MODIFIED SALTER OSTEOTOMY

Abstract

The Salter osteotomy was first described in 1961 for treatment of acetabular dysplasia associated with congenital dislocation of the hip. The use of an innovative Korean modification, first reported by T Yoon in 2003, is outlined in this study. This modification has real advantages for both patient and surgeon.

A review of patients undergoing this surgery at the Starship Hospital between July 2003 and July 2006 by a single surgeon was carried out. All patients were independently assessed from the point of view of any complication of the procedure. All x-rays were reviewed independently of the operating surgeon, with the parameters being measured, including centre edge angle, acetabular index and percentage uncovering (migration index).

All ten osteotomies united with wires being removed at an average of four weeks post-osteotomy. All patients were asymptomatic at follow-up, the only complication recorded being a transient lateral cutaneous nerve palsy. Preoperatively, the centre edge angle was < 20 degrees in seven out of nine patients, indicating poor femoral head coverage. The mean centre edge angle was 11.8 degrees (range of 0.1– 21.1). Post operatively, the centre edge angle ranged from 14 to 38.9 degrees, with an average value of 25.6 degrees. The average improvement was 14.2 degrees. The acetabular index pre-operatively measured an average of 20.8 degrees (11.3–28.3 degrees) and improved an average of 8.3 degrees to a mean value post operatively of 12.5 degrees. The percentage uncovering also revealed improvement- the average uncovering was 34.9% pre-operatively (0–52%) and decreased to a mean of 18% (0–30%) post operatively.

This modification of the Salter osteotomy makes it easier to perform and provides better stability to the graft in the osteotomy site. It prevents the posterior and medial displacement of the distal innominate bone that has been observed in the standard Salter osteotomy. Image intensification is not required. A stable construct is created that can allow the patient to be free of a hip spica. The early results are excellent.