Prediction of Number of Casts and Need of Tenotomy Using Pirani Score in the Management of Clubfoot.

BACKGROUND: Clubfoot also called as congenital tailpipes equinovarus is a complex ankle and foot deformity characterized by forefoot adduction and supination, midfoot cavus and hindfoot varus and equinus. It is estimated that more than 100,000 babies are born each year worldwide with clubfoot, and 80% are seen in developing nations. Different scoring systems are used for grading the severity of deformity or monitoring the natural history of clubfoot. The Pirani scoring system is now routinely used in most clubfoot clinics, including Cure Ethiopia, Children's Hospital. METHODS: A facility based retrospective study was conducted on 278 idiopathic club feet successfully treated by the Ponseti method and scored by Pirani system between September 2013/14 to September 2017/2018. Age at presentation, number of casts required, need for percutaneous Achilles tenotomy, casting effects were recorded. RESULTS: A total of 287 clinical folders of children were retrieved (424 feet). The mean (±SD) number of casts required for correction of the deformity was 5.54 ±â€Š1.63. The number of cast required for correction is significantly, and positively correlated with initial severity of Pirani score (r = 0.62 for right foot; r = 0.675 for left foot). There is a significant difference on the overall initial Pirani score between tenotomy and non- tenotomy group (P value < 0.001). CONCLUSION: The study revealed that severity of initial Pirani score can be used to estimate the number of Ponseti cast required for correction of clubfoot deformity and the need for tenotomy. Besides, the number of Ponseti cast required may not be affected by age of a child at the commencement of treatment.

Anatomical Variation in Morphometry and Morphology of the Foramen Magnum and Occipital Condyle in Dried Adult Skulls.

BACKGROUND: The foramen magnum (FM) is the largest opening and is outlet through which medulla oblongata and spinal cord along with meninges, vertebral arteries, anterior and posterior spinal arteries, tectorial membrane, alar ligaments, and spinal branch of the accessory nerve. Occipital condyle (OC) is an important part of craniovertebral or craniocervical junction located anterolaterally on either side of the FM. The objective of the study was to assess variations of FM and OC in Ethiopian dried adult skulls. METHODS: Observation-based descriptive study design was employed. The study was undertaken in 54 FM and 108 OC of 54 adult Ethiopian skulls. The morphometry of FM and OC were determined using a sliding vernier caliper. RESULTS: The mean values of anteroposterior and transverse diameters of the FM were 35.19 and 30.17 mm, respectively, and the mean area of the FM was 853.36 mm. The shapes of FM were determined as round in 22.2%, oval in 18.5%, egg like in 20.4%, triangular in 3.7%, pentagonal in 11.1%, hexagonal in 7.4%, irregular in 13%, and rectangular in 3.7% of the cases. The mean length of right and left OC was 25.69 and 26.96 mm, respectively, and the mean widths of the right and left OC were 12.76 and 13.04 mm, respectively. CONCLUSION: Our study identified various shapes of FM and diameter. The anteroposterior diameter is greater than the transverse diameter. The morphometric study of OC confirmed the length of left side is significantly greater than the right side.