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SummaryIn the time before steroid therapy it was rare that the hip joints were engaged in the clinical picture of rheumatoid arthritis. Particularly greater destructions and damage were rare, somewhat more often we found osteophyte formations and secondary osteoarthritis.Nowadays it is different. More often we see crippled cases with movement pains and flexion contractures in one or both hip joints. By x-ray examination of such cases we find great osteoporosis and not so seldom big destructions of the femoral head, in some cases intrudance of it deep into the acetabulum and pelvis. If we investigate the cases we find regularly that they have had steroid therapy for a long time.The causes are two: the more pronounced osteoporosis through the steroid therapy,the overuse of the joints through the diminished pains and diminished muscle defence.In rheumatoid arthritis we always have more or less osteoporosis. Serial x-ray-examinations from joints in different parts of the body have clearly demonstrated that th...

SummaryA series of 90 cases of rheumatoid arthritis in children below 15 years, treated in the Rheumatological Department of the University Hospital, Lund, Sweden, before 1951 were re-examined after an interval of at least 5 years. The material contained more than twice as many girls as boys, namely 70 per cent and 30 per cent respectively. Typical Still's disease was uncommon (5 cases).Involvement of the larger joints, particularly knee joints, at the onset was more frequent than in adults. The process often began as monarthritis. In girls above 12 years, the involvement of small joints tended to become as frequent as in adults.In addition to the arthritic symptoms, the onset is marked by insidious subfebrility, a moderate increase in the E.S.R., moderate hypochromic anemia and eosinophilia as well as signs of myocardial injury. Skin and ocular manifestations are common. Peritendinitis and subcutaneous nodules are sometimes seen.There is often a marked tendency to flexion contractures. Movement treatment...

Summary A method is described of treating chronic volar flexion contractures of the digits, following burns and trauma. Basically this involves excision of scarred skin, flexor tendon sheath and volar plate as required with subsequent immobilisation by Kirschner wires and resurfacing with cross finger flaps. Fifteen cases are presented and the results studied.

Summary An analysis is made of thirty-one cases of dog bites of the face which necessitated admission to hospital. Twenty-five of these had tissue loss and six had lacerations without loss. It is thought that in the majority of cases the patients were more to blame than the dogs. Sepsis was no worse a problem in these cases than in other facial lacerations. Special attention is paid to bites of the upper lip which are thought to be due in most cases to damage while kissing the dog, and for which the best treatment is wedge excision of the affected area.

1. The nature of flexion contractures of the knee joint is discussed. 2. It is suggested that division of the anterior cruciate ligament will help in the correction of the deformity when conservative methods have failed. 3. The results of the treatment of twelve such knees are mentioned and illustrative cases are described. 4. It must be emphasised that this method of treatment should be undertaken only when conservative methods have failed.

Acase of Addison''s disease with a specific pattern of muscular contractures has been described. The neuromuscular condition worsened concomitantly with the appearance of an Addisonian crisis. A marked improvement occurred immediately after the administration of glucocorticosteroids. The mechanisms underlying these phenomena were discussed.

1. Methods of correcting flexion contractures of the knee following poliomyelitis fail if posterior subluxation of the tibia is allowed to occur. 2. Careful serial manipulations will give straight, congruous joints in younger patients. Posterior capsulotomy does not facilitate correction. 3. Supracondylar femoral osteotomy is indicated in children over fifteen and in adults, although sometimes arthrodesis of the knee is necessary.

SUMMARY Rheumatoid arthritis occurs not infrequently in childhood. Girls are afflicted more often than boys. The form known as Still's disease seems to be less common in Sweden. The onset of the disease in children differs from that in adults in that the larger joints are more often attacked. The joints of the lower extremities are usually affected, especially the knee joints. The process frequently begins as a monarthritis. In preliminary stage it is often wrongly diagnosed as tubercular arthritis. Besides the arthritical symptoms it begins insidiously with subfebrile temperature, moderate increase in the SB, moderate hypochromic anaemia and signs for myocardial injury. X-ray manifestations of heart-dilatation generally becomes evident first in later stages. Sometimes peritendinitis and subcutaneous nodules. Processes in the eyes occur. Eosinophilia is common. The tendency to flexion contractures is often marked. The movement treatment of the joints is an important part of the therapy in avoiding defects. Internal anti-infectious therapy is also important because of the often pronounced infectious character of the disease (gold-salts or sulfonamides-preparations). For decreasing the hyperergic reaction of the tissues salicylic acid or amidopyrine is given. The prognosis appears to be relatively good – except of the cases of Still's disease. The duration of the disease is on an average from 2 to 3 years for those patients who are cured. Protracted care on hospital is necessary, preferably on arthritic clinics.

Today, total hip replacement for hip joint has already been accepted as a common treatment. But total knee replacement seems to be now under study because it contains many problems in its prosthesis, complication and results.We performed the synovectomies and the arthroplasties with the MacIntosh prosthesis for the two patients who could not walk due to the flexion contractures of the knee from the rheumatoid arthritis.And they gained the relief of pain and restoration of function and attained to be able to walk with a crutch.

In a study of 27 patients with progressive muscular dystrophy of childhood, it was found that duration of ambulation from onset of symptoms could be increased from an average of 4.4 yr to 8.7 yr by a comprehensive rehabilitation program. The program included early diagnosis, close supervision of patients, a physical therapy program with emphasis on passive stretching of flexion contractures about joints, and bracing for ambulation when independent walking was no longer possible. The total increase in ambulation will be greater, since eight patients are still walking independently in braces. This positive program is directed toward assisting the patient to lead as normal a life as possible, both physically and emotionally. The better preservation of the child's physical status should increase the chance for benefit from any future specific pharmacologic therapy.

Complete absence of dermatoglyphics (finger, palm, and toe prints) in more than one member of a family has not been described previously. Various studies of 24 members in one kindred are reported here. The 13 affected members also show bilateral partial flexion contractures of the fingers and toes, bilateral webbing of the toes, and transient congenital milia.

Modern correction of prolapse and collapse of the proximal interphalangeal joint is reviewed. Reasons why no single method has been uniformly successful are discussed. A more selective approach in the treatment of these deformities is suggested and personal solutions to some of the problems are presented:— • use of S-shaped-splints to prevent or correct flexion contractures of the proximal interphalangeal joint; • use of extra-osseous Kirschner-wiring to prevent flexion contractures of proximal interphalangeal joint in burnt-fingers; • use of silastic sheeting to inhibit formation of adhesions between tendon and bone in proximal interphalangeal surgery.

To the Editor.— In trisomy-18 syndrome the hand has a characteristic deformity. There is flexion of the fingers with overriding and medial deviation of the index and little fingers. The dermatoglyphics in these individuals is characterized by a high percentage of arches. A child had a hand deformity closely simulating that seen in trisomy-18 and an increased number of arches, but there were no other congenital defects and no chromosomal changes. The presence of a similar defect in the mother suggested an autosomal dominant mode of inheritance. Report of a Case.— A 6-week-old female child had the hand changes shown in Fig 1 and 2. There was clinodactyly of the index and fifth fingers which caused them to deviate medially and overlap the ring and middle fingers. The child could freely extend the fingers (Fig 2) indicating an absence of flexion contractures. The manner in which this deformity mimics that