The purpose of the study was to assess the usefulness of this combination of operations in this challenging patient group.

18 patients (19 hips) with cerebral palsy and painful subluxed or dislocated hips underwent hip resurfacing with shortening and rotation osteotomy of the femur between 1999 and 2005. The mean age was 25 (range 14–59) and follow-up averaged 47 months. Eleven patients were quadriplegic, five were diplegic and two were hemiplegic.

There were no infections. There were two plate cut-outs and two dislocations. All stabilised following necessary treatment. Four plates were removed after about one year. All quadriplegic and four of the diplegic patients were chair-bound pre-operatively. Their carers all felt that their comfort sitting had improved. Seventeen patients (eighteen hips) were pain-free at latest follow-up. One patient, whose plate had not been removed had some lateral tenderness on transferring, but no apparent pain on sitting. Three of the previously chairbound diplegic patients were able to stand and one was able to walk.

As all eighteen of the carers were very satisfied with the outcome, this approach to the treatment of these challenging patients has proved promising

The aim of this study was to assess the usefulness of Cast index and an indigenously developed Gap index as measures of poor moulding of plaster. 20 cases of re-manipulation of distal third forearm fractures excluding growth plate injuries were compared with a control of 80 patients. 5 patients in the control group had an axial deviation of more than 10 degrees but were not remanipulated and therefore were included in the failure group. The gap index and the cast index of the two groups was compared as predictors of failure of conservative treatment. The groups were similar in terms of demography and post reduction alignment. There was a significant difference (< 0.001) in the Cast index and the Gap index of both the groups. The sensitivity of the Cast index (> 0.8) in predicting failure of plaster was 48% while that of the sum of Gap index (> 0.15) in AP & Lat view was 88%. Gap index was found to be more accurate (84%) than Cast index (78%) in predicting failure. The gap index is a better predictor of failure than the cast index. A quick assessment of these indices, especially by the less experienced surgeons, is a good practice before accepting any plaster following a manipulation of distal radial fractures. It would not only save the patient a second anaesthesia but also complications of a more extensive second procedure and of course hospital resources.

Adverse effects of different preparations of Botulinus Toxin were studied. 97 episodes of injections in 67 children with cerebral palsy carried out between 1994 and 2001 were available for study. A telephonic interview was carried out according to a format in which the nature of adverse effects and the onset and duration of beneficial effect were recorded. 52 children had diplegia, 27 had hemiplegia and 18 had quadriplegia. 69 injections were made using Botox and remainder were made using Dysport. The dose for botox was up to 12 units per kilogram body weight and for dysport up to 40 units per kilogram body weight. The average age at injection was 94 months. The diagnoses were evenly distributed between the groups. A total of 72 adverse effects were noted in 44 episodes. Botox group accounted for 35 episodes and dysport for 9 (p=0.23). Thirty-three children had at least one adverse effect. Botox group accounting for 23 and Dysport group for 10 (p=0.45). The commonest adverse effect was pain at the injection site. The student t test was carried out to test statistical significance. There were no significant differences in the occurrence of adverse effects or the onset and duration of beneficial effect.

It may be concluded that botulinum therapy for cerebral palsy provided a high degree of patient/carer satisfaction. It produced few adverse effects and is generally well tolerated. The effects of botox and dysport were comparable.

We report the results of imaging with labelled white cells in 52 patients before the revision of 54 cemented joint prostheses at which the diagnosis of infection was made from biopsies. Twenty-five hips were imaged with 111In-oxine-labelled cells; 20 hips and 11 knees were imaged with 99mTc-hexamethylpropylene-amineoxime-labelled cells. Of these, 13 hips and five knees proved to be infected. The scans taken together had an accuracy of 82%, a sensitivity of 44% and a specificity of 100%. Indium scans gave 37% sensitivity, 99mTc labelling 50% sensitivity. Infected arthroplasties with positive scans had presented significantly earlier than those with negative scans, the time after the original insertion being 1.1 years for the true-positive scans and 6.1 years for the false-negative scans. The value of labelled white-cell scans in the detection of infection in failed joint replacements is dependent on the activity of the infection. There is reduced sensitivity to the more insidious infections which affect arthroplasties and aspiration under controlled conditions remains an important investigation.