Abstract
The purpose of our study was to evaluate the necessity of blood transfusions in operations for neglected DDH. It is generally known that blood transfusion is necessary in neglected DDH operations. Because of transfusion complications, Erythropoetin and autologous blood donation are proposed for blood replacement. However, these two methods are expensive and not useful in children.
We evaluated Hb-Hct levels in 48 children (52hips) operated on from 1992 to 1997. Mean age was 5.7 years (range 1.5 to14). Open reduction and pelvic osteotomy was performed in 40 hips, and open reduction, femoral shortening, and pelvic osteotomy in 12 hips.
The authors performed all of the operations. We approached the surgical technique and haemostasis carefully by using a curved ostetom instead of a gigly saw and left the medial apophisis and periosteum intact until the roof surgery. Dissection of the posterior-superior part of the ischiadic notch was avoided, and without using a drain. Oral supplemental ferrum (5 mg/kg) was prescribed to all patients until the Hb value increased to 12mg/dl. There was close clinical status follow-up of the patients for ten days after surgery and Hb–Hct levels were recorded periodically.
In the open reduction and modified Salter osteotomy group there were 4/40 hips respectively (10%). In the combined surgery group (open reduction, femoral shortening, pelvic osteotomy) there were 16 hips (33%) that required transfusion. We preferred packed red blood cell transfusion for blood substitution. Transfusions were made within one to five days. Mean loss of Hb was 4.7g/dl. Up to 7g/dl Hb level was well-tolerated by the patients. Digitalisation was required for one patient. There were no mortalities or infections in our patients up to the time of follow-up.
The process requires experienced surgeons, a meticulous surgical technique, a shortened operation time by modification of the pelvic osteotomy, and without using a drain. This is one of the most effective and less expensive ways to perform an operation for neglected DDH with a minimal loss of blood.
The abstracts were prepared by David P. Davlin. Correspondence should be addressed to him at the Orthopedic Clinic Bulovka, Budínova 2, 18081 Prague 8, Czech Republic.
