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This report of a patient with a discoid lateral meniscus is of interest due to its association with a deep distinct cupping of the underlying lateral tibial plateau. This radiographic finding, if present on plain roentgenograms, should alert one to the possibility of a discoid meniscus.

Core biopsies of the proximal femoral growth plate from three patients with slipped capital femoral epiphysis were compared with three normal growth plates from patients of similar ages. The growth plates of patients with slipped capital femoral epiphysis had a normal resting zone, a loose and fibrillated proliferative zone, and a very disarranged and thickened hypertrophic zone. The proliferative zone stained strongly with alcian blue, suggesting the presence of abundant proteoglycans in the cartilage matrix. The thickened hypertrophic zone was strongly positive to periodic acid-Schiff stain, indicating the presence of abundant structural glycoproteins. Enchondral ossification was scanty and irregular, and there were large clusters of cartilage in the metaphysis. Slippage occurred through the thickened proliferative and hypertrophic zones. Clinical Relevance: The proximal femoral growth plate in slipped capital femoral epiphysis is histochemically abnormal and histologically disarranged. These features contribute to abnormal widening of the growth plate and to further slippage.

Twenty-one patients were treated with Zickel nail for neoplastic pathological fracture or impending pathological fracture: in the femoral neck in three, in the intertrochanteric region in three, and in the subtrochanteric region in fifteen. Nineteen patients were restored to bed-chain status by the third postoperative day, and twenty were able to walk. Failure of fixation did not occur and there were no infections.

Seven cases of synovial sarcoma were studied by electron microscopy. The 4 cases of the monophasic spindle type contained elongated cells arranged in sheets and cords; ultrastructurally the cells contained many cytoplasmic processes and were scattered in an amorphous matrix. The monophasic spindle type demonstrates ultrastructural characteristics that are unique and serve to differentiate it from the biphasic pattern and from fibrosarcoma. Three cases of the biphasic variety demonstrated cytologic characteristics of a true glandular epithelium and a malignant spindle cell stroma. The epithelial nature of the biphasic variety is a feature that raises doubt whether synovium is the stem cell.

We evaluated 121 patients who had had slipped capital femoral epiphysis (149 involved hips) twenty-one to forty-seven years after the diagnosis was made. The results were very good in most of the eighty-three hips with the slip left unreduced. Fifty-four hips that were treated by procedures designed to improve the alignment of the slipped femoral head had more complications and less favorable results, but in general, these were the more severe slips. However, there were enough slips of comparable severity that were treated unreduced to suggest that the long-term results, even in moderate and severe slips, were better after in situ fixation than after operative and manipulative treatment (as performed between 1915 and 1952). Twelve of the thirteen hips with acute slips were reduced (the thirteenth was one of the eighty-three unreduced hips) and aseptic necrosis developed in three, while nine had good results.

The femoral heads of 12 dogs with naturally occurring Legg-Calve-Perthes disease were studied by light and electron microscopic techniques. In the early stages of the disease, the bony capital femoral epiphysis was necrotic, but the articular cartilage and growth plate cartilage were not affected. By the early stages of repair, the femoral head had collapsed. the articular cartilage was thickened and furrowed at the sites of collapse, and the chondrocytes appeared more metabolically active. Sites of bone resorption were associated with osteoclasts and macrophages. In some specimens there were areas of necrosis in the metaphysis which interrupted normal enchondral ossification in the growth plate. By the final stages of repair, the epiphysis was almost completely revascularized with the exception of the central proximal segment. In some areas, repair tissue had penetrated into the deeper layers of the articular cartilage. The flattening of the femoral head in Legg-Calve-Perthes disease appears to be the result of several processes: mechanical collapse, asymmetric growth, and disturbed enchondral ossification at the growth plate.

The technique of fine-needle aspiration biopsy seems to be ideally suited for the diagnosis of lytic bone lesions at practically any location in the skeleton. The technique is simple, carries minimum risks, and can often be performed on an outpatient basis. Advances in cytological techniques have made it possible to reach an accurate diagnosis for most patients within twenty-four hours. The accuracy rate in the present study of seventy patients was 87.5 per cent, but the lesions studied included few primary bone tumors. One limitation of the technique is the difficulty in sampling a lesion that is covered by compact bone.

Previous histological and ultrastructural studies of the growth plates in achondroplasia have not pointed out any specific feature characteristic of the abnormal growth pattern. The conflicting data we (12) and others (3,16,22–25) have found were apparently due to different biopsy sites, or related to species differences. Ultrastructural studies of the chondrocytes in human achondroplasia and different animal models of short-limbed skeletal dysplasias have not delineated any abnormal feature other than an increased number of dead cells in the growth plate.

Twenty-one patients were treated with Zickel nail for neoplastic pathological fracture or impending pathological fracture: in the femoral neck in three, in the intertrochanteric region in three, and in the subtrochanteric region in fifteen. Nineteen patients were restored to bed-chain status by the third postoperative day, and twenty were able to walk. Failure of fixation did not occur and there were no infections.

The sternocleidomastoid muscles from five children with muscular torticollis--examined by transmission electron microscopy, exhibited a marked increase in interstitial collagen deposition, and scattered areas of amorphous ground substance with electron dense deposits. No vascular abnormalities were observed. Ultrastructural muscle abnormalities showed various stages of immobilization degeneration including nearly complete loss of myofibrils. The muscle abnormalities ultrastructurally are consistent with immobilization degeneration, probably secondary to the marked fibrosis in the sternocleidomastoid muscle.

The technique of fine-needle aspiration biopsy seems to be ideally suited for the diagnosis of lytic bone lesions at practically any location in the skeleton. The technique is simple, carries minimum risks, and can often be performed on an outpatient basis. Advances in cytological techniques have made it possible to reach an accurate diagnosis for most patients within twenty-four hours. The accuracy rate in the present study of seventy patients was 87.5 per cent, but the lesions studied included few primary bone tumors. One limitation of the technique is the difficulty in sampling a lesion that is covered by compact bone.

We evaluated 121 patients who had had slipped capital femoral epiphysis (149 involved hips) twenty-one to forty-seven years after the diagnosis was made. The results were very good in most of the eighty-three hips with the slip left unreduced. Fifty-four hips that were treated by procedures designed to improve the alignment of the slipped femoral head had more complications and less favorable results, but in general, these were the more severe slips. However, there were enough slips of comparable severity that were treated unreduced to suggest that the long-term results, even in moderate and severe slips, were better after in situ fixation than after operative and manipulative treatment (as performed between 1915 and 1952). Twelve of the thirteen hips with acute slips were reduced (the thirteenth was one of the eighty-three unreduced hips) and aseptic necrosis developed in three, while nine had good results.

In 2 cases of impending pathologic fracture of the proximal femur, the treatment was resection of the metastatic site. The diagnoses were metastatic pheochromocytoma and metastatic renal cell carcinoma. Successful stabilization in th proximal femur was achieved with the Zickel device, wire mesh, and methylmethacrylate.

Core biopsy specimens of the proximal femoral growth plate from three patients with slipped capital femoral epiphysis were studied by light and electron microscopy. In the resting zone, the cartilage matrix was composed of large, densely packed collagen fibrils. The cartilage matrix in the zones of chondrocyte hypertrophy where the slippage occurred contained only scattered fine collagen fibrils in a homogeneous ground substance. The change in composition of cartilage matrix in the distal region of the epiphyseal plate may predispose that region to slippage.

The femoral heads of 12 dogs with naturally occurring Legg-Calvé-Perthes disease were studied by light and electron microscopic techniques. In the early stages of the disease, the bony capital femoral epiphysis was necrotic, but the articular cartilage and growth plate cartilage were not affected. By the early stages of repair, the femoral head had collapsed. the articular cartilage was thickened and furrowed at the sites of collapse, and the chondrocytes appeared more metabolically active. Sites of bone resorption were associated with osteoclasts and macrophages. In some specimens there were areas of necrosis in the metaphysis which interrupted normal enchondral ossification in the growth plate. By the final stages of repair, the epiphysis was almost completely revascularized with the exception of the central proximal segment. In some areas, repair tissue had penetrated into the deeper layers of the articular cartilage. The flattening of the femoral head in Legg-Calvé-Perthes disease appears to be the result of several processes: mechanical collapse, asymmetric growth, and disturbed enchondral ossification at the growth plate.

Seven cases of synovial sarcoma were studied by electron microscopy. The 4 cases of the monophasic spindle type contained elongated cells arranged in sheets and cords; ultrastructurally the cells contained many cytoplasmic processes and were scattered in an amorphous matrix. The monophasic spindle type demonstrates ultrastructural characteristics that are unique and serve to differentiate it from the biphasic pattern and from fibrosarcoma. Three cases of the biphasic variety demonstrated cytologic characteristics of a true glandular epithelium and a malignant spindle cell stroma. The epithelial nature of the biphasic variety is a feature that raises doubt whether synovium is the stem cell.

The roentgenographic findings in unicameral bone cyst may be difficult to differentiate from a solid tumor of bone. When present, the fallen fragment sign may aid in determining the roentgenographic diagnosis of unicameral bone cyst. In this finding, with a pathologic fracture a fragment of cortical bone may become dislodged and gravitate to the dependent portion of the unicameral bone cyst. Two examples of the fallen fragment sign demonstrate the displacement of a fragment of cortical bone to the dependent portion of the cystic cavity.

Core biopsies of the proximal femoral growth plate from three patients with slipped capital femoral epiphysis were compared with three normal growth plates from patients of similar ages. The growth plates of patients with slipped capital femoral epiphysis had a normal resting zone, a loose and fibrillated proliferative zone, and a very disarranged and thickened hypertrophic zone. The proliferative zone stained strongly with alcian blue, suggesting the presence of abundant proteoglycans in the cartilage matrix. The thickened hypertrophic zone was strongly positive to periodic acid-Schiff stain, indicating the presence of abundant structural glycoproteins. Enchondral ossification was scanty and irregular, and there were large clusters of cartilage in the metaphysis. Slippage occurred through the thickened proliferative and hypertrophic zones.The proximal femoral growth plate in slipped capital femoral epiphysis is histochemically abnormal and histologically disarranged. These features contribute to abnormal widening of the growth plate and to further slippage.

The orthopedist is most likely to encounter solitary or multiple forms of eosinophilic granuloma of bone. Management includes curettage for diagnosis and treatment with insertion of autogenous bone. Radiation therapy and chemotherapy are reserved for patients with multiple lesions and for the less common forms of histiocytosis X, i.e., Hand-Schüller-Christian disease and Letterer-Siwe disease.

A 73-year-old housewife with enlargement of her distal right humerus and especially the medial epicondyle due to Paget's disease developed an ulnar nerve palsy. Transposition of her ulnar nerve anterior to her elbow completely relieved her symptoms. A similar case of ulnar nerve palsy associated with expansion of the distal humerus due to Paget's disease seems not to have been previously reported.