1. Five cases of scoliosis with paraplegia are reported, and thirty-six comparable cases from the literature are reviewed. These forty-one cases have been studied with the object of determining the etiology of scoliosis, the reason why cord compression sometimes develops, and the results of conservative and operative treatment of such compression of the cord.

2. The cause of paraplegia is nearly always compression of the spinal cord by the dura, which, in severe scoliosis, is under longitudinal tension because of its firm attachment to the foramen magnum above and the sacrum below. Such tension, resisting displacement of the spinal cord from the straight line, may be shown to cause incomplete spinal block even when there is no paralysis.

3. When paralysis occurs it usually develops during the years of most rapid growth, the tight dura being unable to accommodate itself to the rate of growth of the spinal column; cord compression is probably increased by narrowing of the dural sac by rotational displacement.

4. The most striking results have been secured by laminectomy with section of the dura and sometimes division of dentate ligaments and tight nerve roots. After such division there is evidence of release of compression: the cord herniates through the dural slit; and spinal pulsation returns.

5. It is important to control bleeding in order to avoid post-operative compression by blood clot; and to prevent leakage of cerebro-spinal fluid through the arachnoid.

6. It is unwise to perform spinal fusion at the same time as decompression because it increases the danger of haematoma formation. Moreover the improvement gained by decompression is maintained even if no fusion of the spine is performed.

7. Conservative treatment of scoliosis with paraplegia should not be continued for long periods unless there is evidence of early and progressive improvement because prolonged compression causes irreversible changes in the cord.

8. In three cases, paraplegia was not due to dural compression: one turned out later to be a case of syringomyelia; one, reported by Heyman, was due to the pressure of a bone spur; and one, reported in this series, was due to a congenital tight band of developmental origin which might have caused the scoliosis as well as the paralysis, and in which, after resection of the band, recovery from the paralysis was complete.

1. Four cases of polyostotic fibrous dysplasia are presented.

2. All are males, all show cutaneous pigmentation, and in two there has been precocious puberty.

3. The literature has been reviewed, and present conceptions of the pathology and etiology of the disease have been discussed.

4. The dysplasia if often confused with parathyroid osteodystrophy and sometimes the parathyroid glands are needlessly explored. This confusion should not arise if it is remembered that no general skeletal decalcification, and no constant changes in the blood calcium or phosphorus, occur in polyostotic fibrous dysplasia. The radiographic appearances of healing parathyroid osteodystrophy are, however, indistinguishable.

5. No effective therapy has been discovered for this disease. Pathological fractures and deformities may require treatment.

1. Various types of fracture of the femoral neck represent different stages of one and the same displacing movement.

2. The displacement first produces an "abduction fracture" and terminates in an "adduction fracture," passing through the stage of an " intermediary fracture" which is less well recognised.

3. These three types of fracture occur in response to the same injury and they differ only in the degree of displacement.

4. It is a mistake to believe that in " adduction fractures" the femoral head lies medially to the collum : it lies posteriorly.

5. "Impaction" is no more than the first stage of displacement of fractures in which there is limited displacement, with contact still maintained between the fragments.

6. An "impacted fracture" is not necessarily stable—if there is additional strain it may progress to the next stage of a displaced and unstable fracture.

7. These principles apply not only to fractures of the femoral neck but to all other fractures at the ends of long bones.

1. Trochanteric fractures are classified, with special emphasis on the stability or instability of the fracture. The importance of the cortical buttress of bone on the inner side of the femoral neck and shaft is stressed.

2. Three series of cases are presented: a) one hundred and one cases treated conservatively in hospital; b) twenty-five cases sent home by reason of lack of hospital beds; c) twenty-two cases treated by fixation with a Capener-Neufeld nail-plate.

3. From consideration of these three series, and from study of similar series of cases reported in the literature, it is suggested that routine operative treatment of trochanteric fractures has the advantages of greater comfort and mobility of the patient, lowered mortality, and economy of hospital beds.

4. Certain features of the operation of internal fixation by the Capener-Neufeld nail-plate are discussed. A director, for more efficient insertion of the nail-plate, is described.

5. The importance of early mobility after operation is emphasized. Only a small proportion of Patients can be allowed early weight-bearing but almost all can be got up in a chair, and most can be taught to get about with crutches, without weight-bearing on the fractured limb, within a few days of operation.

1. A series of one hundred consecutive cases of trochanteric fractures treated conservatively by the authors has been reviewed.

2. Analysis of the results obtained and a study of the relevant literature has led us to the firm conclusion that the routine treatment of this group of fractures should be conservative.

3. Internal fixation should be reserved for those exceptional cases where traction is found to be inadequate: this is specially likely in cases associated with an upper motor neuron lesion, where difficulty is experienced in maintaining reduction owing to muscle spasm.

4. The basal type of fracture offers a special problem because it merges imperceptibly into that of the true transcervical fracture. No difficulty has been experienced in this series in the conservative treatment of such fractures, but we recognise that they might well be regarded as a variety of transcervical fracture and treated by nailing in order to avoid the risk of non-union.

1. An operation is described for ischio-femoral extra-articular arthrodesis of the hip joint by posterior open approach, based on the techniques of Trumble and Brittain.

2. The operation has the advantages of affording adequate exposure of the sciatic nerve trunk and permitting visual control of the alignment and penetration of the chisel and graft.

3. The operation has been performed successfully without serious shock or subsequent complications in eighteen cases, mostly of tuberculosis of the hip.

1. After limb injuries with loss of skin and subcutaneous tissue, full-thickness skin flaps afford the most satisfactory cover. It is particularly important to replace unstable and scarred skin before attempting bone reconstruction and similar operations.

2. In the leg and foot, full-thickness skin cover is conveniently obtained by the cross-leg flap technique. The blood supply of such flaps is considered and the technique of operation is described. Free excision of avascular scar tissue is essential.

3. "Delayed transfer" of the flap is advisable unless conditions are favourable; two methods are considered.

4. Immobilisation in plaster is the most satisfactory method of fixation of the limbs after attachment of the flap. Muscle exercises are performed throughout the period of treatment in order to minimise joint stiffness and shorten convalescence.

5. The cross-leg flap technique should not usually be used in children, young women, or the aged and mentally infirm. Contra-indications include arthritis of the knee and hip joints because there is danger of joint stiffness.

6. Vascular complications of cross-leg skin grafting are discussed.

1. Twenty-five cases of benign giant-cell tumour of bone, treated at Westminster Hospital, London, are reported.

2. The diagnosis can often be made on clinical and radiographic grounds alone but biopsy is sometimes necessary and seldom, if ever, contra-indicated.

3. Some cases may best be treated by excision, but in general irradiation is the treatment of choice.

4. Details of treatment by irradiation are given.

1. In this series of thirty-eight cases of osteoclastoma, twenty-five occurred at the end of a long bone. Nineteen were in the lower limb and half tif these were near the knee joint; six were in the upper limb; of the remainder, nine occurred in the vertebrae or the sacrum.

2. More cases occurred in females than males, the ratio being twenty-three females to fifteen males. Just over half the cases occurred in the second and third decades.

3. In seven there was a definite history of injury preceding symptoms by several months.

4. It is often difficult to arrive at a diagnosis on clinical and radiographic findings alone. Histological information is usually necessary before a certain diagnosis can be made. A limited biopsy is safe and reliable.

5. Malignant change with the development of metastases occurs in a small proportion of cases, regardless of the particular treatment that has been employed. This is illustrated in Case 3 of this series, in the case reported by Gordon Taylor, and in the case reported by Finch and Gleave.

6. The methods of treatment used in the patients here reported included curettage or local excision, with or without radiation, and radiation alone.

7. The patients treated by curettage or excision were dealt with during an earlier period than those treated by irradiation alone, and an exact comparison of results is not possible. The follow-up of patients treated by radiotherapy alone is too short to exclude the possibility of recurrence; but the immediate results appear to show definite improvement upon those of surgical treatment.

8. In this limited series it is to be noted that malignant change occurred in a higher proportion of cases treated by curettage and radiotherapy than in those treated by radiotherapy alone.

9. It appears that, in the treatment of osteoclastoma of bone, radiotherapy alone is the treatment of choice.

The problems of diagnosis and treatment of osteoclastoma are considered. The importance of full investigation, and the advantages of drill biopsy in confirming the diagnosis, are discussed. Treatment by radiation is believed to be better than treatment by surgical measures. Curettage and excision are unnecessary. Amputation for benign osteoclastoma is unjustifiable.