Osteomedullography was done in 12 cases of old fractures of the tibia. It is a simple technique. It appears reasonable to investigate by osteomedullography those diaphyseal fractures which show evidence of delayed union. If osteomedullographic sign is positive, conservative treatment can safely be continued with a good chance of union. On the other hand if the osteomedullography is negative, surgical intervention is indicated.

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Sixty-two cases of pyogenic iliacus abscess seen over a period of 7 years are presented with emphasis on the clinical presentaion and their management. The term ‘iliacus abscess’ is preferred over ‘psoas-abscess’ on account of location of the pathology.

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Forty-four synovia (40 arthritis and 4 normal) were studied. The histologic changes were graded and correlated with acid phosphatase content. An increase of acid phosphatase activity with parallel histologic changes were found in rheumatoid and tuberculous arthritis. Traumatic arthritis, Charcot’s arthropathy and osteoarthritis had absent acid phosphatase, low histologic score and no evidence of clinically active disease. No correlation was seen in pyogenic arthritis.

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The present study comprises of detailed bacteriological investigations for the state of asepsis in the conventionally designed orthopaedic operation theatre and ward of G.M. and Associated Hospitals, Lucknow. The findings include identification of organisms isolated, bacterial counts at different periods, sedimentation rate of bacterial particles at different periods and prevalence of phage types of Staphylococcus aureus in operation theatre and ward environment. The study of the air samples of operation theatre revealed a mean bacterial count in terms of colony forming units (CFU) as 640 per liter of air while it was 2,120 per liter of air in the ward. The dust samples of floor and walls of both the operation theatre and the ward showed bacterial counts of not less than 100 CFU sq. inch. The culture isolation from the air and dust showed predominantly Staphylococcus aureus (75 percent). On phage typing, it was found that 58.8 percent of the strains of Staphylococcus aureus isolated from air, dust and other sources belonged to phage group III. The commonest phage pattern was 53.

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Twenty-five low friction arthroplasties were performed in 19 patients suffering from ankylosing spondylitis. All these cases presented either with bony or fibrous ankylosis and with severe deformities at the hip. All the arthroplasties were done in a conventional operation theatre and majority through the anterolateral approach. An ostetomy of greater trochanter was considered essential in such cases to expose the acetabulum widely and to overcome any problems encountered in its reconstruction. Significant benefit was obtained in posture and function so that these patients could be gainfully employed. Patients with bilateral involvement did best when total hip replacement was performed bilaterally. No serious complication was encountered.

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Twenty knees in 18 children suffering from rheumatoid arthritis of knee were treated by synovectomy and were observed for 3 months to 5 years. Pain was relieved in all except one and effusion in 16. Range of movements also improved or remained same in all except one patient. Synovectomy is a useful procedure for those children who have not responded to conservative treatment and do not show bone erosion in X-rays.

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A case of ossifying fibroma treated by curettage and bone grafting is presented.

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Twelve atypical cases of Legg-Calve-Perthes’ disease out of a total of 40 were seen during a 5 years period. The clinico-radiological features were similar to tuberculosis of the hip, with raised erythrocyte sedimentation rate, fever, fixed deformities and gross osteoporosis. Patients improved even without the use of antimicrobial therapy and after a 5 year follow up showed stigmata of classical Legg-Calve-Perthes’ disease.

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An unusual case of chronic granulocytic leukaemia with osteolytic lesion in tibia without blastic crisis is reported.

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A rare case of extensive haemangiomatosis with massive osteolysis and involvement of all the major nerves and vessels in a 6 year old girl is reported.

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A case of giant cell tumour of patella is reported.

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Thirty-four cases of giant cell tumour of bone were analysed. Of the 9 patients (grade I and II) treated by curettage and bone grafting 2 patients developed a local recurrence. Of the 9 patients (grade I and II) treated by en bloc resection there was one recurrence. Due to technical reasons in 2 patients only partial excision was done and both had local recurrence. Ten patients, incidentally belonging to grade I, were treated by radiation, more than 50 percent developed recurrence and one developed sarcoma 8 years after irradiation. Histopathological grading was found of not much importance as far as the recurrence rate was concerned but it may have some value in determining the chances of the tumour behaving like a frankly malignant tumour. Complete resection of the tumour by excision of tumour bearing bone gave the best results.

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A case of giant cell tumour of lower end of fibula is being presented due to its uncommon site and unusual presentation.

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