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The Journal of Bone & Joint Surgery British Volume
Vol. 43-B, Issue 2 | Pages 346 - 361
1 May 1961
Caldwell RA Collins DH

1. Radiological, chemical and histological examinations have been made of the lumbar vertebral bodies in 100 necropsies on patients dying in a general hospital, with a view to determining the range of variation of calcium content and radiographic density in normal and osteoporotic bone.

2. Radiographs were made of sagittal mid-line vertebral body slabs uniformly one centimetre in thickness, and the radiographic density of these specimens was measured in relation to an aluminium step-wedge of one to ten units. Radio-opacity of different vertebrae ranged from four to ten units. The specimen radiographs also clearly revealed the trabecular structure and the lateral profile of the bones.

3. Calcium was chemically estimated and expressed as weight of the element per unit volume of the whole bone mass (that is, of anatomical bone including soft marrow tissue). It ranged from 38 to 102 milligrams per cubic centimetre of bone. In 75 per cent of the cases the range was 50-84 milligrams per cubic centimetre. High calcium values were mostly encountered in young adults, and the calcium per unit volume tended to diminish with age; but a wide range of calcium was still encountered in the older subjects and a better correlation with age was achieved by radiographic density. Both calcium content and radiographic density tended to be higher in the male than in the female bones at all ages.

4. The results of both calcium and radiographic density showed a smooth distribution curve, though skewed through the inclusion in the series of more older people with less mineralised bones; the absence of a double peak in these curves suggests that the examinations were made on a homogeneous population and does not indicate a separate pathological group of osteoporotic subjects.

5. Arbitrary standards must be used to distinguish osteoporotic from normal bones, since neither radiological measurement or chemical assay, nor histological assessment, reveals a point at which the two groups can be separated. In the present series it seemed to us satisfactory to regard as abnormal all bones showing a radiographic density of five or less step-wedge units, and by this standard nineteen of the 100 cases (eight male, eleven female) were deemed to be osteoporotic. Histological examination excluded other forms of bone rarefaction.

6. The regression of calcium on the density measurements proved to be statistically significant and was not affected either by age or by the number of days in bed during the last illness. A small difference between the sexes was apparent, there being slightly less calcium in female than in male bones of equal radiographic density. Provided this is taken into account, the radiographic density scale can be used to predict the calcium content of vertebral bone specimens and should prove a rapid and accurate method in a survey of osteoporosis in post-mortem room material.




The Journal of Bone & Joint Surgery British Volume
Vol. 36-B, Issue 3 | Pages 458 - 463
1 Aug 1954
Collins DH

1. A pathological study has been made of eight femurs containing acrylic Judet type prostheses, in patients who had died two to thirteen weeks after arthroplasty.

2. Haemorrhage occurs into the tunnel and into a limited zone of the spongy bone around the tunnel. Organisation of the blood clot is evident at two weeks and new bone formation appears shortly afterwards. At eight weeks the tunnel is lined by a fibrous membrane. Further fibrosis and new bone growth tend to establish a new surface, healing the wound in the bone and sequestrating the foreign body.

3. There is no evidence that the intact methyl-methacrylate appliance had exerted any toxic action on the tissues.


The Journal of Bone & Joint Surgery British Volume
Vol. 35-B, Issue 4 | Pages 518 - 520
1 Nov 1953
Collins DH




The Journal of Bone & Joint Surgery British Volume
Vol. 33-B, Issue 3 | Pages 436 - 441
1 Aug 1951
Collins DH

1. Rusty staining of the synovial membrane is the gross manifestation of loading of phagocytic synovial-lining cells and of macrophages in the stratum synoviale with haemosiderin.

2. Absorption of blood effused into the joint cavities is the commonest cause of such synovial pigmentation.

3. Obvious discolouration of the synovial tissues usually follows only after repeated haemarthroses, in such conditions as haemophilia, synovial tumour and in some cases of chronic rheumatoid arthritis.

4. An identical naked-eye appearance is seen in multiple joints of patients with generalised haemochromatosis.

5. In haemochromatosis the iron-containing pigment tends to be confined to the surface layer of cells of the synovial membrane.

6. The presence of haemosiderin in synovial cells, per se, leads to no disability of the joint and is unaccompanied either by inflammatory reaction or fibrosis. Arthritis in a patient with haemochromatosis is fortuitous.


The Journal of Bone & Joint Surgery British Volume
Vol. 32-B, Issue 2 | Pages 214 - 222
1 May 1950
Bingold AC Collins DH

1. Clinically, hallux rigidus is a painful condition of the joints of the great toe associated with loss of dorsiflexion of the first phalanx.

2. Pathologically, the morbid changes are those of a traumatic synovitis followed by an early development of osteoarthritis, the initial lesions of which are erosions of the cartilage at the centre and near the dorsal margin of the base of the proximal phalanx. There is no fundamental pathological difference between the adult and adolescent varieties of hallux ngidus. Both represent stages in the developmental cycle of osteoarthritis in the proximal joint of the great toe.

3. The radiographic density and apparent fragmentation of the phalangeal epiphysis do not represent an abnormality of the bone and have no significance in the etiology of hallux rigidus.

4. The cause of hallux rigidus is an abnormal gait developed either to protect an injured or inflamed metatarso-phalangeal joint from the pressure of weight-bearing, or to stabilise a hypermobile first metatarsal. The effects of this gait are to transfer most of the pressure from the flexor brevis tendon and the two sesamoids to the base of the first phalanx. Excessive pressure on this joint predisposes to osteoarthritis.

5. Evidence of this abnormal gait is found in the peculiarities of wear seen in old shoes.

6. There is a high correlation between unilateral hallux rigidus and the patient's footedness.