AIMTo evaluate the effectiveness of the Ponseti method for initial correction of neglected clubfoot cases in multiple centers throughout Nigeria.METHODSPatient charts were reviewed through the International Clubfoot Registry for 12 different Ponseti clubfoot treatment centers and 328 clubfeet (225 patients) met inclusion criteria. All patients were treated by the method described by Ponseti including manipulation and casting with percutaneous Achilles tenotomy as needed.RESULTSA painless plantigrade foot was obtained in 255 feet (78%) without the need for extensive soft tissue release and/or bony procedures.CONCLUSIONWe conclude that the Ponseti method is a safe, effective and low-cost treatment for initial correction of neglected idiopathic clubfoot presenting after walking age. Long-term follow-up will be required to assess outcomes.

Background and objectives: The cost of medical care and availability of resources (human and facilities) which differs from nation to nation are amongst others, factors driving medical tourism (MT) despite its potential drawbacks. The aim of the study was to analyse all patients that presented with neurosurgical complications following MT. Methods: A single institution prospective study was carried out. Data which included patients' demographics, diagnosis, Glasgow coma scale score at admission, type of complication, and outcome were collected over a 3 year period and analysed. Results: A total of 23 neurosurgical cases were seen during the study period with a median age of 42 years (17-70 years). India is the most common country visited by Nigerian patients. Nine patients died from various complications on arrival in Nigeria. There was no significant statistical difference between the outcome and patients clinical status prior to travel (p=0.107), country where the surgery was done (p=0.776), admission GCS in Nigeria (p=0.169), and redo surgery in Nigeria (0.181). Conclusion: Government in different nations should have legislations to ensure that medical tourists' receive appropriate care abroad, proper follow-up care upon their return, and also promulgate laws to regulate quasi and organised MT agencies that are operating in a regulatory vacuum.

Background:The availability of intraoperative fluoroscopy and improved access to varieties of spinal titanium implants has revived posterior spinal stabilization techniques with their distinct advantages. Our aim is to describe the profile of various spine pathologies requiring subaxial posterior spinal decompression, stabilization (using titanium implants), and arthrodesis, and to determine the rate of postoperative complications and factors affecting outcome.Materials and Methods:This is a prospective single institution study of consecutive adult patients seen during the study period. Data collected included the patients’ demographics, radiological findings, indication for surgery, surgical procedure, operation time, intraoperative blood loss, and postoperative complications.Results:There were 26 patients (15 males and 11 females). Their ages ranged between 24 and 78 years (median = 42 years). The most common indications for surgery were spinal trauma and degenerative spine disease (24 patients). The region that was most commonly stabilized was the lumbar- 12 cases (46.2%). No patients experienced neural or vascular injury as a result of screw position; likewise no patient had screw loosening. There was a case each of superficial surgical site infection and transient cerebrospinal fluid leak but no case of implant failure was encountered. The outcome was significantly associated with the etiology (0.030) of the indication for surgery and preoperative power grade (0.000).Conclusion:Spinal trauma and degenerative spine disease are the two most common indications for posterior spinal decompression, stabilization and fusion in our center. It is associated with acceptable postoperative complication rate when done under fluoroscopic guidance. Outcome is related more to the preoperative neurological deficit and etiology of the indication for surgical stabilization.

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Objective: No normative database for bone mineral density (BMD) exists in Nigeria. The study was done to provide the basis for the creation of a normative reference BMD database for women in Nigeria, while assessing the appropriateness of applying normative data for African-American women to Nigerian females. Methods:The BMD measurements of 70 women aged 50 years and above as well as 58 women aged between 23 and 30 years, were taken using an accuDexa Dual X-ray Absorptiometry (DEXA) machine. Their local T-scores were determined using the BMD measurements of the young healthy normal group as control and the patients were grouped using the World Health Organization definitions (WHO) classification into normal, low bone density and osteoporosis. This was compared with the T-scores obtained using the African-American normative database.Results: Using the local reference to determine T-scores for the older women, 24 were normal, 32 had low bone density and 14 had osteoporosis. When the African-American database was used as reference, 31 were normal, 31 had low bone density and eight had osteoporosis. This gave a diagnostic difference of 10% for the normal group, -1.4% for the low bone density group and -8.6% for the osteoporosis group. Conclusion:The preliminary results suggested that the BMD of the local young healthy normal female Nigerian was higher than the African-American female. Since the diagnostic difference for osteoporosis was greater than 5%, the African-American reference values were considered inappropriate for the diagnosis of osteoporosis in the female Black Nigerian.Therefore, there is a need for a larger multicentre study to evaluate these findings.