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Samples of articular cartilage from four different human joints were obtained at surgery. Serial scanning electron micrographs taken at a magnification of 1000× were used to reconstruct an 0.25 mm2 area of articular surface. Within these given areas both normal and degenerated portions were seen. This study supports the concept that the surface morphology of articular cartilage varies from joint to joint and from area to area within a joint. This information should be useful for the interpretation of light and electron micrographs, as well as histochemical and biochemical data.

An important contributory factor in the production of recurrent dislocation of the humerus is a defect in the articular surface of the head of the bone. This is a vertical groove or step which is masked and rarely seen in the direct antero-posterior radiograph. It can usually be demonstrated by internal rotation of the arm until the flexed forearm is at 60 deg. to the sagittal plane. The defect is considered to be caused by trauma, generally that violence which causes the initial dislocation, and it is likened to the dent produced in a ping-pong ball when pressed against a sharp edge.

SINCE the skull of Cryptobranchus allegheniensis is strong and largely composed of bone, it is easy to prepare and to study. Figs. 1 and 2, A and B, are dorsal and ventral views of the skull proper and of the lower jaw, taken from photographs. The skull as a whole has essentially the same structure as that. of the Japanese giant salamander, described and figured by Osawa (:02), but it differs from the latter somewhat in general outline and in the shape of some of its constituent bones. Its, length is greater in proportion to its width than is the case with the Japanese species, and the anterior outline of the head, formed by the maxillary and premaxillary bones, is more rounded in the American species, in which it forms an almost perfect arc of a. circle. In the Japanese form the maxillae and premaxillke, as figured by Osawa, are relatively heavier than in the American species, and the posterior ends of the maxillary bones approach. more closely the anterior borders of the pterygoids. The shape of the lower jaw is about the same in both species, but, if anything, is narrower in the American salamander, so that it does not fit with very great precision against the upper jaw. The anterior border of the skull is formed, as has been said, by the maxillary and premaxillary bones (Figs. 1, 2, 3, M11x., P. M11x.), both of which are armed with numerous small, conical teeth, there being about 12 on each premaxilla, and 38 on each maxilla, making 100 teeth in the entire row. The cartilaginous portions of the skull are not so extensive as in the Japanese salamander, and are superficially visible in the region of the anterior nares only, the anterior part of the orbit,, the auditory region, and the articular surface of the quadrate.

Observations made at the time of surgical exploration of the knee in five patients with osteochondrosis deformans tibiae have been described. In each child, a similar deformity was noted, namely, depression of the posteromedial aspect of the articular surface of the tibia. Whether this deformity is the result of pressure inhibition of enchondral ossification within the epiphysis itself, a secondary effect of growth retardation in the posteromedial growth plate, or a combination of both requires further investigation. The clinical findings of bowing, tibial torsion, sagging of the knee into varus, excessive prominence of the fibular head in the standing position, and a posteromedial rocking instability in slight fiexion are confirmatory clinical signs of intra-articular incongruity.

An experimental procedure is described for performing indentation tests on the articular cartilage of the human femoral head, in vitro. A method is described for calculating the creep modulus of articular cartilage, at 2 sec after application of the load, from indentations measured normal to the articular surface. The method takes into account the limited and variable thickness of cartilage and permits variations in cartilage stiffness on the femoral head, as measured by the creep modulus, to be recorded.

The anterior articular surface of the calcaneus can be compressed by forceful abduction of the fore part of the foot. Under certain conditions there may also be mid-tarsal subluxation. Whenever compression of his area of the calcaneus is observed on the lateral and oblique roentgenograms, careful study of the anteroposterior projection is desirable to rule out avulsion of the navicular tubercle and derangement of the mid-tarsal joint. Not enough cases have been reported in detail to set forth a definite program of therapy; however, initial treatment should extend beyond simple immobilization. In the case reported open reduction resulted in satisfactory function one year after injury despite roentgenographic evidence of slight joint incongruity.

A series of T- and Y-fractures of the tibial condyles is presented. The procedure described consists of closed reduction with heavy traction, and fixation with a transcondylar, subarticular wire loop without arthrotomy. The fragments are kept in position by a relatively minor surgical procedure. As the knee-joint is not opened, the infection risk is small. The fragments of the articular surface are not traumatized. The method was used in 14 cases treated between 1956 and 1962. Follow-up examination was made in 12 cases; in 10 cases more than 10 years after operation. The reduction of the fracture obtained at surgery was in all cases maintained at the follow-up. The functional result was very good in 10 out of 12 cases, and bad in none. This method has advantages compared with other methods used in these fractures.

(A) Autologous costal cartilage which had first been implanted intramuscularly for 4–5 weeks (18 animals) and (B) fresh autologous costal cartilage (17 animals) were transplanted to an osteochondral defect, measuring 3×4×3 mm, on the femoral head in adult rabbits. After 7 different observation times between 1 and 46 weeks the animals were killed. The femoral head was incubated in 35S-sulphate or 3H-thymidine in vitro and examined histologically and autoradiographically. In 34 of the 35 preparations from the two experimental groups, and at all observation times, the transplant area lay at a level with the remaining articular surface. Both histological and autoradiographical examination revealed union of the transplant with the articular cartilage via young hyaline cartilage, with a high 35S-sulphate uptake, at observation times from 4 weeks onwards, in 13 out of 14 cases in group A and in 12 out of 13 cases in group B. At observation times of 1 and 2 weeks, young mature cartilage was found between the transplant and articular cartilage in 2 out of 4 cases in group A and in no cases in group B. Immature cartilage occurred in 3 out 4 cases in group A and in 1 out of 4 in group B. The articular surface in the transplant area consisted to the greatest part of young mature cartilage in 16 of the 18 cases in group A (all observation times) and in 11 of the 17 cases in group B (at all observation times from 4 weeks onwards). This young cartilage showed a high 35S-sulphate uptake and contained 3H-thymidine labelled chondrocytes. At observation times from 8 weeks onwards the chondrocytes in this young cartilage in both experimental groups showed a tendency to a columnar arrangement oriented at right angles to the articular surface, and the layer of cells nearest to the articular surface were arranged tangentially to the joint cavity. The transplants probably contributed actively to the cartilaginous union between the transplant and the articular cartilage and to restitution of the articular surface in the defect area with viable hyaline cartilage. Local tissue from the subchondral bone area also appeared to have contributed to some extent.

馬の指(趾)関節が蝶番関節に近似するとの観点から矢状断面曲線を求め, 解析的に吟味して次の結呆を得た. 1) 指関節は凹凸2つの機素の滑動を主にする低次対偶であつて, 関節を構成する面の断面曲線は幾何学的曲線をもつて表しうると予想し, 曲線の性質, 運動の形式を推定した. 2) 断面曲線の曲率中心及び曲率半径の変異の状態を観察し, 凸面では面はおおむね楕円, 又は円, 凹面では〓物線, 円, 及びその組合せ等を近似的な幾何学的曲線とすることができることを確めた.3) 円と断面曲線との偏差が僅少なので, 曲線の大部分を含む近似円を求めた. 凹面の半径が必ず凸面より大であるから, その運動には多少の転動が加わりうることが考えられた. 4) 平均曲率半径によつて曲線の近似円をえがき滑動を条件にして運動範囲を計算した. 靱帯標本から実測した運動範囲と比較した. 5) 近似円によつて動骨上の定点の軌跡を解析的に表し, 実際の運動の軌跡と比較する基礎方式とした. 終りに臨み終始懇篤なる御指導を賜りたる東大野村助教授に衷心より敬意を表すると共に数値処理に協力援助された東大労役生理学教室富永氏に深謝する次第である.

The authors have made comparative biomechanical tests with the articular surface of load bearing heads of femora and heads of humeri bearing no load. They studied the elastic and permanent deformations of the articular cartilage under mechanical stress, by using an “Instron” tensile strength machine. They conclude that at first the degree of elastic deformation exceeds that of permanent deformation but increasing the load permanent deformation becomes more prominent. The elasticity and deformative capacity of a load bearing joint is higher than that of a joint bearing no load.

Changes in the hallucial tarsometatarsal joint, which forms the fulcrum for the grasping hallux, have played a significant role in primate evolution. Comparative studies suggest that one of the morphological novelties heralding the attainment of a monkey grade of structure was the incorporation of the prehallux within this joint. Such a joint is found in the extant Ceboidea and, paradoxically, the Hylobatidae. Hallux and prehallux then form a composite distal articular surface; the proximal surface on the medial cuneiform is completed inferomedially by a convex facet for the prehallux. Divergence of the hallux into the attitude of opposition is accompanied by conjunct rotation, screwing these joint components into a stable, close-packed position. Suppression of the prehallux is accompanied by clear osteological indicators — the absence of prehallux facets on the first metatarsal and medial cuneiform. This modification of the joint is a feature of cercopithecoid evolution, and has also occurred in the hominoid line, after divergence of the ancestral gibbons and apparently after the Dryopithecus (Proconsul) stage. The cladistic relationships indicated by these morphological changes are in striking accord with recent results on primate evolution at the molecular level.

Summary Synovial specimens from 35 patients with so-called posttraumatic synovitis were examined by light-, scanning electron-, and transmission electron microscopy. The synovial changes were characterized in a few cases by the occurrence of siderosomes in the first few months after trauma, and in most cases by gradual rounding of the synovial cells with progressive intercellular and vascular sclerosis on continuation of the posttraumatic joint symptoms for more than a year. Persistent proliferation of the synovial cells without essential sclerosis was observed in those cases in which an irritation with chronic inflammation was presumably inflicted by traumatic changes of the cartilagenous-osseous articular surface. The findings in the synovial membrane explain in part the persistent effusions and permit to some degree a differential diagnostic morphologic delimitation from synovitides of other etiology.

KOHLER'S disease of the metatarsal is a condition which most commonly affects the second toe and its metatarsal, though it may rarely affect the other toes and their respective metatarsals. According to Kohler,1 it is characterized by the following: (1)A change in the shadow contour of the articular surface of the proximal head of the proximal phalanx, as seen in anteroposterior or postero-anterior views. In normal bones the contour is that of a regular arch, while in Kohler's disease the contour is somewhat irregularly extended, and in many cases is approximately S-shaped. (2)The articular fissure is usually broader than normal, which is helpful in distinguishing it from an arthritis, for in an arthritis (except those with effusions) the total changes are considerable and are always accompanied by a narrowing of the articular fissure, resulting from erosion or shrinkage of the articular cartilage. (3)The articular fissure is not only wider and deeper than normal, but shows considerable variation and is b...

In 60-day (group A) and 90-day (group B) old rabbits a standardized osteochondral graft was taken from the distal articular surface of the femur and replanted immediately. Five animals in each group were observed at 9 different times between 3 days and 6 months. On histological and autoradiographic (35S-sulphate) examination the following were found: In group A there was no 35S uptake in the deep layers of the articular cartilage between 3 days and 1 week; in most cases there was normal articular cartilage in the transplants at 2 weeks to 6 months. In group B later changes (3 weeks—6 months), affecting the greater part of the articular cartilage, were observed. These changes appeared to be irreversible and were found in about 1/3 of the cases. The other 2/3 showed completely normal articular cartilage.

The roentgenograms and clinical records of 630 Mayo Clinic patients with abnormal TMJ roentgenograms seen over a period of 9 years were reviewed. Abnormal TMJ roentgenograms were three times more frequent in women than in men. The highest incidence of TMJ abnormalities, in both men and women, was between the ages of 40 and 70 years. The complaint of pain did not necessarily correlate with roentgenographic evidence of bone changes. The condylar articular surface was the first bony surface of the TMJ to show roentgenographic evidence of destructive disease. Of the 222 patients who had bony crepitus, 164 had roentgenographic evidence of bone change. A decreased range of condylar motion was the most frequently reported abnormality in patients whose TMJ roentgenograms showed no evidence of bone alteration. Neoplasms, sialadenitis, scleroderma, and trigeminal neuralgia were responsible for the TMJ abnormality in forty-four of the 630 cases.

This study is based upon observations made upon the hip joints of 12 embalmed cadavers. Windows were made into the joints and the effects of extension and flexion of the femur, produced both actively and passively, were noted. Particular attention was paid to associated movements. Use was made of x-rays as well as direct observation. It was determined that, as the femur extends it abducts and medially rotates; a terminal medial rotation takes up the last of the slack in the iliofemoral and ischiofemoral ligaments. The locked position therefore is brought about by these three movements. There is no evidence of any medial displacement or translation of the femoral head on extension, as is commonly stated to occur. The passively extended femur also abducts and tends to rotate medially whereas the flexed femur laterally rotates and falls into a position about midway between abduction and adduction. The same general effects are reproducibile in the skeleton articulated in such a way as to leave hip motion practically unhindered. This would indicate that the ligaments play a passive role, restricting motion within physiological limits. The shape of the acetabulum and the direction toward which it faces, together with the topography of the articular surface of the head of the femur, are no doubt responsible for the associated movements.

887, I described some associated bones of an animal from Klipfontein, Fraserberg, r the name Theriodesmus phylarchus (‘Phil. Trans.,' 1888, B., 24). The fossil since received some attention from anatomists, but I am not aware that the place nally assigned to it among the mammalia has been questioned. Professor Carl Bardeleben (‘Proc. Zool. Soc. 1889, p. 259), who critically examined some points y interpretation, concurred that it cannot be said to belong to any known order of mals; and affirms that it is not a reptile in the modern sense of the word. He s that its characters are such that it might be placed between reptiles and imals, but does not offer evidence or argument in support of that determination, is not a substantial difference from my own conclusion, which regarded Theriodesmus as illustrating the reptilian inheritance in the mammalian hand. These lusions may be re-examined in the light of new evidence which I obtained in Africa. Before stating that evidence I propose to examine the interpretation the carpus and phalanges which Professor Bardeleben offers in place of that given paper, published in the 'Philosophical Transactions.’ Professor Bardeleben places four bones in the proximal row of the carpus instead the three bones shown in my restoration. The result of this is to make the carpus than the distal ends of the ulna and radius, so that in his restoration the radius covers a small portion of the smooth proximal articular surface of the bone named me scapho-lunar, and by him named scaphoid. That proximal surface shows no Hence of division into two parts, and, therefore, the hypothetical position assigned it is not supported by evidence. The proposal to name the bone scaphoid is based the hypothesis that I have mistaken the lunar bone for the central bone ; and discovery of this supposed error is the ground for introducing four bones into the proximal row of the carpus. No argument is offered in support of that interpretation and no South African fossil is known with the undisturbed carpus composed in way. In the fossil the carpus is manifestly somewhat displaced, though there is question that the three bones which I have regarded as proximal are substantially their natural positions ; and that the bones of the distal row of the carpus are also their natural positions, in contact with the metacarpal bones, The transverse width over these four distal bones is one-tenth of an inch less than the transverse width over the three bones which I placed in the proximal row. The difference of interpretation is therefore with the bones which I regarded as central bones. These bones a entirely distal in position to the proximal carpal bone, which is in contact with distal end of the radius ; so that, as preserved, the bone which seems to me to be principal central bone is between the magnum and the outer side of the bone articulates with the radius; and that central bone which Professor Bardeleben idenfies as the lunar bone, is in close lateral contact on its inner side with the bones whit he regards as central. There is, I submit, no evidence for the suggested transposith of the bone from the middle row of the carpus to the proximal row; and no arguinet is offered in support of the change of interpretation. The distal end of the rads gives no indication of having supported two bones; while on the outer distal surface of the scapho-lunar is a distinct facet which seems to correspond in size and position with the central bone which is below it.

The anatomical findings in sixteen dissected specimens of infantile congenital talipes equinovarus have been described. The findings were uniform and essentially the same as those found in forty-four of the fifty-two previously reported dissections. Congenital talipes equinovarus is a composite deformity involving all of the tissues of the foot. There are no simple or isolated defects such as contracted bands or peroneal-muscle atrophy, but each tissue conforms to the equinus and varus position. The major bone deformity resides in the talus. Its neck and articular surface for the navicular deviate to face medially and plantarward. Its subtalar surfaces are tilted into varus and equinus and are medially rotated. Since the remainder of the foot is articulated with the distorted hind part of the foot, the fore part falls into supination, equinus, and medial rotation (Figs. 4 and 6). The relationship of the findings in the dissected specimens to the club-foot deformity seen in patients has been discussed, and arthrograms demonstrating this deformity in the club-footed patient have been presented. Therapy was not discussed.

1 . Fractures and fracture-dislocations of the articular surface of the humeral head are severely disabling. 2. Pain is seldom a significant factor in the result (Table III). Rather, weakness, limitation of motion, and reduced endurance are the usual complaints. 3. The patient is more often satisfied with the result than is the orthopaedic surgeon who has treated him (Table V). 4. The result must be evaluated by a realistic set of criteria. Even so, the results of treatment in this study were acceptable to the examiners in only 50 per cent of the cases, and to the patients in 60 per cent of the cases. 5. Results might be improved by following the recommendations made regarding surgical technique. 6. The insertion of a prosthesis, although not yet conclusively demonstrated to be effective in solving the problems raised by this injury, is most logically considered for use in that group of comminuted fractures and fracture-dislocations which, in this series, have been treated by resection or by resection and cuff transplantation. Should the long-term results be superior, the use of a prosthesis may conceivably be advisable in the treatment of the more severely comminuted fractures of the humeral head which are now being treated by open reduction.

In primary osteoarthrosis of the hip, destruction of old cartilage and bone on the femoral head is accompanied by an attempt at repair and remodelling. On the superior surface of the femoral head this attempt at repair tends to be overwhelmed by the continued action of a destructive mechanism. In contrast, on the infero-medial, and sometimes on the lateral, surfaces, remodelling activity can form a layer of new bone external to the line of the old chondro-osseous junction; for the purpose of the present study, this new bone is distinguished from that in osteophytes projecting downwards below the level of the original edges of the femoral articular surface. Femoral heads from patients with primary osteoarthrosis of the hip vary a good deal in their naked-eye and radiological appearance. Methods are described by which this variability can be expressed in terms of contrasting changes of variable amounts of bony flattening and of bony expansion. The methods suggest a new or additional approach to rad...

In adult rabbits, a transplant was made to an osteochondral defect on the femoral head measuring 3×4×3 mm of autologous costal cartilage which had first been implanted intramuscularly for 4–5 weeks and fresh autologous costal cartilage. After 6 different observation times between 2 and 52 weeks the animals were killed. The original material, the tissue in the transplant area on the articular surface and the articular cartilage above the “tidemark” were analysed in each individual animal, after microdissection of freeze-dried sections of these structures, by a quantitative microchemical technique for their content and composition of glycosaminoglycans and for their calcium content. The hexosamine content (% per organic dry weight) was generally higher in the transplants than in the articular cartilage at observation times of 2 and 6 weeks, after which time it was similar. The distribution of the different glycosaminoglycan fractions was different in the transplants compared with the articular cartilage. Thus the glycoprotein and/or keratan sulphate fraction was smaller in the transplant than in the articular cartilage, while the opposite held for the chondroitin sulphate. With increasing observation times, some resemblance became evident between the transplant and articular cartilage with respect to the relative size of these fractions. The solubility profiles of the chondroitin sulphate were similar. The calcium content was generally higher in the transplant than in the articular cartilage, after 12 weeks it showed a pronounced decrease in comparison with the original material. The chemical findings indicate that the cartilage in the transplant area did not undergo any marked degenerative changes.

From this study it has been found that the severe, comminuted, displaced calcaneal fracture is associated with involvement of the two peritalar joints consisting of fracture of the articular surface of the calcaneus at the calcaneo-cuboid joint and, in some instances, associated subluxation of the talar head at the talonavicular joint. The conventional projections are not adequate for the roentgenographic examination of the comminuted, displaced, fractured calcaneus, and two additional projections as described are necessary. Involvement of the two peritalar joints affords an explanation for some of the unsatisfactory results reported in the past. We believe that the injury to the talocalcaneal joint is irreparable and that fusion of this weight-bearing joint is necessary. The associated injuries of the two peritalar joints similarly prevent the restoration of their normal function. It has been our experience that triple arthrodesis as the initial primary treatment of these fractures has given extremely gratifying results.

1. A specially designed loading apparatus and dyeing technique have been used to demonstrate the weight-bearing areas in fifty-one normal adult hip joints. 2. Under loads and positions typical of the stance phase of walking the entire articular surface of the acetabulum is involved in weight-bearing. This contact area is reproduced on the femoral head, and its position determined by the attitude of the femur to the acetabulum. 3. With loads typical of the swing phase, the dome of the acetabulum and corresponding areas on the femoral head are not involved in weight-bearing. 4. The results are compared with the conclusions of previous investigators and their possible significance with regard to joint degeneration is discussed.

1. Sixty-eight crush fractures of the articular surface of the lateral tibial condyle have been analysed. 2. Follow-up examination at a minimum of three years after injury was carried out in all cases. 3. The only factors which appeared to influence the results were the extent of the original depression, and if this was severe, the degree of restoration obtained by the treatment. Prolonged plaster fixation was avoided. 4. At review, no patient complained of symptoms which were attributable to damage to ligaments or menisci and no patient had symptoms of late onset. 5. The results suggest that there is nothing to be gained by open reduction if the lateral condyle is depressed by less than 10 millimetres, as conservative treatment gives good results. If the depression is more severe, however, a good result can only be assured if the articular surface is successfully reconstituted, but this is sometimes difficult to achieve. It is not possible to reconstitute the surface by non-operative means.

Observations on the lower ends of 378 femora from modern Japanese who were accustomed to squat both at rest and at work were made and compared with other published results.The average mean of the so-called squatting number by which the depth of the intercondylar fossa at the level of the intercondylar line was to be multiplied to give the greatest depth of the lower articular surface of the femur for Japanese was 3.23.It gave Japanese an intermediate position between Punjabis (2.90) or Indians (3.10) and modern Canadians (3.43) or Irish (3.44).It was, however, found that the Japanese femora were not distin-guishable from the modern Irish or Canadian ones by the so-called squatting number, because there was a considerable amount of overlap of the squatting number among them.The depth of the intercondylar fossa in female was relatively greater than that in male, the difference being attributed to the fact that the articular surface of the knee joint in female was absolutely smaller than that in male.It was, therefore, necessary in comparison of the so-called squatting numbers of the femora among different populations to consider first whether given bones were of male or of female.In addition, the average mean of the squatting index of SHAH for Japanese was 31.0 (male 30.3, female 32.5), being smaller than that (34.2) for Punjabis.

Prosthetic replacement is a good treatment option in osteoporotic patients with four-part fractures, fracture-dislocations, head-split fractures with more than 40% articular surface involvement, anatomic neck fractures, dislocations present for longer than 6 months, and selected three-part fractures. Early prosthetic replacement of proximal humeral fractures has a better outcome than late reconstructive prosthetic management. Prosthetic design features specific forfracture care have led to a reduction in complications. Techniques will continue to improve as prosthetic design features specific for fractures evolve.

1. A technique of transarticular nailing for subcapital and transcervical fractures of the neck of the femur is described. 2. Forty-four operations have been done, and twenty-one patients have been under observation for periods of from one to six years. In one of these pseudarthrosis has developed; in two others there has been delayed union. 3. The method gives sound fixation by a "squeezing effect" on the proximal fragment, which is enhanced by the locking of the adjacent articulation. 4. It is presented as an alternative to prosthetic replacement for treatment of femoral neck fracture in the aged. The nail damages the articular surface of the acetabulum but not the femoral head. 5. The importance of care after operation is stressed. 6. The advantages of the method, the role of circulatory changes in the femoral head and the mechanics of transarticular fixation are discussed.

MADELUNG'S deformity of the wrist is a rare condition, usually bilateral, developing at the distal end of the forearm of young individuals between the ages of 8 and 20 years—80 per cent of such deformities appear between the ages of 11 and 15 years. The deformity is essentially an anterolateral curvature of the distal third of the radius, with dorsal prominence of the joint end of the ulna. Contrary to early descriptions, it is not associated with an irreducible dislocation of the wrist. The lesion progresses slowly and by the end of one or two years the deformity is complete. During the active developmental stage, pains may or may not be present. If there is discomfort from pain or ache, it may be aggravated by forced movement, chiefly by extension. The anatomical changes are best seen in roentgenograms which include the hand and the entire forearm. There is bowing of the lower third of the radius, usually dorsal and lateral. The articular surface is tilted medially toward the volar side and slightly rot...

In eleven years twenty-one patients with large tumors of the end of a long bone were treated by excision of the end of the bone with replacement by homologous deep-frozen cadaveric bone including an articular surface. The replacement was sterilized by bacitracin and neomycin. Fourteen tumors were giant-cell tumors, six were sarcomas, and one a fibroma. Sixteen patients still have their limbs, three had amputations, one died, and one was lost to follow-up. The functional status of the limbs varied extensively and several patients needed one or more re-operations.

H. SJOvall: Reexamination of Patients with Meniscal Lesions who were Treated Operatively in the Orthopedic Clinic in Lund in the Period OF 1929–1938(See Sjovall: “Die Spatergebnisse nach totaler Meniscusexstirpation.” Acta Orthopaed. Scandinav. 13:153, 1942)Discussion Lagergren, K.-A.: Meniscus Operations and Secondary Arthrosis Deformans

Though the subject of fractures of the calcaneus has been extensively covered (1, 5, 11, 12, 13, 14, 17, 20, 21), our attention has been directed, within the past few months, to a simple calcaneal fracture which to our knowledge has received slight attention in the literature, yet is important clinically and from the medicolegal aspect. Only a few writers (2, 7, 8) have reported small series of cases briefly describing the anatomy and mechanism of this fracture. The portion of the calcaneus involved appears never to have been given a specific anatomical name, though it rightly deserves one. Textbooks of anatomy (6, 10, 19) describe the calcaneus (os calcis) as having on the anterior surface a saddle-shaped facet which articulates with the cuboid bone. On the medial surface at the anterior superior margin is a facet known as the anterior articular surface, which articulates with the anterior calcaneal facet of the talus. Yet the entire anterior superior margin of the calcaneus, especially as seen on the la...

The method is described for the accelerated introduction of the Smith-Petersen pin for fractures of the neck of the femur. This may be divided into different stages. 1.1. Care of the patient from the time of the accident to operative intervention. 2.2. Anesthesia, reduction by Leadbetter's method, incision and insertion of the guide wires. 3.3. The first operative x-rays with one guide wire left in situ. 4.4. Insertion of the cannulated Smith-Petersen pin over the guide wire, the former being driven to a point about 12 inch of the lateral cortex of the shaft and to within 14 inch of the articular surface of the head. 5.5. Removal of the guide wire, final x-rays, impaction and closure of the wound. 6.6. Rules and reasons are given for healing and weight bearing.

A study of the squatting facets of the talus and tibia of 300 male and female ancient Egyptian skeletons in the collection at the Institute of Anthropology at the University of Turin is described. A classification of the different forms of squatting facets of the tibia and talus is reported. The examination of the extensions of the medial articular surface and the trochlear surface of the talus is reported too. The results of the survey are described and the incidence of the facets and the extensions of the medial articular surface and of the trochlear surface in this series of ancient Egyptian skeletons is reported. Finally, the natural history and aetiology of squatting facets is discussed; the two main theories to account for their presence are outlined—that they are either acquired features modified by the squatting posture, or that they are inherited as genetic traits. Further detailed studies and research are required to test both the hypotheses; in particular to clarify the possible role hereditary factors may play, further research on living populations and more extensive foetal studies are suggested.

PURPOSE: To analyze clinical results of arthroscopic trans-tendon repair in a partial articular-side rotator cuff tear.MATERIALS AND METHODS: Of 31 patients presenting with partial intra-articular rotator cuff tears between April 2006 and January 2010, we selected 24 who had received arthroscopic trans-tendon repair. The average age of patients was 55 (27~75) and the average follow-up period was 37 months (19~64). There were 10 men and 14 women and all had at least a 6 mm tear categorized as Ellman grade 3. Change in range of motion, VAS, ASES, Constant score, and ultrasonographic findings were evaluated postoperatively.RESULTS: The average forward elevation range prior to surgery was 150.2 (+/-6.67) and it improved to 170 (+/-5.32) by the last follow-up (p

1. A method of treating severely comminuted fractures of the distal end of the tibia by dual-pin fixation and limited open reductions has been described. The open reduction is done through a small skin incision and soft-tissue stripping is not necessary. 2. The method is indicated in multiple-fragment fractures of the distal tibial articular surface and distal portion of the shaft of the tibia when open reduction is not feasible and satisfactory reduction is not achieved by traction alone. 3. Satisfactory results were obtained in five comminuted articular fractures, even though at first glance there seemed to be little or no hope of preserving function of the ankle.

THE difficulty of accurate fracture diagnosis was first forcibly impressed on me by a case of fracture of the as calcis. Clinically the ankle was suspected, but the usual ankle films were negative. Next, request was made for films of the os calcis. Satisfactory views, both lateral and vertical, were negative. Films of the metatarsals were then requested, but the metatarsals showed no fracture. However, the oblique view of the metatarsals showed very clearly a transverse fracture ½ inch deep in the anterior articular surface of the os calcis. In this case, only one film out of seuen showed the fracture, and that film was made for the study of an entirely different part. In general, more fractures will be demonstrated, and doubtful fractures will be made clear, if the part suspected clinically or after an examination of preliminary films is brought as close as possible to the plate. In many instances, this may necessitate a departure from routine or standard positions. For instance, in making special views ...

Some of the cells in autogenous whole joints remain viable following transplantation. The bone is rapidly revascularized and the dead bone is replaced with new bone. The deeper layers of cartilage cells remain viable, but some degeneration of the articular surface usually results. All of the cells in delayed homogenous transplants and most of the cells in direct homogenous whole-joint transplants die. Revascularization and active osteogenesis are slow. The grafts unite and function satisfactorily for six to eight months, but degenerative changes similar to those seen in aseptic necrosis begin between four and six months after transplantation. These changes may progress to complete disintegration of the joint. Since similar changes occur in direct homogenous transplants as in delayed homogenous transplants, the method of preservation apparently is not the important factor in the early degenerative changes. The factor that produces these degenerative changes, which are so much greater than those in autogenous whole-joint transplants, has not been determined but is probably related to a type-specific physicochemical structure of bone. The writer has had no experience in using whole-joint transfers clinically, but from the experimental data at hand he believes that one could expect satisfactory results from autogenous transfers, particularly in non-weight-bearing joints, such as the small joints of the hand. Homogenous joint transplants, direct or delayed, heal satisfactorily, unite to the host bone, and are technically feasible. Possibly in non-weight-bearing joints, with good cooperation by the patient, satisfactory clinical results might be obtained. In most instances, however, and particularly in weight-bearing joints, long-term good results are not to be expected at present. It is hoped that further investigative work will reveal methods of accurately matching bone types and thus make such massive homogenous transfers as entire joints acceptable.

1. The adjustment of the tibio-fibular mortice for the upper articular surface of the talus is discussed.

SummaryOn the basis of experiments on 37 cats (of which 7 controls), the author concludes that the autogenous full-thickness skin graft with subcutaneous fatty tissue is eminently suitable as interposition material. The epidermis of the skin is destroyed by the weight and function of the joint and the connective tissue acting as interposition material undergoes functional metaplastic development into cartilage. If no interposition material is used, articular weight and function tend to destroy the granulation tissue growing from the freshened articular surface so that in these cases the articular surface consists of naked bone.

This vertebra was collected for the Woodwardian Museum of the University of Cambridge by Mr. Henry Keeping, and catalogued in my ‘Index to the Aves, Ornithosauria, and Reptilia’ (p. 81) as the axis of a Dinosaur. The specimen is perfect, and but very slightly crushed from side to side. It measures 3 1/2 inches in length, from the termination of the dentata to the posterior articular face of the centrum. The vertebra has a small neural arch, and measures 3 1/4 inches from the base of the centrum to the top of the neural spine. The centrum is depressed, and anteriorly measures 1 5/8 inch deep from the neural canal to the base, and is 2 1/2 inches wide over the articular surface. This surface, below the dentata, is nearly vertical (fig. 1, a ), and forms more than a quarter of a circle (fig. 2, a ). In the middle of the base of the centrum a wedge-bone ossification is anchylosed, as in birds (fig. 2, a ), and projects forward for about a quarter of an inch. The vertical articular surface has its superior (or interior) outline nearly parallel to the circumference of the bone (fig. 2), and is rather more than 3/4 inch deep. Confluent with this area, and between it and the underside of the dentata, which it occupies for half an inch, is an articular band margined by a somewhat sinuous anterior border (fig. 1, b ), which is 1/2 inch wide in the middle, but becomes narrower at its two extremities, which

1. The cause of cyst formation lies in the major overloading of certain regions caused by the unevenness of the articular surface produced by the arthritic process. 2. Photoelasticity investigations disclose an overburdening of the bone beneath the surface of the joint, which in turn markedly resembles the shapes of actual cysts. 3. The results of this investigation fit organically into the logical sequence of processes in accordance with our theory. 4. This theory is further borne out by the successful formation of cyst phenomena in healthy joints by overloading (Trias 1961). 5. Our theory has no immediate practical bearing on the treatment of arthritic cysts. However, it uncovers certain interesting aspects of the behaviour of bone tissues under mechanical overloading above the limits of biological, though below those of mechanical bearing capacity. Conclusions arising therefrom might in many respects be useful in research into the physiology of bone.

1. The fibrillar networks of adult human articular cartilage, taken from femoral and acetabular specimens, have been systematically examined by scanning electron microscopy. The internal structures revealed by rupturing the tissue were compared with published findings from transmission electron microscope studies. 2. Though this technique demonstrated the internal fibrillar appearance of cartilage to a remarkable degree, it had several attendant limitations. On final drying, specimens generally exhibited shrinkage which varied within wide limits; this could have altered the internal architecture to some extent. In addition, the rupturing technique, which at the time of this investigation was the only satisfactory method of revealing the fibrillar cartilage structure, may well have had a great influence on the fibril orientations. 3. The fibrils revealed no characteristic collagen periodicity and were considerably thicker than those observed by transmission electron microscopy. It is suggested that a coating of mucin on the collagen fibrils might account for this. 4. At low magnifications the torn layers in the fractured surfaces extended radially from the calcified zone and turned obliquely at or near the articular surface to merge with the distinctly layered superficial zone, thus forming arcade-like structures. That these were not artefacts produced by the fracturing technique was shown by their similarity to the classical arcade pattern of light microscopy. However, the factor which governed the direction of these planes of weakness, be it collagen, mucopolysaccharides or cells, could not be satisfactorily determined. 5. At higher magnifications only three regions of distinct fibrillar organisation could be identified: 1) a surface layer consisting of a random fibrillar network; 2) a superficial zone composed of layers of fibrillar network, intersecting and overlapping in planes parallel to the surface; and 3) elsewhere below the superficial zone a network of virtually random fibrils which extended to the calcified region with apparently little variation in thickness or density. There was little variation from this pattern even in aged fibrillated specimens. 6. At the lower magnification range the scanning electron microscope has revealed the arcade pattern described by light microscopy, while at the higher magnifications the fibrillar organisation as seen by scanning electron microscopy correlated well with the concepts developed by transmission electron microscopy, that is, a random network of fibrils overlaid at the articular surface by a membrane-like system of bundled fibrils. 7. A possible role in the transmission of joint forces is outlined for the above fibrillar organisation.

This small series would seem to show that almost any operative technique adequately performed will prevent redislocation and give good early results. The long-term results, however, are very disappointing. A sturdy of the natural history of the condition suggests that the reason for these poor results is that operations are performed late in the presence of unsuspected but severe degenerative changes. It is suggested that the damage sustained by the articular surface of the patella is due much more to the abnormal excursions of the patella which occur with normal flexion and extension of the knee than to the occassional episodes of dislocation. In view of this, it is felt that surrgical intervention should be undertaken early, in the hope that movement of the patella can be restored to normal before the articular cartilage is destroyed. As it is impossible to assess accurately the degree and extent of articular degeneration by clinical means, it is surggested that the knee joint be opened and inspected in patients on whom operation is performed and, if there is marked damage, the patella should be excised, and the pull of the quadriceps should be re-aligned. Probably the easiest way of re-aligning the pull of the quadriceps is to transplant the tibial tubercle medially. This operation is very successful in adults but has certain hazards when performed on children. If the severe damage to the patellar cartilage which frequrently occurrs is unnnoticed or is ignored, the patient will probably be condemned to an early onset of osteo-arthritis in the knee, with a final result as disappointing as those in patients on whom no operation has been performed.

A combined histological, metallurgical, and clinical study has been made in 19 instances where a surgical operation had been performed to remove a titanium implant used in the treatment of disease or trauma in man. All the implants were static devices such as pins, plates and rods. Histological examination of nonosseous tissue excised from adjacent to the implant was supplemented by estimation of its titanium content by neutron activation analysis. The results indicate that in some patients titanium can be liberated into tissue adjacent to titanium implants. The phenomenon can occur in the absence of corrosion or fracture of the implant, and is unrelated to the possible liberation of wear particles from an artificial articular surface. There is variation from individual to individual in the amount, if any, of titanium released. In the case of those implants showing titanium release, the results suggest that local release of the metal, or its subsequent accumulation in the tissue, is a patchy process at the implant site. The histological features of the local reaction of nonosseous tissue to titanium release are described. No conclusions have been drawn concerning possible effects on the osteogenic response to the insertion of the implants and on the overall state of the bone at the time of their removal. From study of the clinical records it is apparent that considerable caution is needed before concluding that release of titanium can cause clinically significant local effects. Although such effects may have occurred in a minority of patients, this possibility is by no means proven. A distinction must be drawn between a “metal reaction” in the histological sense and a “metal reaction” in the clinical sense.

ESTRUCTIVE changes at vertebral bodies have been described in ankylosing spondylitis. Usually they are seen at a fairly early stage of the disease and are apparently caused by rheumatoid granuloma (1–4, 6, 8). The association of destructive changes at the anterior articular surface of the vertebral bodies in late stages of this disease and at a segment where neither the spinous ligaments are completely ossified nor the apophyseal joints are fused has apparently not been reported. It appears that the vertebral destruction is caused by a pseudarthrosis. Motion of some degree is present and, because of solid fusion of the spine above and below the area of pseudarthrosis, great stress forces are being exerted on the anterior margins of the vertebral bodies, leading to absorption of bone and bone sclerosis. Patient S. S. (CASE I) clearly showed massive vertebral bone absorption, motion on flexion and extension, and open apophyseal joints by quite conventional x–ray methods (Fig. 1). His major complaint had bee...