Abstract
Which of several osteotomies described for approximation of the pubic bones in wide congenital diastasis of the pelvis best facilitates closure is controversial. This paper describes the benefits of the horizontal innominate osteotomy in approximation of the pubic bones when there is wide congenital diastasis.
Between 1994 and 2000, 11 children, ranging in age from one week to eight years, were treated by horizontal innominate osteotomies. Six children had exstrophy of the bladder. There were ischiophagus tetrapus twins and cases of duplication of the genitalia and sacral teratoma. The follow-up time ranged from six months to six years.
General surgical procedures were followed by bilateral innominate osteotomies to facilitate approximation of the pubic bones for bladder, genitalia and anterior abdominal wall repair. The ilium was exposed subperiosteally with the patient supine. A Salter-type osteotomy was performed, dividing the innominate bone from the sciatic notch to just above the anterior inferior iliac spine. The distal fragments were rotated medially, the pubic bones approximated in the midline, and the surgical soft tissue procedures completed. Postoperatively, children were maintained in gallows traction for two weeks and immobilised in plaster for four further weeks.
All osteotomies healed well. Abdominal wound infections occurred in two children, resulting in separation of the pubis. One child had repeat osteotomies one year later and healed well. Abdominal wall hernia occurred in one child. The gap between the pubic bones in the remaining patients ranged from 1cm to- 5 cm. Internal rotation of the hip improved in all patients.
Horizontal iliac osteotomies enable complex pelvic malformations to be corrected without turning the patient. The approximation of the pubis relieves the tension for reconstruction of the bladder, urethra, genitalia and anterior abdominal wall. The procedure is quick and permits single stage closure.
The abstracts were prepared by Professor M. B. E. Sweet. Correspondence should be addressed to him at The Department of Orthopaedic Surgery, Medical School, University of Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193 South Africa
