The diagnosis of Herpes zoster is obvicus in the presence of its characteristic vesicular eruptions. A condition presenting with the symptoms and signs highly suggestive of zoster but without the rash, had been recorded previously and termed “zona fruste� by Widal (1907) and “zoster sine herpete� by Weber (1916). Painful muscle paralysis due to zoster sine herpete was described by Lewis (1958). He did not, however, have any serological or virological evidence of varicella-zoster virus infection. In orthopaedic practice, cases of painful paralysis of the trunk and extremities are occasionally seen. In most of these cases, the etiology remains a mystery. Neuralgic amyotrophy (acute brachial neuritis) was such a condition described by Spillane (1943). Parsonage and Turner (1948) also described a syndrome comprising of pain and flaccid paralysis of the shoulder girdle muscles. They considered hospitalization, operations, infections, serum injections and trauma as some of the precipitating causes of the paralysis. Johnson and Kendall (1961) reported cases of sudden onset of isolated paralysis of the long thoracic nerve of Bell, circumflex nerve and accessory nerve, without recognizable cause of the paralysis. Zoster paralysis has characteristic segmental pain with sclerotomal and or dermatomal distribution (Lewis 1958). Without the rash, the diagnosis becomes difficult. We have endeavoured to define the clinical syndrome and applied a serological method to confirm it.

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Mendel first described arachnoiditis in 1908. In this condition arachnoid gets thickened and it becomes adherent to the cord and other coverings of spinal cord. Spinal arachnoiditis is much more common than its cranial counterpart, it may be localized or generalized. Symptoms are caused by mechanical compression of cord, roots or by interference with the blood supply. Clinical and radiological presentation of arachnoidits solely as a prolapsed intervertebral disc is rare and the present paper lays stress on this aspect.

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For preservation of sterile bone grafts many sophisticated physical, chemical and biological methods have been employed. Boiling and autoclaving are relatively simple and easily available methods of sterilizing bone grafts. Not much work has however been reported regarding the behaviour of heat treated bone when used as a bone graft for bridging a gap. Successful application of heat-treated bone grafts may be of special significance in economically underdeveloped countries where sophisticated facilities are not available and perpetual power failures and shortage does not ensure suitable temperature for preservation in the bone banks. Many practical orthopaedic surgeons have had an occasion of using a bone graft after autoclaving or boiling in operation theatre, however only a few cases of successful use of heat treated bone in clinical practice have been reported (Thompson and Steggal 1959, Kirkup 1965, Abell 1966, Tuli 1967, Evens et al. 1969, Enneking and Flynn 1969, Lippmann 1969, Pauker 1971, Synbrandy 1973). The follow up in most of the clinical cases out of necessity was confined to radiological examination. The following experimental work was done primarily to observe the histological changes that would take place in a heat treated bone graft.

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In the last 2 decades prosthetic replacement of the femoral head has become the accepted procedure in the elderly patients with femoral neck fractures, whose closed reduction or previous internal fixation has failed, who are seen late or who are admitted with special situations such as seizure disorder, parkinsonism, alcoholism or pathological fracture. In our country the incidence of non union is very high because most of our patients are primarily treated with indigenous methods. We have been treating these fractures in the elderly over the age of 60 years, whose fracture cannot be reduced or those with non union, by prosthetic replacement. The functional restoration after this surgery is so gratifying that we thought, it would be appropriate to review our cases. This paper is based on a series of 35 cases done at the Kilpauk Medical College and Hospital in the years 1975-77.

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As limited data is available on bending and torsional moments of tibial shaft fractures, some knowledge of the strength characteristics, deformation under load and various stresses responsible for the tibial shaft fractures was therefore considered essential to anyone directly or indirectly involved with the care, treatment and early mobilization of the limb. Hence it was endeavoured to evaluate the bending and torsional moment responsible for tibial shaft fractures and mechanism of failure of bone in bending and torsion.

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Traditionally, minimal acceptable length for fitting a below hip amputation stump with a conventional above knee prosthesis is 12.5 cm as measured from the top of the greater trochanter of femur. For optimal prosthetic rehabilitation however, a stump length of 25 to 30 cm is desirable, with a mandatory minimal clearance of 7.5 cm below the end of the stump for placement of prosthetic knee joint in a functional anatomical position in relation to contralateral sound knee joint. For short below hip stumps which cannot be fitted with above knee prosthesis, the alternative is the hip disarticulation prosthesis. This prosthesis provides comfortable weight bearing, but has inferior locomotion performance due to its entire dependence for mobility on pelvis and trunk action. On the other hand, short below hip stump fitted with above knee prosthesis yields better locomotion capability as compared to hip disarticulation prosthesis. At the Artificial Limb Centre Pune, we have designed a new method of fitting very short below hip stumps with above knee prostheses.

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Trauma or ablative surgery in the shoulder region for malignant tumours may result in a forequarter amputation, disarticulation at shoulder or lead to a loss of a large segment of bones and muscles of the shoulder girdle. Such major loss presented several problems to the patient like functional and cosmetic loss and danger of mechanical damage to the remaining part of upper extremity. The problems are more distressing if the dominant upper limb is involved. Sophisticated upper limb prostheses have been developed for such patients but they are expensive and difficult to maintain. A mechanical device is more suited to Indian patients and conditions. At the Artificial Limb Centre Poona, modified prostheses and orthoses have been designed to solve some of the problems of these patients with a loss in the dominant upper extremity.

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Solitary eosinophilic granuloma of the bone has been described in almost every bone of the body. It is more common in children than adults. The disease had been variously described among the xanthomatoses and Osteomyelilis, but Lichtenstein and Jaffe (1940) described it as a separate entity and suggested the name eosinophilic granuloma. Otani and Ehrlich (1940) named it as Solitary Granuloma of the Bone. Faber (1941) suggested a pathological gradation to include eosinophilic granuloma, Hand-Schuller-Christian disease, and Letterer Siwe disease. For these the title Histiocytosis X was coined by Lichtenstein in 1953. He suggested that eosinophilic granuloma is a localized form. Letterer Siwe and Hand-Schuller-Christian disease are considered as the acute and disseminated forms. Tow cases of solitary eosinophilic granuloma of the bone are presented here.

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Synovial chondromatosis is a rare variety of arthropathy which is characterized by formation of cartilaginous bodies within the synovial membrane. The infrequency of this lesion and also the need for differentiating this condition from other conditions which are also characterized by loose body formation within the joint cavity such as osteochondritis dessicans and detached osteophytic spurs of osteoarthritis, prompted the reporting of 3 cases which were recorded within a period of 5 years. The disease is usually monoarticular, the knee joint is most frequently involved, but involvement of other joints as hip, shoulder, ankle and some of the smaller joints is seen occasionally.

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A distinct clinicopathological entity called aneurismal bone cyst was described by Jaffe and Lichtenstein (1942). It is clinically, radiologically and pathologically characteristic, but the etiology and pathogenesis and nature of the lesion are debatable. These lesions are quite uncommon and any one having a large series of cases is unusual. We fortunately had the opportunity of studying 14 cases in the last 10 years. Most of them have already been published (Sivaramappa et al. 1968, Chari and Rao 1971, Chari and Reddy 1976). There are quite a few reports in which presence of associated lesions along with aneurismal bone cysts are described and the pathogenesis of the ancurymal bone cyst explained as a secondary phenomenon to the primary bone lesion (Buraczewiski and Dabska 1971, Biesecker et al. 1970). The following is an analysis of our 5 cases with associated pathology.

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Osteochondromatosis or chondromatosis originating from the synovial tissue of the diarthrodial joints has often been encountered in practice and almost every joint of the body affected by this disease process, is on the record. Extraarticular synovial tissue, which is found in a normal human body either around the tendons as tenosynovial sheath or in the inner wall of the various bursae, can infrequently be the site of this pathology. However, reports of this nature are very few and this fact prompted us to report this case of bursal synovial osteochondromatosis affecting the semimembranosus bursa.

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Osteopetrosis is a rare skeletal dystrophy of unknown origin, characterized by diffuse abnormal thickness and density of bones. The first report of osteopetrosis was by Heinrich Albers Schonberg in 1904. The disease has also been designated as ‘marble bone disease’ ‘osteosclerosis fragilis generalisata’, ‘congenital osteosclerosis’. The affected bones exhibit hardness along with brittleness. Dyson (1970) after examining the available literature, found only 16 references to Albers Schonberg disease complicated by osteomyelitis of the jaws. It was therefore considered appropriate to record the following 2 cases.

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“In theory the clavicle at the sternal end may be dislocated forward, upward, backward or downward. In practice dislocations upward and forward are the most frequent ones. Posterior dislocations are rare. I have never seen one�. –BOHLER. Dislocation of the sternoclavicular joint is an uncommon injury. The displacement of the clavicle is nearly always anterior, only rarely is it displaced retrosternally. The condition is important despite its apparent rarity. The sudden intrusion of the medical end of the clavicle among the structures of the thoracic inlet may produce serious effects from pressure upon the trachea, the oesophagus or the great vessels; sometimes rapid death has resulted. The following is a case report of retrosternal dislocation of the clavicle treated by open reduction.

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Classical subtalar arthrodesis is not advisable in children less than 12 years of age. Extra-articular fusion was suggested by Grice (1952) who obtained successful fusion and correction of valgus deformity by inserting grafts from upper tibia into the sinus tarsi. Brown 1968), and Seymour and Evans (1968) reported a much simpler operation using fibular graft to transfix the talus and calcaneum. It was a modification of Grice’s procedure as originally suggested by J. S. Batchelor of Guy’s Hospital, London. Six years experience with Batchelor’s technique, in 50 children suffering from post-polio paralytic valgus instability, is reviewed in this presentation.

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Total hip replacement was first performed by wiles in 1938 on 6 patients severly affected by Still’s disease and next by McKee who performed 3 total hip replacement arthroplasty in 1951. Subsequently both Wiles and McKee performed number of these operations. In 1958, John Charnley started arthroplasties using fluon cup initially and later using high density polyethylene cups. He subsequently established a hip center with a very high standard of operating theatres which he proudly named “Green House� (Germ free, thermostatically controlled temperatures, etc.). Farrar later joined McKee at Norwich and began to perform these operations using methyl methacrylate to fix both (Vitallium) metal components. In 1964 Ring at Redhill, Surrey, used a prosthesis in which both components are made of metal without the addition of bone cement. It is the purpose of this paper to review retrospectively the experience of the author in this form of surgery in one of the British district hospital and to report the indications, short terms results and complications.

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The concept of tibio-fibular osteotomy is not new. In 1875 Volkmann reported on tibiofibular osteotomy for correction of deformities around the knee. Sir Robert Jones and Mr. Murray used tibio-fibular osteotomy in adults for correction of deformities of knee as a result of childhood disease notably ricke’s and also for those knees in which there was osteo-arthritis with deformities (Helal 1965). Interest appears to have been revived by the description in 1961 of II patients with osteo-arthritis of knees treated in this manner by Jackson and Waugh. Subsequently a number of reports of this operation in osteo-arthritis of the knee have been published.

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Interest in serum enzymology began when diagnostic significance of alkaline phosphatase and acid phosphatase was established (Bodansky 1954). Several serum enzymes corresponding to the metabolically involved enzymes in the tissues have been recently studied as a reflection of the neoplastic process (Wroblewsky 1961, korn et al. 1962). Isocitrate dehydrogenase activity has been investigated to a limited extent in the follow up of malignancy of bone, prostate, breast, lungs, uterus, cervix etc. At present the utility of serum enzyme levels in malignancy is far from definite conclusions. The aim of this study was to find out the serum levels of the enzyme isocitrate dehydrogenase (ICDH) and its relation to the activity, treatment, and spread of growth.

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Corticosteroids, the so called “Wonder Drugs� after their first discovery in 1948, had found their use for almost every conceivable malady till their hazards came to light. Besides the systemic side effects which interest the physicians, the musculo-skeletal system also manifests certain striking harmful effects, like osteoporosis with or without pathological fractures (Boland and Headley 1950, Demartini, Grokoest and Ragan 1952, Kendall and Hart 1959, Lindholim 1960) and avascular necrosis of articular ends of long bones with arthropatly (Harnagel 1962, Boksenbaum and Mendelson 1963, Cruess, Blennerhassett, Macdonald, Maclean and Dossetor 1968) muscular cramps, weakness and frank myopathies, (Golding and Begg 1960), bilateral rupture of achillis tendon (Lee 1961, Cowan and Alexander 1961). Frequent and prolonged systemic use of corticosteroids in various medical disorders and its common use as local injections by orthopaedic surgeons have prompted us to carry out this study and find out the harmful musculo-skeletal side effects.

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Subtaloid dislocation is a rare injury. We herewith record our experiences in the management of 4 such cases.

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