One hundred and sixty-four cases of intramedullary nailing of the long bones have been studied with special reference to the difficulties and complications encountered.

There was one death not attributable to the method.

Two cases of pulmonal fat embolism and one case of thrombosis occurred, all in fractures of the femur.

The lessons we have learned from our mistakes can be summarised as follows:

1 . The method requires technical experience and knowledge and is not suited to inexperienced surgeons or surgeons with little fracture material at their disposal.

2. Intramedullary nailing should only be used in fractures to which the method is suited. In general, comminuted fractures or fractures near a joint are unsuitable.

3. Open reduction is preferable to closed methods.

4. The nail should never be driven in with violence. It should be removed and replaced with a new one if difficulty is encountered when inserting it.

5. In fractures of the femur the nail should be driven in from the tip of the trochanter after careful determination of the direction.

6. The nail should be introduced only to the level of the fracture before exploring and reducing the fracture.

7. Distraction of the fragments must be avoided.

8. If the nail bends it should be replaced by a new one, at least in femoral fractures.

9. If union is delayed, the fracture should be explored and chip grafts of cancellous bone placed around it.

10. Improvised nails or nails which are not made of absolutely reliable material should never be used.

11 . Make sure that the nail is equipped with an extraction hole for removal.

1. Léri's pleonosteosis is characterised by broadening and deformity of the thumbs and great toes, flexion contracture of the interphalangeal joints, limited movement of other joints, and often a Mongoloid facies. Four such cases are described.

2. A review of the twenty reports in the literature, and the cases now described, shows that the deformities are due to capsular contracture rather than deformity of bone.

3. In one patient there was striking evidence of fibro-cartilaginous thickening of the anterior carpal ligaments. It is suggested that the primary pathological change in pleonosteosis may be in the joint capsules rather than in the epiphyses.

4. The patient with thickening of the anterior carpal ligaments had bilateral median palsy from carpal tunnel compression.

5. The causes of carpal tunnel compression of the median nerve are reviewed. Acute compression may be due not only to dislocation of the semilunar bone but to haemorrhage in the palm. Late compression by bone may occur twenty to fifty years after injury. Late compression without bone abnormality has been attributed to occupational stress, but it is suggested that pathological thickening of the anterior carpal ligament may be the cause.

6. The patient with pleonosteosis and bilateral median palsy had also bilateral Morton's metatarsalgia with large digital neuromata.

7. Plantar digital neuritis has already been shown to be an ischaemic nerve lesion preceded by degenerative changes in the digital artery. The significance of the fibrous tunnel through which the artery passes to reach the digital cleft is considered.

Summary—Fifty-two cases of exposure of the glenoid labrum are recorded. Fifty-one operations with anterior exposure, followed by capsular reefing and shortening of the subscapularis, were successful. One operation with superior exposure, and without capsular reefing or shortening of the subscapularis, was unsuccessful.