The Value of the Salter Osteotomy as a Routine Adjunct to Open Reduction of Developmental

Dislocation of the Hip.

The Value of the Salter Osteotomy as a Routine Adjunct to Open Reduction of Developmental

Dislocation of the Hip.

Dr. Alaa Azmi Ahmad-Ramallah, Palestine

Dr. Colin Mosely, Shriner Hospital - Los Angeles - USA

IntroductionIntroduction

59 cases of established hipdislocation were detected

59 cases of established hip dislocation were detected

All were treated by open reduction with & without salter osteotomy

All were treated by open reduction with & without salter osteotomy

Comparison between hips managed with and without Salter osteotomy was done

Comparison between hips managed with and without Salter osteotomy was done

Comparison between hips managed by Salter osteotomy as

primary and secondary procedure was done

Comparison between hips managed by Salter osteotomy as

primary and secondary procedure was done

Follow up to or almost

to skeletal maturity

Follow up to or almost

to skeletal maturity

METHODS METHODS

We reviewed records of 59 dislocated hips with surgical treatment after 1.5 years of age between 1975- 1992

We reviewed records of 59 dislocated hips with surgical treatment after 1.5 years of age between 1975- 1992

33 hips – without Salter osteotomy ( R )

26 hips – with primary Salter osteotomy (RS)

4 hips - with secondary Salter osteotomy ( R/S )

33 hips – without Salter osteotomy ( R )

26 hips – with primary Salter osteotomy (RS)

4 hips - with secondary Salter osteotomy ( R/S )

Evaluation through:Acetabular index (AI)Center edge angle (CE)Sphericity of femoral headAvascular necrosis Severin classification

Evaluation through:Acetabular index (AI)Center edge angle (CE)Sphericity of femoral headAvascular necrosis Severin classification

RESULTS

RESULTS

3.6

9.6

4.9

11.3

0

2

4

6

8

10

12

with Salter without Salter

Mean age at 1st op. (years)

Mean radiological follow-up (years)

Mean pre-op. acetabular index

3535.2

34.5

35

35.5

with Salter without Salter

Subsequent surgery

23%

57.5%

0%

10%

20%

30%

40%

50%

60%

with Salter without Salter

Mean CE angle at final follow-up

30.1

26.5

24.525

25.526

26.527

27.528

28.529

29.530

30.5

with Salter without Salter

Mean Mose circle indices

2.4

3.8

0

0.5

1

1.5

2

2.5

3

3.5

4

with Salter without Salter

mm

mm

Avascular necrosis incidence at final follow-up

31%

57.5%

0%

10%

20%

30%

40%

50%

60%

with Salter without Salter

Severin grade 1,2 (good)

81%63.0%

0%

13%

25%

38%

50%

63%

76%

88%

with Salter without Salter

Mean acetabular index pre-op.

31 37.6

0

5

10

15

20

25

30

35

40

Secondary Salterosteotomy

Primary Salterosteotomy

SecondarySalter

osteotomy

Primary Salter

osteotomy

Mean CE angle at final outcome

3430.1

Mean Mose circle indices2.5mm2.4mm

Avascular necrosis at final follow-up

50%31%

Severin grade 1,2 (good)75%81%

ConclusionsConclusions

Effects of primary Salter osteotomy compared to no Salter osteotmy:

1- Femoral head is better

2- Acetabulum provided better coverage

3- Avascular necrosis is less

4- higher good results according to Severin classification

Effects of primary Salter osteotomy compared to no Salter osteotmy:

1- Femoral head is better

2- Acetabulum provided better coverage

3- Avascular necrosis is less

4- higher good results according to Severin classification

Without Salterosteotomy

With Salterosteotomy

No. of hips3326

Mean age at 1st op. (years)4.93.6

Mean radiological follow-up (years)11.39.6

Mean pre-op. acetabular index3535.2

Subsequent surgery57.5%23%

Mean CE angle at final follow-up26.530.1

Mean Mose circle indices3.8mm2.4mm

Avascular necrosis incidence at final follow-up

57.5%31%

Severin grade 1 or 2 (good)63%81%

In comparing results of primary and secondary Salter osteotomy:

Better end results for primary Salter osteotomy, even though this group was more dysplastic at the start.

In comparing results of primary and secondary Salter osteotomy:

Better end results for primary Salter osteotomy, even though this group was more dysplastic at the start.

SignificanceSignificance

Dislocated hip

Child older than 1.5 years

Routinely including Salter osteotomy with the primary open reduction produces the best result.

Dislocated hip

Child older than 1.5 years

Routinely including Salter osteotomy with the primary open reduction produces the best result.

Thank you