The vulnerable, rapidly growing thoracic spine of the adolescent.

The upper and lower surface of the vertebral bodies are covered with a thick cartilaginous plate in which the secondary ossification centres develop at puberty and continue to grow throughout adolescence. Congenital indentations in the cartilaginous plates are not uncommon and they constitute regions of diminished resistance, which yield under physical stress. Prolapse of disc tissue occurs into the vertebral body, causing a disturbance of growth but little if any pain. The vertebrae in the mid-thoracic region become wedge-shaped, and a kyphotic deformity results, the so-called Scheuermann's disease, or adolescent kyphosis. A plea is made for the screening of children exposed to risk.

Fat embolism and the fat embolism syndrome. A double-blind therapeutic study.

Fifty-five adults who had sustained a tibial fracture, or a femoral fracture, or both, were subjected to a double-blind randomised study to determine the efficacy of methylprednisolone in treating the fat embolism syndrome. This drug maintained arterial oxygen levels, stabilised or reduced the serum level of free fatty acids, and decreased the risk of the fat embolism syndrome in a statistically significant proportion of patients. Gurd's criteria for the diagnosis of the fat embolism syndrome were found inadequate. Other more sensitive criteria for early diagnosis and effective management were determined. There were no deaths or serious morbidity in our series.

Traumatic atlantooccipital dislocation.

A young adult sustained a traumatic atlantooccipital dislocation together with fracture-dislocation at C.4/5 level and had total neurologic deficit below C4 segment. He retained full consciousness but required respiratory support. He developed a stress ulcer with hemorrhage and evidence of "shock lung." He responded to intensive care. Surgery on the 11th day secured reduction and internal fixation at both levels. Death due to respiratory and cardiac arrest followed on the 14th day. Postmortem examination revealed edema of the brain and brainstem.

Congenital bifurcation of the femur with aplasia of the tibia. A case report.

Congenital bifurcation of the femur in association with aplasia of the tibia has been reported in only about 20 cases. One case is reported, the physical findings in this case and in others are described, and the important prognostic features are outlined. Amputation at knee joint level is a common outcome.

Extraosseous blood supply to the neonatal femoral head.

The extraosseous blood supply to the femoral head was studied by microdissection of latex-injected vessels in 19 neonatal hips. The fetuses were of black African descent. Although the general pattern was similar to that described by previous investigators, in seven of the specimens the largest contribution to the blood supply of the femoral head was from the inferior gluteal artery. To the authors' knowledge, this has not been noted before, but other studies generally have used techniques that would not demonstrate this source. This pattern may represent a genetic variation in the blood supply to the hip, a theory that has been presented to account for differences among races in the incidence of some vascular diseases of the hip joint, e.g., Perthes' disease.

The arteries, arterioles, and capillaries of the spinal cord. Surgical guidelines in the prevention of postoperative paraplegia.

The principles or constant features of the blood supply of the spinal cord are described and illustrated. The variable features of individual patterns of supply are outlined and their practical significance is stressed. Surgical guidelines based on the constant and variable features of the macro- and microcirculation are presented, which if carefully observed are helpful in avoiding the dread complication of postoperative paraplegia.

Juvenile fibromatosis and other diseases of connective tissue.

There are a number of features which are common to such variable conditions as juvenile fibromatosis on the one hand and torticollis and congenital dislocation of the hip, and possibly scoliosis, on the other. Various pathological syndromes are presented, all of them characterized by disturbance and contracture of connective tissue. Surgery is carried out in severe cases when it is a practicable proposition. The administration of an enzyme inhibitor at cellular level has introduced a new dimension in the management of localized fibromatosis.

Fractures of the tibial shaft.

The closed treatment of fractures of the tibial shaft will usually result in bony union within a period of 4 months. Early weight-bearing in a suitable cast or cast brace is advised. Infection following open reduction is often undetected until months or even years have elapsed. When infection occurs, union is delayed on average for 4 years, and amputation is not infrequently the end-result.

Fractures and dislocations of the ankle joint.

The classification of fractures of the ankle joint is based on the mechanism of injury, which provides the clue to successful reduction. The physiological movements of the ankle and foot are defined, and the pathological movements associated with injury are described.

The lumbar disc brace.

An inexpensive, light-weight and cosmetically acceptable brace for the lumbar spine has been submitted to clinical trial over a period of 16 months and has proved effective, both in averting surgery and in facilitating a quick return to duty.

Arteries and veins of the lumbar nerve roots and cauda equina.

An abundant vascular system supplies the nerve roots, within the cauda equina, in the spinal canal and in the nerve root tunnels. The arterial supply of nervous tissue, as noted by previous observers, is "just adequate for its minimal needs." The veins of the area are classified into 3 groups, those of the spinal canal within the extradural space, those of the nerve roots themselves (radicular veins) and those which drain the bony skeleton. These thin-walled venous channels are a source of serious bleeding both at operation and in the postoperative period. Elsewhere in this symposium, emphasis has been placed on the way in which spinal stenosis and pressure on nerves cause the complex group of symptoms. Pressure on arteries, veins and capillaries can impair nerve conduction, with changes in sensation and loss of motor power in one or both limbs. If the pressure is prolonged, irreversible changes take place in the substance of the nerve roots. Recovery of sensation and of motor power following adequate surgical decompression will then be incomplete.