Effectiveness of the Ponseti Technique in the management of clubfoot

Background: Clubfoot is a common developmental anomaly of the musculoskeletal system and it remains a burden to developing countries due to lack of appropriate medical care, poverty and ignorance. The Pirani scoring system is an instrumental tool for assessing both the severity of the deformity, and the progress of treatment.Objectives: To determine the effectiveness of the Ponseti technique in clubfoot correction in our centre.Methodology: This was a prospective study carried out in a tertiary hospital. Ethical clearance was obtained from the hospital Ethics Committee. Patients who met the inclusion criteria were randomly selected. The Pirani score of all feet were obtained before initial manipulation was commenced, and was also done at each follow up visit until correction was achieved.Results: A total of 50 patients (64 clubfeet) were recruited. The mean Pirani score at presentation was 4.33± 1.56 while the mean number of casts used for correction was 7.61 ±2.87. Clubfoot correction using the Ponseti technique was achieved in 58 (90.6%) clubfeet. Tenotomy was done in 37 (57.8%) clubfeet.Conclusion: From the results of this study, it is concluded that the Ponseti technique is an effective method for clubfoot correction. The Pirani scoring system is also an effective tool in monitoring progress obtained in the clubfoot during correction. It is therefore recommended that the Ponseti technique be used routinely in the treatment of clubfoot.Keywords: CTEV, Ponseti technique, Pirani score, Congenital feet malformatio

Does improvised waterbed reduce the incidence of pressure ulcers in patients with spinal injury?

Background: Pressure ulcers are lesions caused by unrelieved pressure over bony prominences, resulting in damage to underlying tissues. The etiology is multifactorial including prolonged immobility. They usually complicate spinal cord injuries with long periods of bed confinement. The use of bed replacements markedly reduces the incidence of pressure ulcers, but the unaffordability of these replacements in low-income countries has necessitated the need to explore cheaper alternatives. Aim and Objective: The aim of this study was to ascertain whether the use of our cheap and locally improvised waterbeds would reduce the incidence of pressure ulcers in patients on prolonged bed confinement due to spinal injury. Methodology: Over a 16-month period, 51 patients (age range 1-80 years) with spinal injuries were managed conservatively in our service using improvised waterbeds in 21 (41.2%), while using the regular hospital bed/foam in 30 (58.8%). Biodata, the time interval between injury and presentation to the hospital, nature of the injury, use of improvised waterbed and development of pressure ulcer, were collected, collated, and analyzed. Statistical significance was calculated with the Chi-square test. Results: Most were males (98%), in the age range of 21-30 years (25.5%), and due to fall from heights (35.3%). Of 21 patients who were managed on improvised waterbeds, 6 (28.6%) had pressure ulcers, and of the 30 who did not use the waterbed, 17 (56.7%) developed ulcers. The c2 = 3.9381, while P = 0.0472. This difference was statistically significant. Conclusion: The improvised waterbed, which is much cheaper than the standard waterbed, was observed to have significantly reduced the incidence of pressure ulcers among our patients. Nonetheless, further studies would still be needed to confirm this observation