Verne T. Inman

The major determinants in normal and pathological gait.

Human locomotion is a phenomenon of the most extraordinary complexity in which so great are the multitude of individual motions occurring simultaneously in the three planes of space that analysis is difficult without some unifying principle. The adoption of the concept that fundamentally locomotion is the translation of the center of gravity through space along a pathway requiring the least expenditure of energy supplies the necessary unifying principle which permits of qualitative analysis in terms of the essential determinants of gait. The six major determinants are pelvic rotation, pelvic tilt, knee and hip flexion, knee and ankle interaction, and lateral pelvic displacement. The serial observations of irregularities in these determinants provides insight into individual variation and a dynamic assessment of pathological gait. Pathological gait may be viewed as an attempt to preserve as low a level of energy consumption as possible by exaggerations of the motions at unaffected levels. Compensation is reasonably effective with the loss of one determinant of which that at the knee is the most costly. Loss of two determinants makes effective compensation impossible and the cost of locomotion in terms of energy is increased threefold with an inevitable drain upon the body economy.

The Clinico-Anatomical Aspects of the Lumbosacral Heqion1

The problem of low back pain with sciatic radiation continues to present many puzzling features, which are reflected by the uncertainty in differential diagnosis and by the multiplicity of procedures which have been advocated for its treatment. The contributions of Mixter and Barr on the intervertebral disc as an etiologic agent constitute a major advance. Nonetheless the enthusiasm engendered by popularization of posterior herniations of the disc as the cause of sciatica has proved too sanguine. The problem is a good deal too complex to be explained by purely mechanistic concepts of pressure on the spinal roots. This is evidenced by the disappointments which have so often followed surgical intervention with this concept solely in mind. On the other hand, in the great majority of cases, sciatica is but a subjective complaint which for the most part is unaccompanied by objective signs. It is now generally accepted that the etiology of this syndrome is extremely varied, being related to congenital, traumati...

FEMORAL HEAD AND NECK RESECTION.

1. Loss or removal of the femoral head and neck was accepted as a final result in thirty-seven patients; 2. Relief of pain was complete in thirty-five patients and partial in two patients; 3. One patient was not able to walk after operation, six required external support to walk at all, twenty-eight could walk without support but preferred to use external support, and two preferred to walk without external support; 4. The average extent of shortening was 1.3 inches (range, .75 to two inches); 5. The over-all subjective results in our experience were superior to those after arthroplasty or fusion in patients with similar disorders.

SIMULTANEOUS ANTERIOR AND POSTERIOR APPROACH TO THE CERVICAL SPINE. REDUCTION AND FIXATION OF AN OLD FRACTURE-DISLOCATION WITH CORD COMPROMISE.

Open reduction and fusion of dislocations arid fracture-dislocatiomms of the cervical spine are sometimes necessary ; it is generally recognized that certaiim types of dislocation of the cervical spine are irreducible by closed methods .8 Evemi mm situations in mvhich the dislocation might be reduced initially by closed methods, time possibility of successful reduction diminishes mvith the passage of time after iiijury 8,10 Furthermore, compression fractures with displacement of the vertebral bodies may be accompammied by disruption of the inmtervenming discs arid cause potemmtially hazardous permanent deformity of the cervical spine, despite adequate fixation .2 Finally, the presence of obvious compromise of the spinal cord is a cornpellinmg inmdication for stabilization of the spine, with or after decompression. Reported here is the case of a boy treated by open reduction and simultaneous anterior and posterior’ fusion for arm old, previously irreducible fracture-dislocation of time cervical spine.