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

Introduction & Discussion: From an experience of over 250 Salter osteotomies, 148 of which have been reviewed at skeletal maturity, certain technical tips merit discussion:-. Preoperative positioning and the incision. Psoas tenotomy, capsular exposure and the capsulotomy. Facilitation of the Gigli saw osteotomy. Sizing and procurement of the graft. Displacement and fixation of the osteotomy. Application of the hip spica. Some questions are worthy of debate:-. Can the osteotomy be safely combined with open reduction of the high dislocation?. Should the osteotomy be fixed before reducing the femoral head?. Are there alternatives to autogenous bone graft and K-wire fixation?. Is minimally invasive surgery an option?. Are the contraindications and alternatives to the Salter osteotomy fully appreciated?

Purpose: Iatrogenic acetabular retroversion is a known complication after pelvic osteotomy leading to persistent hip pain and increasing risk of subsequent osteoarthritis. The purpose of this study is to document the incidence of acetabular retroversion and signs of impingement in patients who have had a Salter pelvic osteotomy in childhood. Method: Twenty eight patients (32 hips) had a Salter Osteotomy between 1980 and 1999, 16 were lost to follow-up. Of the 12 studied, eight had a diagnosis of DDH and four had Legg Calve Perthes. Clinical assessment for the presence of the impingement sign, range of motion and leg length discrepancy was done as well as functional scores. AP pelvic radiographs were taken to assess acetabular retroversion (cross-over or ischial sign), osteoarthritis using the Tonnis grade, center-edge and Tonnis angles. Results: The mean age of the sample was 17.25 years (SD=7.27) with a mean follow-up of 10.56 years (SD=6.27). Impingement sign was positive in seven patients (58.3%). Nine out of the 12 had acetabular retroversion. Nine had Tonnis grade 1, two Tonnis grade 2, and one had a Tonnis grade 3. Mean center edge and Tonnis angles were 26° (SD=16.43) and 9.09° (SD=6.49), respectively. There was no correlation between presence of acetabular retroversion with Tonnis grade (p=.700), hip pain (p=.317) or impingement sign (p=.621). Conclusion: Retroversion is highly prevalent (69.2%) in patients who underwent a Salter pelvic osteotomy for a childhood hip disease. Although acetabular retroversion is a known cause of impingement in adulthood, our patient cohort was too small to detect a significant impact on the functional scores

Salter’s innominate osteotomy predisposes the hip to acetabular retroversion as it hinges upon the symphysis pubis. Retroversion is a recognised cause of osteoarthritis, hip pain and clinical signs of impingement, but there is uncertainty as to whether this over cover persists with growth and development. We reviewed the long-term follow up of twenty patients that had undergone a Salter’s osteotomy between 1985 to 1993 at The Royal Orthopaedic Hospital Birmingham or New Cross Hospital Wolverhampton. Sixteen skeletally mature patients were available for review that had previously had the pelvic osteotomy performed at a mean five years of age with a contralateral normal hip. Salter’s osteotomy had been performed for developmental dysplasia of the hip in 13 patients and for Perthes’ disease in three patients. Follow up was performed at an average age of 20 years. Outcome was assessed using the Harris Hip Score and a clinical examination for signs of impingement and by a measurement of acetabular version, on well centered pelvic radiograph. Acetabular version was evaluated by the relationship between anterior and posterior walls of both the normal and Salter acetabulum, using radiographic templates as described by Hefti. Mean acetabular version averaged 16.9 degrees (95% CI 7.6 to 26.1) of anteversion on the Salter side and 17.6 degrees (95% CI 10.4 to 24.8) anteversion on the contralateral normal hip. There was no statistical difference between the version on operated and normal hips, paired t test (p = 0.83). Harris Hip Score averaged 85, indicating a good outcome at long-term follow up. Two patients (12%) demonstrated retroversion, however neither of these had signs of impingement on clinical examination. After a Salter innominate osteotomy in childhood, we believe there is remodelling of acetabular version by skeletal maturity

The management of developmental dysplasia of the hip (DDH) requiring open reduction between 12 and 18 months of age is controversial. We compare the outcome of medial approach open reduction (MAOR) versus delayed anterior open reduction with Salter osteotomy in such patients. 17 consecutive patients who underwent MAOR aged 12–20 months were reviewed (mean follow-up of 40 months, range 6–74). This group was compared to 15 controls who underwent anterior reduction and Salter osteotomy aged 18–23 months (mean follow-up of 44 months, range 14–134). 13 of the 17 (76%) MAOR patients required subsequent Salter osteotomy at a mean of 22 months post-reduction, with a further 2 patients under follow-up being likely to require one. Acetabular index improved from 42 (32–50, SD − 5.5) to 16 (7–24, SD − 4.5) in the MOAR group after Salter osteotomy compared to an improvement of 40 (30–53, SD − 6) to 13 (4–24, SD − 5) in the control group (p>0.05). Acetabular index at last follow-up was within normal limits in 15 of 17 (88%) MAOR patients. All patients in the control group had acetabular indices (or centre-edge angles of Wiberg) within the normal range. There was 1 subluxation (7%) in the control group. There were 6 cases (33%) of post-operative avascular necrosis (5 Kalamchi & MacEwen Grade I, 1 Grade 2) in the MAOR group and 6 (40%) in the control group (5 Grade 1, 1 Grade 4). All of the MAOR patients had good or excellent clinical results according to McKay's criteria, compared to 14 out of 15 (93%) controls. This study suggests that MAOR or delayed open reduction and Salter osteotomy is a reasonable treatment for children with DDH presenting between the ages of 12 and 18 months. However, the majority of MAORs are likely to require a subsequent Salter osteotomy

Purpose of study. The management of developmental hip dysplasia requiring open reduction between 12 and 18 months of age is controversial. We compare the outcome of medial approach open reduction (MAOR) versus anterior open reduction with Salter osteotomy (delayed until the child is of sufficient size) in such patients. Patients and methods. 19 consecutive patients who underwent MAOR aged 12-22 months were reviewed at a mean follow-up of 3.5 years (range: 1.0-6.2). This group was compared to 14 patients who underwent anterior reduction and Salter osteotomy aged 18-23 months (mean follow-up 4.1 years). Results. There was 1 mild subluxation and 1 re-dislocation in the MAOR group. The anterior reduction group had 2 mild subluxations. 14 of the 19 (74%) MAOR patients required subsequent Salter osteotomy at a mean of 22 months post-reduction, with another 2 patients under follow-up being likely to require one. There were 4 cases (21%) of post-operative avascular necrosis in the MAOR group (Kalamchi and MacEwen grade I) and 7 cases (50%) in the anterior reduction group. All patients had good or excellent clinical results according to the McKay criteria. Acetabular index at last follow-up was within normal limits in 16 of 19 (84%) MAOR patients; 2 of the 3 with abnormal acetabular indices had not (yet) undergone Salter osteotomy. All patients in the anterior reduction group had acetabular indices (or centre-edge angles of Wiberg) within the normal range. Conclusion. This study suggests that MAOR is a reasonable treatment for children presenting with developmental dysplasia of the hip between the ages of 12 and 18 months requiring open reduction. However, the majority are likely to require a subsequent Salter osteotomy

Introduction: There are several possibilities for the treatment of Legg-Calve-Perthes (LCP) disease in older age group (more than 10 years of age): varus femoral osteotomies, different pelvic osteotomies (Salter, Chiari, triple), and the combination of pelvic and femoral osteotomies (Salter with femoral shortening). Material and methods: We analyzed 214 hips with LCP disease surgically treated in our Institute in the period 1972–1999. Age of our patients ranged from 10–13 years. All of them were operated in the fragmentation phase of the disease. The distribution according to Catteral classification was: group II – 29 (13,5%), group III – 108 (50,5%), group IV – 77 (36%). Different risk factors were present in 154 (72%) cases. We performed: 69 (32,3%) varus femoral osteotomies, 32 (14,9%) Salter osteotomies, 69 (32,3%) Salter osteotomies with femoral shortening, 23 (10,7%) Chiariosteotomies and 21 (9,8%) triple pelvic osteotomies. There were no statistically significant differences between treatment groups (preoperatively). Postoperativelly hips were assessed clinically and radiologically. Follow-up period was in average 9,2 years (at least 3 years). Results: All procedures showed improvement in hip containment and functional status. The best anatomical results were in the group of patients treated by triple pelvic osteotomy (p=0,02), very good results were found in the groups of patients treated by varus femoral osteotomy and Salter osteotomy with femoral shortening, whereas the results of treatment in the other groups were slightly worse. Triple pelvic osteotomy and Salter osteotomy (with or without femoral shortening) showed the best functional recovery. Positive Trendelenburg sign and waddling gait were present only in the groups of patients treated by varus femoral osteotomy and Chiariosteotomy. Conclusion: Triple pelvic osteotomy is the best procedure for the treatment of LCP disease in the older age group

We compared the clinical and radiological effects of the Salter and the Chiari pelvic osteotomy on congruent dysplastic adolescent hips with mild symptoms and free of degenerative changes. The Salter innominate osteotomy has a significant role in the surgery of paediatric hips with significant elasticity of triradiate cartilage, while the Chiari procedure is reserved for incongruent dysplasia with mild or moderate arthrosis in adolescents or young adults. Neither of these operative procedures is an ideal indication for congruent dysplastic adolescent hips free of arthrosis. Hypothetically, the residual remodelling potentials of immature congruent dysplastic adolescent hips can be sufficient to overcome the disadvantages of the Salter and the Chiari osteotomy and give good, long-lasting results. The effects of these quite different procedures in two homologous groups were compared. There were 30 hips treated with Chiari and 25 hips corrected by Salter osteotomy. All hips were congruently dysplastic according to the distance between the centres of the femoral head and the acetabulum (Klaue et al., classification). Groups were homologous considering mean age (14.5 years), follow-up period (8.5 years), presence of preoperative pain, Trendelenburg sign, and degenerative changes. Assessment for pain and Trendelenburg sign was made at follow-up. Radiological measurement was made of the central-edge angle of Wiberg (CE), acetabular angle of Sharp (AAS), and the femoral head coverage index of Heyman and Herndon (FHC). Progression of degenerative changes was analysed according to the criteria of Kellgren and Lawrence. At follow-up in the Chiari group, presence of pain was reduced from 54% to 6.6%, and from 35% to 12% in the Salter group. The presence of Trendelenburg sign was reduced 3% in the Chiari group and remained the same in the Salter group. At control, mean values of radiological parameters were normal in both groups (Salter: CE-27.8°, AIS-36.8°, ING-82.8%; Chiari: CE-36.8°; AIS-39.7°; ING-90.8%). Individual analysis showed 16% of dysplastic hips in the Salter group, and none in the Chiari group. Only one hip (4%) had grade 1 arthrosis after Salter osteotomy. There were five grade 1 hips (17%) in the Chiari group and one (3%) grade 2 arthrotic hip. At follow-up (mean 8.5 years) greater reduction of pain was found in the Chiari group than in the Salter group, but the presence of Trendelenburg sign remained almost unchanged in both groups. There was normalisation of the mean values of radiological parameters in both groups, but the Salter osteotomy was unable to correct dysplasia in 16% of the adolescent hips. Progression of degenerative changes was more rapid in the Chiari group

The June 2014 Children’s orthopaedics Roundup. 360 . looks at: plaster wedging in paediatric forearm fractures; the medial approach for DDH; Ponseti – but not as he knew it?; Salter osteotomy more accurate than Pemberton in DDH; is the open paediatric fracture an emergency?; bang up-to-date with femoral external fixation; indomethacin, heterotopic ossification and cerebral palsy hips; lengthening nails for congenital femoral deformities, and is MRI the answer to imaging of the physis?

Aims: Purpose of the study was comparison of the results of different pelvic osteotomies (Chiari, Salter, triple osteotomy) in the treatment of consequences of DDH in adolescents. Methods: Analysis included 124 patients treated operatively for consequences of DDH in adolescence. The average age of patients was 13.6. All patients were divided into four groups according to the operative technique used (isolated Salter pelvic osteotomy, Salter osteotomy and corrective femoral osteotomy, Chiari pelvic osteotomy and triple pelvic osteotomy). Preoperative and postoperative values of CE angle of Wiberg, acetabulum-head ratio of Heyman-Herndon and Harris hip score were analysed. Congruency was assessed according to Stulberg classiþcation before and after operative treatment. Results: Signiþcant improvement was achieved in all groups. The greatest improvement was noticed in the group of triple pelvic osteotomies. Comparison between groups has shown that signiþcantly better results were achieved with triple pelvic osteotomy. Conclusions: In dysplastic hips without signs of damage of the femoral head and neck we suggest triple pelvic osteotomy in patients older than 10. If deformity of femoral head exists, additional radiographic examination should be made to assess the possibility of achieving spherical congruency of the hip operatively. If this can be done we suggest performing triple or Salter osteotomy with corrective osteotomy of femur. Chiari pelvic osteotomy should be reserved for patients older than 10 in whom spherical congruency can not be achieved or if degenerative changes of the hip already exist

Purpose of the study. This study aims to evaluate the use of closed reduction of hips with developmental dysplasia of the hip (DDH) and medial open reduction of these hips as a subsection of closed reduced hips. Methods. The study was a retrospective analysis of treatment of 30 children with developmental dysplasia of the hip (DDH). These children were taken from a consecutive series of children treated over a period from June 2000 to 2011 with closed reduction by a single surgeon. The ages at the time of diagnosis were between 1 day and 13 months (mean 5.25 weeks). Included in this series are 7 patients treated with medial open reduction, all done with the Ludloff approach. Follow up of these patients was from 8 months to 12 years (mean 5 years). All patients needing secondary procedures were noted. The X- rays were evaluated for percentage acetabulum cover in patients over the age of 8 and improvement of the acetabular index in all these patients. Results. 4 children needed secondary procedures. 1 child of the closed reduction group developed avascular necrosis of the femoral head that was treated with a Salter osteotomy and a further 2 needed secondary open reductions after redislocation following initial closed reduction. One child with bilateral open medial reductions had a Salter osteotomy 6 years after the initial treatment was done. 26 of the children had good outcomes with improvement of the acetabular angles, percentage acetabular cover and pain free independent ambulation. The average acetabular index improved from 37.5° to 23.3°. Conclusion. Closed reduction of DDH hips is a good treatment modality. Early treatment allows for acetabular and femoral development. There are minimal secondary procedures necessary after closed reduction, and open medial reduction does not increase the complication rate. NO DISCLOSURES

Introduction: Insufficient femoral head coverage is found in a variety of diseases, with acetabular dysplasia as the most frequent disorder and the triple pelvic osteotomy as the most recently introduced surgical treatment. Objective: The study analyses pre- and postoperative pathoanatomical characteristics of triple in comparison to Salter and Chiari osteotomies, with a logistic regression analysis of outcome predictor and effect explanator factors in relation to the chosen type of operation. Methods: The study involved 136 adolescents, treated with Salter and Chiari osteotomies or a triple pelvic osteotomy. The patients were between 10–20 years old at the time of operation. The following data from all the patients were analysed: illness history, operative parameters, preoperative and postoperative pathoanatomic data. The data was statistically processed using the statistical software SPSS, defining standard descriptive values, and by using the appropriate tests of analytic statistics. Results: The average CE angle after triple pelvic osteotomy was 43.5 degrees, more improved than after the Salter osteotomy (33.0 degrees) and Chiari osteotomy (31.4 degrees). Postoperative spherical congruence was also more frequent after the triple osteotomy than after the other two types of operations. Preoperative painful discomfor was found to be a valid predictor of indications for the triple osteotomy over both Chiari and Salter osteotomies. The valid explanators of the effect of the triple osteotomy are: postoperative joint congruence (compared to the Chiari osteotomy) and increase in joint coverage (compared to Salter osteotomy). Conclusion: Triple pelvic osteotomy is the method of choice in the management of acetabular dysplasia and other disturbances of hip joint containment in adolescent age

The object of this work was to retrospectively study the recommendations and the results of cruent reduction of idiopathic congenital displacement of the hip following ineffective orthopaedic treatment. From 1993 to 2001, 15 cruent reductions were performed in 11 children (seven girls and four boys). Initially, the 15 hips were treated by orthopaedic techniques (Pavlik harness and/or slow reduction according to the Sommerville-Petit method). Four of these have benefitted from surgical treatments after orthopaedic treatment proved to be ineffective (psoas tenotomy, Salter osteotomy). At the time of the cruent reduction the mean age was 24 months (range 9 months to 5 years). For the surgical reduction, always associated with a shortening-derotation osteotomy of femur, the Smith-Petersen antero-medial approach was used. In five of these cases, the cruent reduction was complemented by Salter osteotomy. The mean post-surgical follow-up is 5.6 years (from 1 to 9 years). In none of the hips studied was recurrence of the dislocation observed. The functional outcome, studied by Mackay criteria, is good for all the hips. No significant dysmetria of the lower limbs was present. According to the radiological criteria in the classification of Severin outcome was good or excellent in 12 hips and average in three hips. According to the Bucholz and Ogden classification, six hips showed signs of necrosis as a result of the orthopaedic treatment. The surgical treatment did not cause necrosis in the remaining nine hips. Recourse to a surgical procedure can result because of the anatomical obstacles typical of specific dislocations. Surgical reduction must be considered as an operation to preserve the hip; this operation is suitable at about 1 year of age if progressive orthopaedic practices are ineffective. Before 2 years of age, the cotyloid cavity can continue to develop after femoral head reduction, whereas, after this age, it is preferable to integrate a Salter osteotomy with the cruent reduction

Purpose of the study: The appropriate treatment for Legg-Perthes-Calvé disease (LPCd) remains a subject of debate. Certain teams consider orthopedic treatment adequate. Others advocate surgery to improve prognosis. Is surgery necessary? When is the proper time? We reviewed retrospectively 91 surgically treated hips (Salter osteotomy or triple pelvis osteotomy) at the end of growth. Material and methods: Among 485 hips with LPCd, 349 (71.9%) presented massive involvement (Catterall 3 and 4, Herring B and C, Salter B). Ninety-one patients with severe disease were reviewed at the end of growth. Complementary explorations included magnetic resonance imaging, scintigraphy and arteriography using the Dias protocol which enables an assessment of the excentration and the femoral head deformation and identifies hips at risk. Surgical treatments were Salter osteotomy (SA) or triple osteotomy (TO). Three groups were identified depending on the age at disease diagnosis: less than 5 years, 5–9 years, more than 9 years. Using the Stulberg and Mose classifications, outcome was considered good (Stulberg 1 and 2, Mose good), fair (Stulberg 3, Mose fair), or poor (Stulberg 4 and 5, Mose poor). Results: There were 50 Carttell 3, Herring B, Salter B hips and 41 Catterall 4, Herring B and C, Salter B hips (80% boys). Distribution by group of age at diagnosis was: 34 (37.4%) less than 5 years, 48 (52.7%) 6–9 years, 9 (9.9%) more than 9 years. Salter osteotomy was performed on 32 hips (35.2%) and triple pelvic osteotomy on 59 (94.8%). Outcome at end of growth was: less than 5 years Catterall 3: 77% good, 15.4% fair, 7.6% poor; Catterall 4: 52.4% good, 33.3% fair, 14.3% poor; 6–9 years: Catterall 3: 70% good, 20% fair, 10% poor; Catterall 4: 55.5% good, 22.2% fair, 22.2% poor; more than 9 years: Catterall 3: 42.9% good, 42.9% fair, 14.2% poor; Catterall 4: 50% good, 50% poor. Conclusion: Outcome worsens with increasing age at diagnosis. Despite surgery, a spherical femoral head (Stulberg 1 or 2) is achieved in only one hip Catterall 4 hip out of two. This result is observed in Catterall 3 hips only in children whose diagnosis is established after the age of nine years. Prognosis is better in Catterall 3 hips

Method. The anteroposterior pelvic radiographs of 84 children (87 hips with developmental dysplasia) seen between 1995 and 2004 were reviewed retrospectively. Each radiograph was photographed digitally and converted to the negative using Microsoft Photo Editor. Arthrograms were also assessed at the time of femoral head reduction. The acetabular index (AI) and femoral head deformity were assessed. Acetabular response was measured using the AI at 6 and 12 months post-reduction. Results. Mean age at presentation was 11 months for the closed reduction group, versus 19 months for those with an arthrographic soft tissue obstruction requiring open reduction. Additionally, the average age of the children that underwent open reduction who later required a Salter osteotomy was 27 ± 3 months compared to an average of 14 ± 1.5 months for those who did not. The acetabular response was maximal during the first 6 months following treatment. Closed reduction (24 hips) gave comparable results to open reduction (63 hips), although the initial AI was greater in those requiring open reduction (39.5 ± 6.3° versus 36.1 ± 4.6°). Using two separate Bonferroni pairwise comparisons revealed no statistical difference in response between closed and open reduction. Arthrography revealed that hips requiring open reduction were more deformed, with spherical femoral heads in 29% as opposed to 68% in the closed reduction group. The AI was also slightly less (36.6 ± 3.2°) when the femoral head was spherical in comparison to those hips with an aspherical femoral head (38.0 ± 6.6°). Conclusion. Age at presentation and femoral head deformity therefore influence the outcome of reduction, but the acetabular index improves to a similar degree whether closed or open reduction is required

Treatment of residual acetabular dysplasia is still controversial regarding the timing of Surgery, and the type of surgical procedur. Material and Methods: We analyzed 70 patients (83 hips) operated between 1980–1988 year, in which Salter innominate osteotomy was performed in the treatment of residual acetabular dysplasia in DDH. Patients were divided in two different age groups: from 2–4 (53 hips) and 4–6 (30 hips) years. The average follow up was 7 years (from 2 to 10 years). Acetabular remodeling was radiographically assessed by measuring of the Acetabular Index (AI) at the beginning and after the 5 years of age subsequently by measuring the CE angle of Wiberg. All preoperative hips were dysplastic according to Tonnis (+2SD) criteria. Results were statistically analyzed by using the Student’s T test, and One Way Repeated Measures ANOVA, with the correction for the different age groups. Results: We found that there were no statistically significant differences in AI and CE angle between these two age groups and between these groups and normal values. Conclusion: We recommend Salter innominate osteotomy as a procedure of choice in the treatment of acetabular dysplasia in DDH, provided the patient is younger than 6 years of age

The results of the Ferguson medial open reduction of the hip for DDH were reviewed to determine the complications, re-operation rate, clinical and radiological outcome. Notes were reviewed for 75 cases, of which 5 were bilateral. X-rays were available for 69 hips and were analysed for Acetabular index (AI) and Centre Edge (CE) angles of the operated and unaffected hips. The hips were assessed for avascular necrosis by the method of Kalamchi and MacEwan and were graded according to Severin. The mean age at operation was 11.8 months (range 3-23, SD 4.42, mode 11). The mean clinical follow up was 65.1 months (range 4-148, SD 33.4). The mean radiological follow up was 58.2 months (range 3 – 131, SD 31). No further surgical procedure was required for 60 hips (75%). Of the remainder, a Salter osteotomy was performed for 8 hips, of which 6 had additional procedures. 8 hips required a femoral osteotomy, 2 an Arthrogram and one a triple pelvic osteotomy. The AI improved following surgery, with a rate of increase double that for the unaffected side. The mean centre edge of the operated side was 6 degrees less than the unaffected side. Tables 2 and 3 show that the majority of hips had no avascular necrosis and a good radiological outcome. The results compare favourably with the literature. The conclusion is that the Ferguson medial open reduction has good long-term results with low rates of avascular necrosis

Aim: The neonatal screening procedure in South Australia has shown that the late diagnosis of developmental dysplasia of the hip (DDH) is rare with well conducted clinical screening. We studied the cases of late diagnosis of DDH to determine the epidemiological features and the out come of management with special reference to development of the femoral head and acetabulum. Methods: Patients’ case records and radiographs with a delayed diagnosis of DDH, identified by the South Australian Birth Defects Register between 1988 and 1993, were reviewed. Epidemiological features, acetabular angles, size of femoral head, spherical index, CE angle and migration percentage were examined. The Severin’s grouping and Makey’s criteria were used to assess radiological and clinical outcomes. Late DDH was defined as DDH diagnosed after three months of age. Results: The acetabular angles and percentage coverage improved rapidly -faster in younger children. The CE angle also improved rapidly. When treatment was started late (after one year) the improvement was slower and final out come was unpredictable. The femoral head continued to grow irrespective of age at reduction and became normal in most cases. In some patients Salter osteotomies stabilised the hips after open reductions and gave excellent results. The epidemiological features were compared with that of DDH diagnosed early in postnatal life. Conclusions: Clinical screening and early detection is important in the outcome of DDH. Early treatment may give better results

Introduction and Aims: In a radiological study we evaluated the outcome of the Chiari osteotomy as a primary method of femoral head containment in patients with Perthes’ disease presenting at the age of eight years or older. Even when Salter’s prerequisites are met, the results of a Salter osteotomy is known to be poor in this group. Method: Thirteen patients underwent a Chiari osteotomy at a mean age of nine years and four months. The osteotomy was performed before femoral head deformity had occurred. The hip was considered to be at risk because of the late onset of the disease. Measurements were made on the pre-operative x-ray, the pre-operative arthrogram and the latest follow-up x-rays. Patients have been followed up for an average of five years and four months. On the pre-operative arthrogram there was no femoral head deformity or hinging on abduction. At the time of surgery it was too early in the disease process to assign a hip reliably to a particular classification. During the follow-up period, 12 hips manifested as a Catterall group IV. Eleven hips became Herring type B and two Herring type C. Results: At latest follow-up all hips could be reliably graded according to the Stulberg classification. Currently, eight hips were a Stulberg type II and five a Stulberg type III, but this might change as skeletal maturity is reached. It is clear that none of the hips will be a Stulberg type IV or V, which is seen in a significant number of untreated hips at this age. Conclusion: The Chiari osteotomy achieves a congruent hip in this specific group of patients where a poor outcome would otherwise be anticipated

In a radiological study, we evaluated the outcome of the Chiari osteotomy as a primary method of femoral head containment in a distinct group of patients with Perthes’ disease. Even when Salter’s prerequisites are met, the results of a Salter osteotomy are known to be poor in this particular group of patients. At the time of operation, the mean age of the 13 patients who underwent Chiari osteotomy was 9 years 4 months. The osteotomy was performed early in the disease process, before femoral head deformity had occurred. The hip was considered to be at risk because of the relatively late onset of the disease. Measurements were made on the preoperative and latest follow-up X-rays, and on the preoperative arthrogram. Patients were followed up for a mean of 3 years 4 months. On the preoperative arthrogram there was no femoral head deformity or hinging on abduction. At the time of surgery, it was too early to assign a hip reliably to a particular lateral or Herring lateral pillar group. However, during the follow-up period, 12 of the hips manifested as Catterall group IV and one as Catterall group II. Further, 11 hips advanced to become lateral pillar type B, and two to become lateral pillar type C. At follow-up, nine hips could be reliably graded according to the Stulberg classification: five were Stulberg type II and four Stulberg type III. It was clear that none of the remaining hips would be Stulberg type IV or V. The Chiari osteotomy achieves a congruent hip in a specific group of patients where a poor outcome would otherwise be anticipated