Three cases of multiple epiphysial dysplasia in three generations of one family are described. The history indicates that three further members, one in a fourth generation. have been affected.

Conclusions based on forty-six osteotomies show this to be a sound pain-relieving operation for osteoarthritis of the hip. The field of operation has been widened and some of the disadvantages have been avoided by nail and plate fixation. Early results from this method are similar to those from osteotomy and immobilisation in plaster, and it seems likely that the relief of pain will be just as enduring.

1. A dynamic muscle-tendon transposition is described for supplementing the power of weak lateral abdominal muscles, and the details of the operative technique are given.

2. A clinical assessment of the results in a series of twenty-four patients is given.

3. The indications for the operation in poliomyelitis are suggested.

1. In this series of posterior onlay grafting with fresh autogenous bone and without internal fixation, in the treatment of non-infective structural lesions in the lumbo-sacral area, 71 per cent of the patients were relieved of their symptoms, but bony fusion was obtained in only 60 per cent.

2. It is probable that with this technique twelve weeks' immobilisation in a plaster bed is required.

3. Some failures are ascribed to the use of an insufficient quantity of bone or to poor apposition of the graft to its bed.

4. It is evident that the more vertebrae one attempts to fuse the more difficult it is to succeed. When the diseased area is successfully fused but an unnecessarily long graft has been used, a pseudarthrosis above the level of the pre-operative pathology may be the cause of persisting backache. For these reasons we believe that one should not attempt to graft more vertebrae than is necessary to stabilise the local lesion.

5. The complication rate, particularly from deep vein thrombosis, was high. This major complication could perhaps be overcome by using banked bone.

6. The indications for the operation are assessed as follows. It should be done for low back pain only when there is a definite diagnosis and a limited extent of structural pathology; one can then expect excellent results when successful fusion is achieved and also an appreciably high proportion of satisfied patients even when bony fusion has not been obtained, presumably because there is a fibrous union strong enough to stabilise the affected spine.

It is inadvisable to undertake lumbar-lumbo-sacral fusion for intervertebral disc degeneration when there are more than three adjacent vertebrae involved, and in any case operation should be confined to the indicated extent.

A review of fifty cases of idiopathic pseudocoxalgia (Legg-Calvé-Perthes disease) followed into adult life for periods of eleven to thirty years (average seventeen years) after diagnosis shows:

1. In the whole series rather more than one-third of the patients developed hips which were normal or nearly normal.

2. An equal number had hips which could only have been considered "fair."

3. About one quarter had hips which gave pain and which showed marked loss of movement and gross degenerative changes radiologically.

Judged from the point of view of symptoms, the results were better than the foregoing would suggest. Three-quarters of the patients were fully active and free from pain but only two-fifths had hips which were radiologically good. It is possible that such apparently good results are unlikely to be permanent, and I hope, therefore, to continue this follow-up for another ten or fifteen years. It can, however, be concluded at this stage that an immediate good result is likely to be maintained at least until the age of twenty-five years, even though half of such patients will have radiologically abnormal hips.

There is a characteristic pattern of deformation of the femoral head and neck in the adult resulting from this condition in childhood, based on the degree of flattening of the head and shortening of the neck.

The end-results are better in adequately treated cases.

Two cases are reported in which osteochondritis dissecans developed as a late complication.

1. A case of persistent exercise ischaemia affecting the anterior tibial group of muscles is described.

2. Pathogenesis and treatment are discussed. Decompression of the anterior tibial compartment is required if the patient is unwilling to give up whatever activity causes the exercise pain.

1. The thesis is advanced that in the treatment of fractures of the adult tibia rigid fixation is desirable.

2. The mechanical factors are discussed and a technique is described which provides a high degree of fixation without exposing more than one surface of the bone.

3. The process of healing of such fractures is described and the results in thirty-three unselected patients are given.

1. Two cases of arterial damage complicating shoulder injuries are reported.

2. The treatment is described and the importance of early diagnosis is stressed.

3. Operation was indicated in both cases by developing ischaemia in spite of conservative measures.

1. Eight cases of solitary eosinophilic granuloma of bone are described, along with two possible complications.

2. The main pathological, clinical, and radiographic features of the condition, and its treatment, are discussed.

3. The essentially benign course of the solitary lesion, even in the presence of complications, is confirmed.

1. A case of posterior dislocation of both shoulders, in a patient believed to be epileptic, is described.

2. The difficulties of early diagnosis are discussed.

1. The occurrence of congenital discoid medial cartilages in two patients is reported: in one the abnormality was bilateral. The three specimens are described and illustrated.

2. The literature on the subject is reviewed and the specimens discussed and classified.

1. By reducing the viscosity of the synovial fluid within the ankle joints of rabbits and then subjecting these to prolonged exercise, wear and tear of articular cartilage can be consistently produced.

2. This finding is an indirect confirmation of the view that fluid film lubrication is an important factor in the mechanical efficiency of joints.

3. The special properties of synovial fluid and articular cartilage that allow fluid film lubrication to exist within joints that are, in effect, slowly moving, heavily loaded, reciprocating bearings are discussed. They account for the remarkable resistance to wear and tear exhibited by synovial joints under physiological conditions.