blood supply was studied by means of India ink injections in monkeys. Two types were identified depending upon whether the epiphysis was entirely or partly covered by articular cartilage. In the former, nutrient vessels enter the epiphysis by traversing the perichondrium at the periphery of the plate. In the latter they enter the epiphysis by penetrating the cortex at the side of the epiphysis at a point remote from the epiphysial plate.
2. The histological changes after separation of the second type of epiphysis were also studied. After temporary interference with endochondral ossification marked by increased thickness of the epiphysial plate, healing occurred so rapidly that within three weeks it was difficult to determine that the epiphysis had been separated at all.
3. It is concluded that when nutrient vessels enter an epiphysis at a point remote from the epiphysial plate, that epiphysis can be separated without serious disturbance to its blood supply and accordingly without interference with its capacity for growth. As it has been established that an epiphysis which is entirely covered by articular cartilage cannot be separated without destruction of its blood supply and subsequent avascular necrosis (Harris and Hobson 1956), it is concluded that the prognosis of an epiphysial separation is dependent upon the degree of damage to its blood supply rather than the mechanical disturbance of the epiphysial plate.
1. A study of normal and osteoarthritic hyaline cartilage has been made with the electron microscope and x-ray diffraction.
2. Normal cartilage consists of a three-dimensional network of collagen fibrils with no preferred orientation, surrounded by a matrix containing polysaccharide.
3. In the osteoarthritic joint the collagen fibrils show definite orientation and a decreased proportion of ground substance. X-ray diffraction confirms this and shows the orientation to be at right angles to the surface of the femoral head.
4. Tensional forces across the joint may explain why osteoarthritic changes first appear in the non-weight-bearing area of the joint.
1. Eighteen normal discs from cadavers and seventy-five specimens of abnormal disc material obtained at laminectomy have been compared.
2. Imbibition pressure, and not osmotic pressure, is the important factor in maintaining hydration of the nucleus, and the comparison has been based on this finding. The terms "free imbibition index" and "effective imbibition index" are suggested as being readily determinable means of expressing the functional efficiency of a nucleus.
3. A reduction in imbibition pressure was a constant feature of the specimens obtained at operation. No evidence was found to support the theory that hyper-hydration or engorgement of the nucleus plays a part in disc protrusion. A reduction in imbibition pressure can, however, be expected in itself, by a combination of mechanical and hydrostatic effects, to cause disc derangements.
4. The reduced imbibition pressure of abnormal discs is related to abnormal loss of, or deterioration in, the protein/polysaccharide of the nucleus. The premature onset of, or some disturbance in, the normal ageing process is a prime cause of mechanical derangement of the disc.
1) Our attention has been called to an omission in the account sent to us of the May 1957 meeting of the South-West Orthopaedic Club held at Bath (Journal of Bone and Joint Surgery,
2) Novemter 1957,
