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      Angulated Salter osteotomy in the treatment of developmental dysplasia of the hip


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          Salter osteotomy is widely used to improve acetabular coverage in the treatment of developmental dysplasia of the hip. Herein we describe angulated Salter osteotomy (ASO) as the modified Salter osteotomy, which creates a two-point contact between the proximal and distal fragments and better stabilizes the fixation of the fragments. We reported our results of ASO and compared it with that of Salter osteotomy performed previously by us. We retrospectively reviewed 41 unilateral hips that underwent ASO, with no other accompanying procedures, between 2012 and 2018. We investigated the radiographic measurements included the preoperative values of the acetabular index and center-edge angle (CEA), immediate postoperative values of distance d (lateral displacement of the distal fragment), lateral rotation angle (LRA), the ratio of the obturator height (ROH), pelvic height increase percentage (PHIP) and the values of acetabular index and CEA during the last follow-up. Measurements were compared with 20 unilateral hips that underwent Salter osteotomy. The mean age at the time of surgery was 5.4 years, and the mean follow-up duration was 3.3 years. Immediately after surgery, the mean distance d, LRA, ROH and PHIP were 8 mm, 19°, 70 and 1%, respectively. The last follow-up values of acetabular index and CEA significantly improved from the preoperative values by 18° and 21°, respectively. Patients treated with ASO showed significantly larger distance d, more improvement in CEA, and lesser PHIP than those treated with Salter osteotomy. The short-term outcomes of ASO are favorable. ASO was as effective as or better than Salter osteotomy in pulling out and stabilizing the distal fragment anterolaterally. ASO prevents elongation of the ilium, which causes pelvic obliquity.

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            The First Fifteen Years?? Personal Experience with Innominate Osteotomy in the Treatment of Congenital Dislocation and Subluxation of the Hip

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              Radiographic analysis of movements of the acetabulum and the femoral head after Salter innominate osteotomy.

              Salter innominate osteotomy (SIO) is widely used to improve the coverage of the femoral head in dysplastic acetabulum, but the geometric change after osteotomy and its effect on the outcome have not been well elucidated. Pelvic radiographs of the 90 hips in 86 patients who underwent SIO for the treatment of acetabular dysplasia were reviewed and the movement of the distal fragment and the shift of the femoral head after SIO were analyzed. On the basis of the anteroposterior radiographs of the pelvis in a supine position taken at 5 weeks after operation, various parameters including an open-wedged angle at the osteotomy site (lateral rotation angle, LRA), lateral displacement of the distal fragment (distance d), and the ratio of the bilateral obturator foramen heights (the ratio of obturator heights, ROH), were measured. Improvement in the center-edge angle (CEA) and acetabular index (AI) after SIO was correlated with the LRA, distance d, and ROH. Horizontal and vertical distances from the pubic symphysis to the center of the femoral head were also measured from preoperative and postoperative pelvic radiographs and changes in the position of the femoral head were calculated. For the patients who were followed until skeletal maturity, final radiographic results were also assessed according to the Severin classification. The average improvement of the CEA and AI after SIO was 19.6 and 13.3 degrees, respectively. The average value of the LRA, distance d, and ROH were 30.2 degrees, 4.07 mm, and 73.0%, respectively. The LRA and distance d positively and the ROH negatively correlated with the improvement of the CEA and AI. The center of the femoral head moved an average of 7.06 mm caudally and 3.11 mm medially after SIO. Thirty-six hips (40%) in 36 patients were available for follow-up until skeletal maturity. The radiographic outcome was good (Severin I or II) in 33 hips and poor (Severin III) in 3 hips. Preoperative CEA was relatively smaller in a poor group. Greater improvement of the CEA during postoperative follow-up was observed in a good group. Favorable coverage of the femoral head was obtained after SIO by shifting the center of the femoral head caudally and medially as well as rotating the distal fragment anterolaterally. SIO is a very effective procedure in improvement of the dysplastic acetabulum for the hips with round and spherical femoral head. Therapeutic studies, level III (retrospective study).

                Author and article information

                J Pediatr Orthop B
                J Pediatr Orthop B
                Journal of Pediatric Orthopedics. Part B
                Lippincott Williams & Wilkins
                21 May 2021
                May 2022
                : 31
                : 3
                : 254-259
                [a ]Department of Orthopaedics Surgery, Saga Handicapped Children’s Hospital, Saga, Japan
                [b ]Belarusian Research Institute of Traumatology and Orthopaedics, Minsk, Belarus and
                [c ]Department of Orthopaedics Surgery, Fukuoka Children’s Hospital, Fukuoka, Japan
                Author notes
                Correspondence to Akifusa Wada, MD, PhD, Department of Orthopaedic Surgery, Saga Handicapped Children’s Hospital, 2215-27 Kinryu, Kinryu-machi, Saga 849-0906, Japan, Tel: +81 952 98 2211; fax: +81 952 98 3391; e-mail: ssgwada@ 123456vip.saganet.ne.jp
                Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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                beta-tricalcium phosphate,developmental dysplasia of the hip,salter osteotomy


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