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Ten cases diagnosed as epidermoid carcinoma arising in the sinus tracts of chronic osteomyelitis have been reviewed. In two cases there were histologically proved metastases. Attention has been called to the signs and symptoms associated with carcinomatous change. The investigation of such a patient includes roentgenographic study of the limb and chest and a search for metastases in the regional lymph nodes and liver. A biopsy will guide the management. The histological diagnosis may be difficult because of pre-existing and coexisting metaplasia and pseudoepitheliomatous hyperplasia, which simulate cancer. The benign group should have extirpation of the sinus tracts and eradication of the osteomyelitis. Patients with atypical pseudoepitheliomatous hyperplasia and epidermoid carcinoma should have amputation at an adequate level and biopsy of suspicious regional lymph nodes. None of the three deaths in this series could be attributed to epidermoid carcinoma arising in osteomyelitis.

Important technical requirements for the successful use of the Holt nail are outlined. Emphasis was placed upon obtaining and maintaining a good reduction of the fracture with special attention given to the integrity of the calcar femorale. The Holt nail provided an excellent means of treating base-of-the-neck fractures and simple intertrochanteric fractures. This method was satisfactory in treating comminuted intertrochanteric fractures. Early weight-bearing was possible with all of the three types of fractures. There was no advantage in utilizing a Holt nail over other types of nails in treating comminuted subtrochanteric femoral fractures. The highest incidence of implement complication was in this group. Minimum migration of the nail was observed in all patients as impaction occurred with weight-bearing. Penetration was a complication in 8 per cent of patients. No fracture of the nail was observed, but fracture of the bolts occurred in nine patients. Measures to prevent these complications were discussed. There were thirteen surgical infections, and the mortality rate was similar to that of other series. The advantages of early weight-bearing were discussed.

AN OPEN-shoulder spica has provided a satisfactory means of managing several conditions previously requiring the traditional full spica (Fig 1). A combination of a waistband and a long arm cast connected with a wooden and plaster outrigger was first applied to an adult patient who was unwilling to remain in the traditional spica following a shoulder fusion. He had torn his plaster down in order to maintain his skin hygiene and to gain comfort. The open-shoulder spica was designed as a compromise, but it maintained the desired position until union was achieved. This spica cast has since been satisfactorily used to maintain the desired position in patients undergoing shoulder fusion, derotational humeral osteotomy, soft-tissue release with tendon transfer around the shoulder (L'Episcopo-Zachary procedure), and following reconstruction of a posterior dislocation of the shoulder. An open-shoulder spica has the following advantages: (1) simple application, (2) easy and accurate positioning, (3) light