A few points in this report deserve to be stressed.

Indications–It is important that the orthopaedic surgeon should decide at a very early stage which of the two methods, closed or open, he must use. These do not exclude each other but are on the other hand complementary. Nowadays the dislocated hip can be reduced by open operation with a very good chance of lasting success. This should be carried out if a hip cannot easily be reduced otherwise, or if there is any doubt that closed reduction has been successful–and as early as possible, preferably before the age of three years.

Technique–Ample exposure of the joint and removal of all obstacles to reduction are important. Reduction must be complete and stable but without stress, and there must be no interference with the articular bone and cartilage.

After-care–Reduction, however perfect, is only the first step towards recovery. The hip must be observed carefully and the most suitable moments for mobilisation and for walking must be chosen; this calls for nice judgment. When it is clear that the roof of the acetabulum is not developing or that persistent valgus and anteversion may encourage subluxation, a secondary operation should be undertaken at once. Radiography is necessary about every three months for the first two years.

Assessment of results–With a strict system of assessment, like McFarland's, we have observed 68·3 per cent favourable results in 171 hips treated by open reduction.

It is obvious that the problem of congenital dislocation of the hip has not yet been completely solved. But if we review the progress of recent years we come to the encouraging conclusion that much has already been achieved, and that the efforts of the many orthopaedic surgeons who have dedicated themselves to the treatment of congenital dislocation of the hip have not gone unrewarded.

1. Congenital dislocation of the hip can be diagnosed clinically immediately after birth and the diagnosis confirmed radiologically by a special technique.

2. If the affected joint is reduced during the first two or three days after birth and held reduced for a period not exceeding three months, the joint will remain stable.

3. This treatment probably leads to normal development of the hip joint.

4. The cause of congenital dislocation of the hip may be laxity of the soft tissues of the joint and not a primary dysplasia of the acetabulum.

1. A simple test more sensitive than Ortolani's for the diagnosis of instability of the hip in the new-born is described. It takes only a few seconds to perform and can be quickly taught to doctors, nurses and midwives.

2. About one infant in sixty is born with instability of one or both hips. Over 60 per cent of these recover in the first week of life, and 88 per cent in the first two months. The remaining 12 per cent are true congenital dislocations and persist unless treated, giving an incidence of 1·55 per thousand.

3. Treatment with the type of splint described begun within the first week is simple and effective, and gives a hip clinically normal long before the child begins to walk.

4. The concept of a pre-dislocation phase should be abandoned.

1 . Twenty patients with fibrous dysplasia, confirmed histologically, are reported and discussed in regard to classification, etiology, pathogenesis and treatment. The various fibrous or fibrocystic lesions of bone are characterised briefly for purpose of contrast, and the position of fibrous dysplasia in this heterogeneous collection is suggested.

2. The classification of fibrous dysplasia based on the degree of skeletal involvement is used, and the diagnostic, therapeutic and prognostic implications of this classification emphasised. The authors endorse the opinion that fibrous dysplasia is a developmental defect. Clinical, histological and radiographic evidence is presented to point to the distinct evolution of the monostotic lesions, to which a positive and aggressive approach is recommended.

1. Five new cases of pyogenic osteomyelitis of the patella are reported.

2. The clinical features are reviewed and the diagnostic pitfalls enumerated.

1. A method of medullary nailing of fractures of the shaft of the tibia with a straight clover-leaf nail of large calibre is described. The nail is introduced, without exposure of the fracture, through the deep infrapatellar bursa. No external splint is used and the patient is usually allowed to walk as soon as the wound is healed. The technique is essentially that of Küntscher.

2. The results obtained in the first fifty patients so treated are described. The average period of absence from work for those twenty-five whose treatment was satisfactory was eleven weeks. There were no cases of sepsis or non-union; the only difficulties encountered were mechanical ones.

1. Correction of hallux valgus by spike osteotomy of the neck of the first metatarsal is described, and the results in eighty-two feet are presented.

2. A high proportion of satisfactory results can be obtained, but great care is needed in both selection and technique.

3. The ideal case is one of moderate deformity, without degenerative arthritis, and with symptoms referable to increased width of the forefoot; the operation should not be performed in cases with obvious degenerative change, nor when metatarsalgia is a prominent symptom.

4. It is important to displace the metatarsal head as far laterally as possible, and vital to avoid dorsal angulation or displacement.

5. It is suggested that enough is now known about the natural evolution of hallux valgus and the results of some operations for prophylactic surgery to be undertaken in carefully selected cases.

1. A modification of the Keller's arthroplasty is described, in which one of two types of distractor–intramedullary wire and external staple–is used to maintain normal length of the great toe for three weeks after operation.

2. The results of the modified operation are analysed. They appear to show that the use of a distractor can be expected to produce an improved end result and to aid post-operative wound healing.

3. The possible reasons for the improvement in results are discussed.

4. The intramedullary wire and the external staple are compared with respect to ease of introduction, effectiveness in maintaining distraction and end results.

1. The average number of cases of osteogenic sarcoma found in the years 1946-58 inclusive in the northern division of the South-west Hospital region of England was 6·7 for each year, varying from three to ten.

2. The annual incidence of this sarcoma in this area was one tumour per 230,000 population.

3. These figures were compared with similar figures from Norway which indicate a rather similar tumour incidence among juveniles, but a very much smaller number of tumours in elderly persons.

4. Among the eighty-seven sarcomata collected in the specified area in thirteen years twenty-Six were associated with Paget's disease.

5. It is estimated that among the population of the specified area there were probably 26,000 persons at any time with Paget's disease, of whom one in 650 (0·15 per cent) would eventually develop sarcoma.

6. This study suggests that Paget's disease increases the risk of sarcoma about thirty-fold in persons over forty years of age.

7. It is tentatively suggested that the incidence of Paget's disease is influenced more by heredity than environment.

1. Recurrence of deformity after operations for drop foot is often associated with opening of the front of the ankle joint: this has previously been regarded as a complication of the operation.

2. This study of sixty paralytic drop feet treated conservatively reveals that this laxity was in fact present in no less than 43 per cent.

3. The laxity is most commonly found when the calf muscle is strong and it can occur within a year of the onset of the paralysis. It is not always prevented by wearing a toe-raising spring.

4. Such anterior laxity may well be a common cause of failure of many of the standard operations for drop foot.

5. Before operation for drop foot is undertaken a lateral radiograph of the ankle should be taken in forced plantar-flexiori. If this demonstrates anterior laxity any standard operation is unlikely to succeed unless the anterior fibres of the collateral ligaments are protected from strain by simultaneous tendon transplantation or unless the ankle is included in the arthrodesis.

1. Sustained medial rotation of the hind limb in the immature rabbit produces femoral anteversion and acetabular dysplasia.

2. Sustained lateral rotation produces retroversion.

3. Splinting the hind limbs in the Lorenz position corrects both anteversion and retroversion.

4. The mechanism of the Lorenz position is discussed.

1. Femoral neck deformities that developed in patients under clinical observation are described.

2. Experiments made on ten decalcified femora produced similar deformities.

3. The two sets of observations are correlated and discussed with reference to the role of muscular imbalance in the causation of deformities of the femoral neck.

1. Some physical properties of living and dead bone have been studied in rats; most of these are interrelated and ultimately depend upon the composition of the tissue.

2. Dead bone, remaining within the body, does not take up measurable amounts of mineral from the tissue fluid but retains its original physical properties of radiographic density, specific gravity, strength and composition.

3. The altered radiographic density of avascular bone seen in clinical practice is almost certainly relative unless there has been concomitant appositional new bone formation.

4. Some other explanation must be sought for the finding that dead bone takes up significant amounts of bone-seeking isotopes in radioactive tracer studies.

1. Penetrating defects were cut in the femora of twenty-five albino rats. In fifteen of the animals the defects in the right legs were protected with cellulose-acetate shields while those in the left legs were unprotected and allowed to heal as controls. In the remaining ten animals the defects in both legs were protected with shields made of homogenous organic bone.

2. New bone was found to proliferate into the concavity of the shields in most of the animals and this protruded beyond the contour of the femur. The development of the protuberance appeared to depend upon the degree to which the shield was adapted to the femoral surface.

3. The cellulose-acetate shield was not removed by the host, but the homogenous organic bone was actively resorbed; multinucleated giant cells were associated with this process.

4. There are indications that the maintenance of the protuberance is dependent upon the continued presence of the shield. Exostoses protected by intact cellulose-acetate shields have been recognised up to eighteen months after operation.

5. The function of the shield in the formation of the bony protuberance is thought to be two-fold, in that it protects the haematoma from invasion by non-osteogenic extra-skeletal connective tissue, and that it governs the size of the haematoma and prevents its distortion by the pressure of the overlying soft tissue.