1. One hundred cases of congenital elevation of the scapula are reviewed; thirty-four were treated by operation.

2. A method of grading of appearance is suggested to assist in selecting cases for operation.

3. In very mild cases operation does not confer worthwhile benefit.

4. Very severely affected patients cannot be made to look normal.

5. The appearance often deteriorates during a period of rapid growth of the neck, making continued observation and reassessment essential.

6. The primary aim of treatment is to improve appearance; improvement in function is uncertain.

7. Excision of the supero-medial part of the scapula, and of the omo-vertebral bone when present, is recommended in most cases requiring operation. It is safe and simple, with little risk of loss of function and with simple after-treatment.

1. In fifteen patients with unilateral osteoarthritis of the hip bilateral measurements of the intraosseous pressure of the femoral neck and determination of femoral vein pressure were done simultaneously. These pressure examinations were followed by bilateral intraosseous phlebography of the proximal part of the femur.

2. In a second series of fifteen patients the intraosseous pressures of the femoral head and neck were measured simultaneously before operation for osteoarthritis.

3. The pressure in the femoral vein was equal on the two sides. The intraosseous pressure in the femoral neck was always higher in the arthritic hip than on the unaffected side. In hips with osteoarthritis the pressure in the femoral head was higher than the pressure in the neck.

4. Intraosseous phlebography indicated a state of intramedullary venous engorgement in osteoarthritis. The normal channels for venous drainage from the femoral head and neck were not visible in the phlebographs from the arthritic side. Instead, drainage took place through descending intramedullary vessels to the trochanteric region and down into the femoral shaft. The emptying of intraosseous contrast material from the arthritic hip was delayed.

5. The phlebographs indicated that the abnormally high intraosseous pressure observed in osteoarthritis is caused by a high resistance to flow across the cortex of the proximal part of the femur.

6. The aching rest pain typical of severe osteoarthritis was noted only in patients with intraosseous femoral neck pressure above 40 millimetres of mercury, an indication that this type of pain is caused by intramedullary hypertension. The decrease of arteriovenous pressure difference, caused by increase of resistance to venous outflow, is probably accompanied by disturbances of nutritive flow. This "venous ischaemia" may play an important role for the structural changes of cancellous bone in osteoarthritis.

1. The problem of paralytic hip instability has been studied in a series of twenty-one patients brought to a spina bifida clinic.

2. Thirty iliopsoas tendon transfers were done in an attempt to reduce deformity and improve hip stability.

3. At the time of review, ten of these hips were stable and twenty were unstable. Ten hips were improved by operation, and one hip was worse. The other nineteen remained the same.

4. All of the children except one were capable of walking with an orthotic device.

5. Some of the complexities of the problem of paralytic hip instability in the patient with myelomeningocele are discussed.

1. A modification of the McLaughlin technique of lag screw fixation of the fractured scaphoid is described.

2. Fifty-six patients operated upon between 1956 and 1966 have been reviewed and their fractures classified under the headings recent, delayed union and non-union.

3. Plaster casts were avoided and early return to work encouraged; 95 per cent did so within two months.

4. Of twenty-two recent fractures, including three perilunar trans-scaphoid dislocations, nineteen united; of fifteen showing delayed union, eight united: and of nineteen cases of non-union, only two united.

5. The function of the wrist in the seventeen cases of persistent non-union stabilised by lag-screw was surprisingly good; only one patient has required arthrodesis to date.

6. The indications and contra-indications for the operation are discussed.

1. This is a preliminary report of an attempt to determine an objective reference point or "point of motion" during flexion and extension of the lumbar spine.

2. The method described uses superimposition of lateral radiographs taken in flexion and extension with the patient standing.

3. In seventy-eight radiographically normal subjects with no symptoms a "point of motion" was determined for each of the lowest three disc levels. At each level these points clustered within a specific zone approximately 2·5 centimetres square. Sixty-four per cent fell within a square centimetre.

4. In a comparative study of twenty-four patients with confirmed pathology, the "point of motion" fell outside the larger zone at the level of pathological change in 65 per cent of the disc levels.

5. The determination of the "point of motion" is a special technique for studying spinal motion. Its role as a diagnostic and prognostic aid in assessing patients with back pain is the subject of continuing study.

1. A study has been made of thirty-two patients who had had operations for their spastic hands.

2. In twenty-seven a flexor muscle slide was done, either by itself or in association with an arthrodesis of the wrist. The rationale of the operation is discussed.

3. The first muscle slide was done in 1959 and the average follow-up was seven and a half years.

4. Selection is crucial : drive, usually coupled with intelligence, is essential for success.

5. Operation is not a replacement for physical therapy. The object is to make rehabilitation easier. The flexor muscle slide, in carefully chosen cases, may play a significant part in achieving this.

1. Twenty-two cases of synovial rupture of the knee have been studied. This condition may complicate any chronic synovitis of the knee in which a tense intra-articular effusion is subjected to increased tension during flexion and extension of the joint.

2. Two types of rupture have been seen; a herniation of the synovial membrane into the popliteal fossa and down the leg, and an acute synovial tear with extravasation of joint contents between the muscle planes of the calf.

3. The diagnosis of this condition, the differentiation of the types of rupture and their treatment are discussed.

4. The acute rupture usually responds to simple bed-rest; the large synovial herniations often need removal and repair of the posterior capsule.

1. in thirty-five patients, twenty-eight with classical haemophilia and seven with Christmas disease, arthropathy of the knee of various grades has been investigated by radioisotope scanning after intravenous injection of technetium, ^99mTc.

2. The abnormality of the colour scan particularly matches the clinical severity in acute haemarthrosis.

3. In patients with no clinically apparent joint disease the scan may be of value in the early detection of involvement.

4. The possible value of articular scanning in the selection of patients for treatment and in the assessment of the short and long term results is discussed.

1. The pathogenesis of recurrent anterior dislocation of the shoulder has been studied at operation and by experiments on cadavers.

2. Lesions of the subscapularis muscle leading to lengthening and laxity have been demonstrated.

3. This lengthening is the prime factor in producing instability of the shoulder; capsular and bony defects are no more than subsidiary causes.

4. Good results have been obtained by a procedure based on this theory of etiology.

1. The results of 243 thoracoplasty operations are discussed. It was found that scoliosis developed in over 99 per cent of cases and that the curve was convex towards the side of operation. The angle of curvature correlated closely with the number of ribs removed.

2. If the head, neck and tubercle of the rib and the transverse process of the corresponding vertebra were all removed the degree of scoliosis was increased, whereas if a thoracoplasty was performed with apicolysis and embedding of the scapula the spinal deformity was less. Possible explanations for these phenomena are discussed.

3. No evidence was found to support the theory of causation by imbalance between the paired "pneumatic cylinders" (lungs and thoracic cage) supporting the thoracic spine.

4. The scoliosis was found to progress for many years; some factors influencing this course are discussed.

5. No correlation was found between the age of the patient at the time of thoracoplasty and the degree of subsequent scoliosis, but severe spinal deformity can arise even in older adults.

1. Resistant cases of tennis elbow are explained on the basis of an entrapment neuropathy of the radial nerve and its branches.

2. An operation is described to explore these nerves through an anterior muscle-splitting incision.

3. Thirty-eight elbows in thirty-six patients have been operated on with improvement in all.

1. A large Caucasian kindred in South Africa are affected by a previously undescribed inherited deformity of the hands and feet called digito-talar dysmorphism.

2. The principal features of digito-talar dysmorphism are flexion deformities, narrowing and ulnar deviation of the fingers. The thumb may be held in an abnormal position by a soft-tissue web. Rocker-bottom foot may develop, due to vertical talus. The facies is normal and the mentality is unimpaired.

3. The general health is good but orthopaedic measures may be needed for function and cosmesis.

4. The condition is transmitted as an autosomal dominant trait, with varying clinical expression of the abnormal gene.

1. Rotational deformity of a finger caused by malunion of a phalangeal fracture has been corrected by metacarpal osteotomy.

2. Because of the anatomical arrangement of the metacarpo-phalangeal joint this method gives good control of the distal phalanges.

3. Division through the metacarpal rather than through the phalanx avoids adhesions in the flexor and extensor mechanisms and in the joints of the fingers, allows early mobilisation and is an easier procedure.

Two cases of ganglion arising in the alar folds of the infrapatellar fat pad are reported. Both patients had symptoms of internal derangement of the knee, sufficient to justify operation.

1. A modified method of stabilisation of the thumb of the spastic hand is described whose rigidity overcomes the difficulty of maintaining a good position while fusion is proceeding.

2. The method seems to have a place in the management of suitably selected patients with severe spastic thumb-in-palm.

1. A case is described of bilateral congenital contracture of the ilio-tibial bands in a healthy girl of ten months.

2. With the hips extended each lower limb was held in about 25 degrees of fixed abduction.

3. Division of the ilio-tibial bands abolished the abduction contractures.

1. Histochemical staining and correlated biochemical estimations of five hydrolytic enzymes were done on eighteen benign and twenty malignant fibroblastic lesions of bone and soft tissue.

2. Alkaline phosphatase activity was moderate in a fibroma and very high in fibrous dysplasia. In a typical fibrosarcoma the fibroblasts showed no enzyme activity and estimations were low. Exceptions indicated an osteogenic potential in the tumour.

3. ß-glucuronidase, leucine aminopeptidase, and to a less extent non-specific esterase, were more active in malignant than in benign lesions, and the highest activities were found in sarcomata arising in Paget's disease of bone.

4. Acid phosphatase showed no correlation with malignancy and was generally unremarkable except for high activity in osteoclasts, but was raised in two sarcomata that occurred after irradiation of giant-cell tumours.

5. A non-osteogenic fibroma and a fibrous cortical defect, though poorly represented in this series, are not uncommon; they sometimes lead to pathological fracture, but sarcoma is very rare in such lesions. They tend to show more alkaline phosphatase than fibrosarcoma but not the very high activity of fibrous dysplasia, which is related to its osteogenic potential.

6. Fibrous dysplasia most often presents in the five to fifteen age group but seldom leads to malignancy, though this may occur, usually as osteosarcoma, which has a similar high content of alkaline phosphatase. Fibrosarcoma is typically negative or very weak in this enzyme: the exceptional cases with high activity were tumours which were in part osteosarcoma. Generally the demonstration of high alkaline phosphatase activity in a fibroblastic lesion of bone, in the absence of trauma or inflammation, suggests the diagnosis of fibrous dysplasia.