Background:Treatment for developmental dysplasia of the hip (DDH) varies according to the age of the patient. For children under 3 months, the preferred treatment is Pavlik bandaging and/or dynamic hip orthosis;for children of 3–18 months (with/without arthrography), closed and open reductions (ORs) are most common; and for children 18 months and older, pelvic osteotomies are used. Radiological and functional outcomes of patients between 16 months and 7 years of age who underwent Pemberton pericapsular osteotomy (PPO) were evaluated.Materials and Methods:Twelve patients with developmental dysplasia of the hip (DDH) received treatment on 14 hips between 2001 and 2006. All patients with DDH had PPO as pelvic osteotomy. PPO was done solely in 3 hips, PPO and open reduction (OR) in and OR + PPO + femoral shortening in 6. The average age was 39.85 months (range 16–83 months). All had 1-stage surgery. Acetabular index (AI) and the grade of displacement were determined according to Tönnis’. Center-edge (CE) angle was evaluated. Clinical evaluations were made as described by McKay, radiological assessments by Severin's criteria and femoral head avascular necrosis measurements by Kalamchi–MacEwen's criteria. Average followup periods were 83.35 months (range 48–115 months).Results:Preoperative and postoperative average AI levels were 41.92° (range 30–50°) and 19,5° (range 5–34°), respectively (P < 0.001). According to Severin's classification, 11 (78.57%) patients were Ia, 1 (7.14%) was Ib, 1 (7.14%) was II and 1 (7.14%) was III. According to Kalamchi–McEven criteria, 12 (85.71%) patients were type I, 2 (14.28%) patients were type II. CE postoperatively was measured as 24.24° (range 12–41°). Clinically (McKay), the functional results in 13 (92.85%) patients were very good (I) and in 1 (7.14%) was good (II).Conclusions:Functional and radiological mid term outcomes were found to be comparable in most of the patients with DDH undergoing PPO between the ages of 16 months and 7 years.
Cleidocranial dysostosis is a skeletal dysplasia inherited in an autosomal dominant manner and may lead to complications such as scoliosis and kyphosis, concurrent with various orthopedic involvements. Since concurrent spinal deformities are of progressive nature, surgical treatment may be necessary. In addition to other orthopedic problems, possible accompanying complications such as atlanto-axial subluxation, myelopathy, syringomyelia, congenital spine deformities, spondylosis, and spondylolisthesis should be kept in mind while planning for the treatment of scoliosis and kyphosis. Lengthening the use of growth-friendly systems (growing rod) in patients, like ours, with an early onset of symptoms, and performing posterior instrumentation and fusion once the spinal growth is complete will yield successful results with no complications in the middle and the long term. Further multicenter studies with more comprehensive assessments are required to find solutions to spinal problems related to this rare skeletal dysplasia.
We aimed to share our experiences on perioperative blood loss and the prevalence of side effects of high-dose tranexamic acid (TXA) used intraoperatively in vertebral surgeries. Material and Method: Thirty-four patients with the class of American Society of Anaesthesiology(ASA) I-III who underwent posterior spinal instrumentation and osteotomy at ≥5 vertebral levels were retrospectively analysed. TXA was administered intravenously from beginning to end of surgery at a loading dose of 50 mg/kg and a maintenance dose of 10 mg/kg/h. In addition to routine monitoring, minimal invasive cardiac output measurement was also used. Operative parameters, intraoperative-postoperative blood loss, mean volume of blood transfusion and fluids, hospitalization time, Hb, BUN, creatinine, Plt, INR levels, side effects and complications were recorded and evaluated. Results: Median value of fused spinal segments was 12 (7-13). Intraoperative blood loss was 1448.53±767.18 ml, 133.85±61.77 ml per fused spinal segment and 172.79±82.12 ml per hour during the operation. While intraoperative blood loss was significantly lower in patients undergoing primary surgery than in revision patients, there was no difference in terms of postoperative blood loss. It was directly correlated with the number of fused vertebrae, duration of surgery, age and ASA. Mean amount of red blood cell transfused was 1.5±1.29U. There were no significant complications or side effects such as thromboembolism, seizure or renal failure in our patients. Conclusion: Although appropriate dosages are not yet established, we think that a loading dose of 50 mg/kg TXA can be used safely in vertebral surgeries without causing significant side effects.
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