Role Of Salters Innominate Osteotomy In The Treatment Of Congenital Dislocation Of The Hip:

Gamal Ahmed Hosny

Our review of the literature explained the methods ofdiagnosis of congenital dislocation of the hip and biomechanicalaspects, the indications, the operative steps and the complicationsof Salter’s innominate osteotomy.We studied 28 patients (33 hips) with congenital hipdislocation, which had been treated by open reduction and Salterosteotomy at the Misr International Hospital and Benha UniversityHospital. Radiological assessment of acetabular index, centeredge angle, status of Shenton’s line and Severin classificationwas done before and after the operation. Clinical assessment ofstability, pain, Trendelenburg test, limping gait, lower limblength inequality, and range of motion was performed. The meanfollow-up period was 2.3 years. The mean age at operation was2.7 years. Six cases required a concomitant procedure during theprimary operation. These procedures were either femoralshortening, varus derotation, osteotomy or shelf. Four casesrequired subsequent procedures later on due to either redislocationin one case and progressive subluxation in three cases. Theoverall radiographic results were 91%excellent and good results.214ROLE OF SALTER!S l[NNOMINATB OSTBOTOMY..INTREATMENT OF CONGBNlTAL DISLOCATION OF THE HIP SUMMARYClinically, 89% of the cases had been classified as excellent orgood at the last follow-up visit. Results were better when theoperation was performed as a primary procedure, than as asecondary procedure”. We obtained better results in childrenyounger than 4 years than older cases. For the patients withacetabular index less than 35°, we obtained 100% excellent orgood results. Performing a Salter osteotomy - by itself - may bea stimulating factor to the growth and ossification of the dysplasticacetabulum.There were few complications: one case of redislocationand four cases of vascular necrosis of the femoral head. One ofthese cases developed contralateral avascular necrosis of thefemoral head. The combination of open reduction and Salterosteotomy is a safe and reliable method of treatment of neglectedcongenital hip dislocation.