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Three cases of avascular necrosis of the lesser metatarsal heads following forefoot surgery are presented. The variable blood supply of the metatarsal heads is described. Interruption of this delicate circulation at the time of surgery is thought to be a major etiological factor. Repeated trauma following transference of load to the lesser metatarsal heads after operation may also play an important role. Although not previously described this may be a cause of persistent pain following surgery to the forefoot which is easily overlooked.

This article reviews a study in which distal forearm fractures in children were treated with a below elbow semi-rigid cast, with instructions for removal at home. Patient satisfaction surveys established that children and parents were pleased they did not have to return to hospital to have the cast removed, and most patients returned to normal activity immediately or within one week after removing the plaster at home. Although semi-rigid casts are slightly more expensive to apply than standard plaster, the authors believe this is outweighed by the advantages of patients not having to return to the fracture clinic. Hospital clinics were significantly less busy, allowing them to create slots for new referrals.