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PubMed1998

[One hundred years of orthopedics in the Netherlands. VIII. Pediatric orthopedics].

Orthopaedic disorders in children differ in type from those in adults: most frequent are congenital anomalies and disorders of growth and development. The special nature and relative rarity of these conditions justify the separate development of this branch of the discipline. Fractures almost always heal normally after closed reduction and immobilization in a plaster cast; fractures close to epiphyseal discs and in joints require special attention. Slipping of the upper femoral epiphysis necessitates surgical fixation of the epiphysis. Benign bone tumours occur relatively often and mostly require no surgical intervention. The prognosis of solid malignant bone tumours has improved since the introduction of (neo)adjuvant chemotherapy and limb-sparing surgery. In case of difference in leg length, the length of both legs is predicted with the aid of roentgenological measurements. Inhibition of the growth of the longer leg gives rise to fewer complications than lengthening of the short leg. The essence of the treatment of growth disorders due to abnormal ossification of the cartilage is to monitor the natural repair process and to intervene if permanent malformation threatens.

Bone Diseases, Developmental↗
PubMedDate not supplied

[Development of orthopedics and founding of the Clinic for Orthopedic Surgery and Traumatology in Novi Sad].

A study of the development of the orthopaedic surgery in Novi Sad from the antique times till 1980 when the Clinic for Orthopaedic. Surgery and Traumatology was established has been carried out. Development from Roman Times till the Second World War. The first material evidence of the surgical activities in this area originates from the epoch of the Roman Empire, when under the emperor Augustus (Augustus, 27 B.C.-14 A.D.), the northern border of the Empire was established and fortified on the river Danube. At that time on the place of the contemporary Petrovaradin Fortress, a small fortification with a permanent garrison, called Cusum, was built. As it was proved by excavation of the surgical instruments from the Roman time at the nearby Sremska Mitrovica (Sirmium) the surgery in the Roman legions was quite developed and it could be concluded that some forms of surgery and orthopaedics were practised in the antique Cusum as well. There is no reliable evidence about the health service in the area after the Roman era till the 1689 when Petrovaradin was finally sized by Austrian troops from the Turks, and when the first recorded hospital (Petrovaradin Military Hospital) in this region was founded. At that time on the northern shore of the river Danube a new settlement, developing later into the town of Novi Sad, was established. Surgery together with orthopaedics at that time were performed by the so-called "feldschers", and then by primitive, self-taught surgeons who were actually experienced barbers, while educated doctors started to practice surgery only in the 19th century when the first surgical department in Novi Sad was founded in the Great Town Hospital, and for years after that, the orthopaedics was practised by general surgeons. The foundation of the Anglo-Yugoslav Children's Hospital for Tuberculosis of the Bones and Joints at Sremska Kamenica in 1934 by Dr. Katherine S. Macphail, a great benefactress of our people, was of great importance for the development of orthopaedics in this area as it was the first orthopaedic hospital in the country. The first small unit for orthopaedics, as a part of the Surgical Department of the Novi Sad State Hospital, was established in 1937 and led by a surgeon, Dr. Nikola Pravdica. Development from the Second World War till the 1980. After the Second World War the Main Provincial Hospital with two surgical departments was established in Novi Sad. At the so-called Second Surgical Department led by Dr. Nestor Teodorovic a small unit for traumatology and orthopaedics was founded in 1946, which functioned as such till 1953. The first properly trained orthopaedic surgeon was Dr. Stojan Letic who passed the specialty exam in 1953 and was attached to the Second Surgical Department of the Main Provincial Hospital. The first independent Orthopaedic and Traumatologic Department, led by an experienced orthopaedic surgeon, Dr. Vladimir Razenj, was established in 1956. From 1959 till 1963 the department was led by Prim. Dr. Dobrivoje Gradistanac. In 1963 this department together with the former "English Hospital" at Sremska Kamenica were incorporated into the so-called Clinic for Surgical Diseases and divided in the Orthopaedic (led by Prof. Milenko Dosen) and separated Traumatologic (led by Prim. Stojan Letić) departments which existed as such till 1975 when they were integrated again into a single unit which evolved into the Clinic for Orthopaedic Surgery and Traumatology in 1980.

Health Facilities↗
PubMed1995

[Mechanical autologous transfusion in orthopedic surgery in children. Is the use of mechanical autologous transfusion possible even in pediatric orthopedic surgical procedures?].

The use of autotransfusion devices is an established method of reducing the need for homologous transfusions in surgery [3, 11, 13], but technical factors still contraindicate the washing and concentration of blood volumes smaller than 300 ml. Therefore, haemoconcentration of small volumes of salvaged blood, as usually found in paediatric surgery, is considered to be a complicated and questionable practice [5]. Whereas these amounts of blood loss are easily tolerated by adults, they may necessitate homologous transfusions in paediatric surgery. In a prospective study, we investigated whether a simple technical modification in the processing of salvaged blood could facilitate the use of autotransfusion devices, especially in children. PATIENTS AND METHODS. Intraoperative blood salvage was performed in children 6 months to 10 years old undergoing surgery for hip dysplasia. Autotransfusion (Dideco STAT) was started when the blood loss was estimated to be more than 20% of the total blood volume (TBV). As a reference, we used a formula based on body weight [10]: for children up to the age of 6 years 80 ml/kg blood volume and for children up to 10 years 75 ml/kg. The total volume of salvaged fluid including blood, anticoagulant solution, and surgical irrigation was collected in a reservoir and transferred to the autotransfusion set, after which the reservoir was rinsed with 500 ml 0.9% saline solution in order to save the remaining blood. After processing, the blood was stored in the retransfusion bag. By adding the same volume of plasma expander (6% hydroxyethyl starch [HES], molecular weight 450,000), spontaneous sedimentation of the washed autologous erythrocytes (RBCs) for 10-15 min led to a concentrate of RBCs. After 10 mu filtration, the RBC suspension was retransfused (Figs. 1-3). RESULTS. Within 12 months, autotransfusion was performed during 6 out of 15 surgical procedures according to the method described above. The calculated blood loss averaged 25.6% of TBV, of which 21.4% (= 272 ml) could be processed by the autotransfusion device (Table 3). The mean values of 2.6 g/dl haemoglobin (Hb) and 6.8% haematocrit (HCt) in the salvaged blood increased to 9.4 g/dl and 27.3% in the processed RBC concentrates. After adding 6% HES solution, spontaneous sedimentation of the RBCs led to values of Hb 22.1 g/dl and HCt 59.8%. An average of 59.5 ml (22-99 ml) sedimented RBCs was retransfused to the patients, including 11.6 ml 6% HES solution (Table 4). In this manner, the need for homologous transfusions could be avoided in these patients both during and after surgery. CONCLUSIONS. This study shows that the use of blood salvaging in paediatric surgery is indicated under certain conditions. With the aid of the simple modification described above, we solved the main problem in paediatric autotransfusion by concentrating RBC suspensions with low Hb and Hct values after using the autotransfusion device.

Blood Sedimentation↗