A prospective cohort study on comparison of early outcome of classical Ponseti and modified Ponseti post tenotomy in clubfoot management.

INTRODUCTION: Ponseti method has become the main treatment modality for the management of clubfoot producing good long-term results. However, variation in cast application post tenotomy has not been evaluated. METHODS: A prospective cohort study involving 40 patients with 67 clubfeet were randomized into two groups: 32 above knee cast (AKC) and 35 below knee cast (BKC) after percutaneous tenotomy. All had foot abduction brace after post tenotomy cast. The median age was 21 weeks (range: 1-104 weeks) and 1.9:1 male/female ratio. 27 (67.5%) patients had bilateral clubfoot and unilateral in 13 (32.5%). Patients were followed-up for 6 months with documentation of the Pirani Score and the cost of treatment. RESULTS: No significant difference between AKC and BKC mean Pirani score before treatment (p = 0.550) and after treatment (p = 0.702). However, mean Pirani score at 6 months was significantly different (p = 0.038). Overall mean number of casting was 6.4 in AKC group and 4.7 in BKC group (p = 0.003). There was recurrence in 2 feet before completion of treatment (6.3%) among AKC and none among BKC group. However, there was no recurrence at 6 months after treatment in both groups. The mean cost for AKC and BKC were ₦10,427.34 (52.33 US dollars) and ₦7021.54 (35.24 US dollars) respectively (p = 0.002). CONCLUSION: Early results of below knee cast after tenotomy were comparable to the classical above knee cast after tenotomy in Ponseti treatment protocol for clubfoot. There was also reduction in cost of treatment in the modified Ponseti compared to the classical Ponseti. Long-term result will be desirable.

Vulnerability of motorcycle riders and co-riders to injuries in multi-occupant crashes.

In developing countries, most motorcycles are ridden with more than one occupant. The objective of this study was to establish the relative vulnerability of riders and co-riders to injury and determine the injury risk factors in multi-occupant motorcycle crashes. Between January and December 2010, we collected crash and injury data from victims of multi-occupant motorcycle. It is a hospital-based study. The probability of sustaining injuries was similar for co-riders and riders, but co-riders were more likely to sustain severe injuries. Occupants of >2-occupant motorcycles were also more likely to be involved in risky behaviours like not wearing helmet and speeding than those on 2-occupant motorcycles. Occupants of motorcycles on which there were more than two occupants were at an increased risk of sustaining injuries compared with occupants of motorcycles with only two occupants (OR: 2.1, 95% CI: 1.1-4.3). Motorcycle co-riders were more vulnerable to severe injuries than riders. The significance of the study finding to prevention was discussed.