Introduction

Paediatric hip fracture accounts for less than one percent of paediatric fractures. Previous studies report complication rates between 20 and 92%.

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.

Treatment of severe Perthes disease remains a major challenge. Various surgical options exist for containment. We describe the Birmingham interlocking triple pelvic osteotomy (BITPO) and report the results at skeletal maturity.

We reviewed 22 hips in 21 consecutive patients with severe Perthes who had the BITPO. There were 16 males and 5 females. The mean age at presentation was 7 years 7 months. Seventeen hips were Herring group C and five were Herring group B. Six patients had four head-at-risk signs (HARS), 9 had three HARS, 4 had two HARS and 3 had a single HARS. The mean age at operation was 8 years 2 Months.

Clinical, radiological and functional evaluations were under taken on these patients who have since reached skeletal maturity. The minimum follow up was 6 years. Average age at review was 18 years 8 months (range 16–25). Two patients have since had hip resurfacing, and two patients a double femoral osteotomy and one patient a surgical dislocation of the hip and valgus osteotomy.

The average Harris Hip Score pre-operatively was 52, which improved to a mean score of 82. Eleven hips were classified as Stulberg I/II (50%), 9 hips Stulberg III/IV (41%) and 2 hips Stulberg V (9%). The average increase in Centre-Edge angle was 31 degrees and there was an average improvement of 24.6% in the head coverage. At follow up the average abduction was 31 degrees (improvement of 8.5 degrees), internal rotation 22 degrees (10.5 degree improvement) and flexion 106 degrees (11 degree improvement).

We conclude that the Birmingham interlocking triple pelvic osteotomy provides excellent coverage of the femoral head in severe Perthes disease, recaptures and remoulds the deformed head and avoids retroversion of socket. Good results in severe Perthes disease are maintained beyond skeletal maturity.