Safety and efficacy of Achilles tenotomy under local anaesthesia: as part of the Ponseti clubfoot management -experience at the Sudan clubfoot clinic

Introduction: Ponseti method of treatment of clubfoot is a gold standard method. It includes serial casting to be followed by percutaneous tenotomy of the Achilles tendon under local anaesthesia. In the current study the safety and efficacy of tenotomy under local anaesthesia following serial casting will be studied

Patients and Methods: 89 patients who were seen at the Sudan Clubfoot clinic at Soba University Hospital between 2011 and 2012. All underwent serial casting according to Ponseti method and that was followed by Achilles tenotomy under local anaesthesia using a single stab using a size 15 scalpel

Results: there were 89 patients [135 feet], 64 [71.9%] males and 25 [28.1%] females. 46 patients [51.1%] had bilateral involvement. Familial history was there in 11 [11.2%] babies. Tenotomy was performed in all feet after an average of 6.2 casts [range, 3 to 11]. All were discharged 2 hours after the tenotomy. No adverse events were related to local anaesthesia and/or the procedure itself, and there was no delay in discharge in any of the operated babies. All patients had an uneventful course. Only one patient [1.12%] had previous conservative treatment before coming to the clinic. Pressure sores were observed as a result of casting in one foot. Residual equinus deformity after the tenotomy was experienced in 5 feet. 86 of the parents were satisfied with the correction. The rest; 3 patients [3.37%] were not satisfied because of the residual equines

Conclusion: tenotomy procedure using local anaesthesia is an effective and safe procedure

Phantom sensation and phantom pain among amputees at the national centre for prosthetics and orthotics in Khartoum

Although amputations and prosthetic rehabilitation at the National Centre for Prosthetics and Orthotics [NACPO] were studied before, phantom pain and phantom sensation which affect rehabilitation and prosthetic use were not. The aim of this paper is to report on phantom sensation and pain among amputees presenting to NACPO. Amputees presenting to NACPO between February 1998 and February 1999 for prosthetic fitting were included in the study. The occurrence of phantom pain and phantom sensation and their relation to sex, age, cause and level of amputation and prosthetic rehabilitation were studied. There were 256 amputees, 209 males [81.6%] and 47 females [18.4%], [M:F= 4.4:1]. Their ages ranged between two and 79 years. The overall occurrence of phantom pain and phantom sensation were 27.7% and 55.1% respectively. Males and females had almost the same occurrence. About 9% of amputees below 15 years of age had phantom pain compared to 34.6% for those who were above 40. Occurrence of phantom pain among Mycetoma amputees was less than those of land mine, 22.2% and 36.4% respectively which could be due to that mycetoma is a painless pathology. More than 25% of transtibial and transfemoral amputees had phantom pain, only 9.1% of Symes amputations experienced pain. Phantom pain occurred in 22.5% of amputees who had prosthesis within the first 6 month after amputation while it occurred in 33.4% of amputees who received the prosthesis after more than three years. Occurrence of phantom pain among amputees is affected by age, cause and, level of the amputation and time elapse between amputation and prosthetic fitting