The advantages of a movable hip are so great that surgeons have been striving since the dawn of modern surgery to find a way of obtaining or restoring movement when the hip is diseased (Wiles 1959). Resection of the head and neck of the femur was first described in the obituary of Mr. Anthony White an English physician who resected the hip joint of a nine year old boy for septic arthritis in 1849 (Parr et al. 1971). The first serious attempt to form pseudoarthrosis for chronic arthritis was practised by Robert Jones in 1921. This would seen to have been the idea from which Girdlestone in 1923 developed his excision on which the whole of the head and neck of femur with greater trochanter was removed the gluteal muscles attached to the diaphyseal stump (Girdlestone 1928, 1943). Later, Girdlestone in 1945, modified his first operation by merely removing the head and neck up to the inter-trochanteric line leaving the muscular attachments to the greater trochanter undisturbed (Capener 1956). With the advent of more sophisticated reconstructive procedures such as cup arthroplasty and replacement by prosthesis, resection of femoral head and neck has come to regarded as a salvage procedure to be used only when cups and prosthesis have failed due to infection or technical difficulties (Parr et al. 1971).

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Rhinosporidiosis, caused by the fungus Rhinosporidium seeberi with a predilection for mucous membrane of nose and nasopharynx and endemic in this area, affects the peripheral skeletal system very rarely. From this area over a period of 5 years (1965-1969) 348 cases of rhinosporidiosis were reported (Dardari et al. 1972) but there was not a single case of skeletal involvement, though visceral and systemic rhinosporidiosis is known (Rajam et al. 1955, Agarwal et al. 1959). We are reporting a case of skeletal rhinosporidiosis who first came to the hospital with features of osteomyelitis in the foot and had asymptomatic nodules of rhinosporidiosis in the nasopharynx.

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Traumatic rupture of muscles is suffered by young people, while tendons rupture when attritic especially in old people (Anderson 1963). The commonly seen muscles ruptured due to trauma are quadriceps (Anderson 1963) and biceps. Muscles rupture particularly around shoulder and forearm as a complication of compound fractures of humerus and forearm bones. Closed traumatic rupture of pectoralis major is rare and has been reported also (Mcenitire et al. 1972). One of the authors has reported possibly the fist case of traumatic rupture of pectoralis major form this country (Pachnanda et al. 1978). A rare rupture of adductor longus has been also been reported (Rawat 1977). The authors have not been able to trace a single report of traumatic avulsion/ rupture of infraspinatus muscle at its origin, although paradoxically the shoulder cuff injuries, a very common entity, are seen frequently in elderly people. An interesting and rare case of traumatic rupture of infraspinatus proved at operation is reported.

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Plantar ulcers in leprosy is not specific of the disease, it instead represents one of the neuropathic disorders. However, plantar ulcer is one of the commonest lesion in leprosy (Cochrane 1967) and no and no singular method of its treatment is known to provide the best results. Neuropathic plantar ulcers therefore continue to exist as a challenge to most leprologists and orthopaedic surgeons. A study of 68 plantar ulcers among lepers and its treatment by the author is presented.

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There is perhaps no structure in the body that reflects the aging process so early, so often, and to such an extent as does the intervertebral disc of the spine. Frequent association of these changes with the clinical symptoms originating from the spine has drawn a good deal of attention from the Orthopaedic Surgeons and persons interested in the basic research. Adson (1925) and Stookey (1928) reported a number of cases of protruded intervertebral discs producing compression of the cervical cord. Schmorl (1928) described protrusion of nucleus pulposus into vertebral bodies in 38 per cent of his postmortem cases. Shutkin (1952) described the spine the first organ in the body to undergo degenerative changes with age. In clinical practice on radiological examination the space between fifth and sixth vertebrae is the seat of degenerative changes in most of the cases. Therefore it was aimed to visualise in this study the various morphological and histological changes that occur with age in the C5-C6 intervertebral disc.

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Pycnodysostosis is a rare condensing bone syndrome characterised by short stature, generalized osteosclerosis, delayed closure of fontanelles and cranial sutures, obtuse mandibular angle, defective terminal phalanges of hands and feet, a tendency to bone fractures and genetic predisposition. Originally described by Montenari (1923), this syndrome owes its present status as a distinct clinical entity to Maroteaux and Lamy (1962) who separated it from osteo-petrosis and coined the name from the Greek Pycnos (dense), Dys (defective) and Ostosis (bone). Maroteaux and Lamy (1965) reported that this malady affected the famous French painter, Henri de Toulouse-Lautrec. Lautrec’s parents were first cousins. This disease is extensively reviewed by Elmore (1967) and Sedano et al. (1968). More recent case reports include a few from India also (Baker et al. 1973, Diwan and Gogate 1974, Mehta and Buharimala 1971, Muthkrishnan and Shetty 1972, Shanmugasundaram 1973). We are reporting a case of pycnodysostosis not only because of the rarity of the syndrome but also because of the partial closure of cranial sutures and presence of intracranial dural calcification.

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Synovial chondromatosis is a rare condition which usually involves knee, elbow and shoulder joints. Involvement of metacarpo-phalangeal joint of hand is extremely rare. Donald and Dolam (1966) while reviewing the literature were able to find reports of three cases of synovial chondromatosis of the metacarpo-phalangeal joints in the hand. They themselves reported one case involving interphalangeal joint of a finger in that article. Because of its rarity we are reporting a case a case of synovial chondromatosis involving the metacarpo-phalangeal joint of middle finger.

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Maroteaux and Lamy, in 1962, coined the term from Greek Pycnos-thick, Dysdefective and ostosis-bone, and in 1965 described the first definite case of Pycnodysostosis in a french artist called Toulouse Lautrec. Though Elmore (1967) mentions in his review on pycnodysostosis that a case that could fit into the characteristics of pycnodysostosis was recorded in 1923 by Montenari, who reported an unusual variation of achondroplasia in an 18 year old boy. The condition is transmitted as an autosomal recessive trait with an approximate consanguinity rate of 20%. A family with many of its members being affected by pycnodysostosis is presented because of its variety.

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Fractures of the tibial shaft are of the common problems seen in an orthopaedic. Because of the long period of total recumbency and severe socioeconomic burden imposed by these fractures, there have been constant efforts to develop method of treatment which reduce period of hospitalization and recumbency. Sarmiento (1967) reported on the effectiveness of lower extremity prosthetic principles applied to casting and cast bracing techniques to permit early weight bearing ambulation in treatment of fractures of the tibia.

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In 1961 Todd reported the first case of quadriceps contracture due to repeated injections. Later on several workers described the fibrosis of quadriceps muscle (Fairbank and Barrett 1961, Gammie et al. 1963, Karlen 1964, Gunn 1964). Makhani (1971) described in detail the osteo-articular lesions in quadriceps fibrosis. In the present series 16 cases with involvement of 29 limbs were examined and their radiological findings have been discussed (Table I, II).

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Traumatic fracture results from a single violence severe enough to be imprinted on the patient’s memory, whereas stress fracture occurs during the course of normal activity without significant trauma. Stress fracture, although known for over a century was considered a relatively rare ‘disease’. It was not until shortly before the World War II, when large masses of humanity were mobilized that the condition became universally recognized. At one time stress fracture was considered an ‘occupational disease associated with military training’. Although recruits and young soldiers undergoing sustained physical efforts still constitute the majority of the cases, no age, sex or occupation is exempted. No bone in the lower extremity has been found exempted. The importance of early recognition of the condition has been universally accepted. The multiplicity of causes of pain, absence of clear cut aetiological factors and belated appearance of radiological features often lead to delay in diagnosis and treatment and prolong the disability. A study of stress fracture is thus of special importance to the military surgeon as it is responsible for considerable morbidity in the Armed Forces.

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Arteriography is an important preoperative technique which has been used in the evaluation of tumours of the extremities (Chavez and Hardy 1966, Santos 1950, Yaghamai et al. 1971). Many reports have been put forward to determine its place in the management of musculoskeletal tumours (Halpern and Freiberger 1970, Kendrick et al. 1971, Strickland 1959, Viamonte et al. 1973). The appearance of vessels within the lesion, contributes the most important diagnostic clue. At the same time the principal vessels feeding the tumour mass can well be evaluated pre-operatively and guide the surgeon while doing a local resection of the mass. The biplane technique is particularly informative. Arteriographic findings must however, be evaluated in the light of clinical history. Preservation of extremity, without sacrificing the principles of cancer surgery, is a desirable goal in patients suffering from peripheral malignant lesions. Radical ‘enbloc’ resection alongwith a wide soft tissue excision may help in removal of the tumour leaving behind a useful functional extremity. In assessing suitability for a radical local excision of this type, an angiogram is most useful (Marcove and Jensen 1977). It is also helpful in delineating the location, extent and the vascularity of the tumour and guides for the most productive biopsy. The purpose of this paper is to relater our experience of peripheral arteriography in the management of musculoskeletal tumours and to emphasize the clinical application of the procedure in various lesions.

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The role of acute trauma in the causation of tears of the menisci of the knee, and of accurate history taking in their diagnosis has widely emphasized (Benin 1956, Duthie and Ferguson 1973). Benin (1956) has made only a passing reference to tears of the menisci without a definite history of injury. However Watson-Jones (1962) has emphasised that in posterior horn tears of the medial meniscus especially the localized one, the classical history is not elicited and there is no localizing tenderness. Except for a positive McMurray sign, the clinical examination may be entirely negative. All the same he attributes these tears, which according to him are no less common than bucket-handle tears, to abduction-lateral-rotation strain of the flexed knee. Smillie (1978) recorded the incidence of nontraumatic tears as 25 per cent between 1955 and 1960, 41 per cent between 1963 and 1967 and 53 per cent between 1969 and 1974. The number of cases in each of these three series reported by Smillie (1978) was 2000 amounting to nearly 500 cases per year. Thus whereas the etiology of meniscus tears showed a definite change of pattern, the overall incidence remained the same. He attributes this changing pattern to mechanization of coal-mining industry, increasing age of the patients, and in particular the prevalence of degenerative horizontal cleavage lesion of the medial meniscus. In view of the changing pattern he warns against categorical statements.

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A case report of discoid medial meniscus with a tear and cystic degeneration is presented for its rarity. The preservation of fibrocartilaginous structure as discoid meniscus is common only on the lateral side. Such lateral menisci are prone for tears following trivial injury and for cystic degeneration.

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Association of fracture of head of radius with fracture of lower end of the ipsilateral radius, is not recorded in the available literature (Watson-Jones 1976). Case records of two such cases are presented.

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