Aims. This study compared the long-term results following Salter osteotomy and Pemberton acetabuloplasty in children with developmental dysplasia of the hip (DDH). We assessed if there was a greater increase in pelvic height following the Salter osteotomy, and if this had a continued effect on pelvic tilt, lumbar curvature or functional outcomes. Patients and Methods. We reviewed 42 children at more than ten years post-operatively following a unilateral Salter osteotomy or Pemberton acetabuloplasty. We measured the increase in pelvic height and the iliac crest tilt and sacral tilt at the most recent review and at an earlier review point in the first decade of follow-up. We measured the lumbar Cobb angle and the Short Form-36 (SF-36) and Harris hip scores were collected at the most recent review. Results. During the first decade of follow-up, there was a greater increase in pelvic height in the children who had a Salter osteotomy (Salter, 10.1%; Pemberton, 4.3%, p < 0.001). The difference in the increase in pelvic height was insignificant at the most recent review (Salter, 4.4%; Pemberton, 3.1%, p = 0.249). There was no significant difference between the two groups for the lumbar Cobb angle, (Salter, 3.1°; Pemberton, 3.3°, p = 0.906). A coronal lumbar curve was seen in 41 children (97%), 30 of these had a compensatory curve. Sacral tilt was the radiographic parameter for pelvic imbalance that correlated most with the lumbar Cobb angle (Pearson correlation co-efficient 0.59). The Harris hip score and SF-36 were good and showed no differences between the two groups. Conclusion. In the long-term, we found no difference in the functional results or pelvic imbalance between Salter osteotomy and Pemberton acetabuloplasty in the management of children with DDH. Cite this article: Bone Joint J 2016;98-B:1145–50

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

A Salter innominate osteotomy is used to treat acetabular dysplasia, but reports of its effects on the position of the femoral head are few and conflicting. Lateral shift would increase the resultant forces acting on the joint and be detrimental. We studied 15 Salter innominate osteotomies and demonstrated that a correctly performed osteotomy does not significantly alter the distance from the centre of the femoral head to the midline of the body. Stereophotogrammetry was used in three patients to delineate the axis of rotation of the distal acetabular fragment and determine the locus of movement of the centre of the femoral head about it. Our results explain why the Salter osteotomy does not lateralise the femoral head

The Salter innominate osteotomy has been used successfully for many years in the treatment of developmental dysplasia of the hip. One of its main drawbacks is the need for internal fixation with pins and their subsequent removal. We describe a modification of this osteotomy that does not require pin fixation and secondary removal. We retrospectively reviewed 114 hips in 94 patients who had been operated on by a single surgeon. An oblique rather than the original horizontal osteotomy was used without internal fixation. There were 80 female and 14 male patients. The mean age at operation was 25 months (18 to 84) and the mean follow-up was 30 months (12 to 88). Most patients required additional open reduction and capsuloplasty. The mean pre-operative acetabular index was 37.9° (24° to 54°), which decreased to 19.9° (7° to 29°) in the immediate post-operative period, and improved to 14.6° (5° to 25°) at the final follow-up (student’s t-test, p < 0.0001). We believe that by changing the direction of the osteotomy line, it is possible to avoid pin fixation. The radiological outcomes are comparable to those of the original technique, but longer follow-up will be necessary

Salter innominate osteotomy is an effective reconstructive procedure for the treatment of developmental dysplasia of the hip (DDH), but some children have a poor outcome at skeletal maturity. In order to investigate factors associated with an unfavourable outcome, we assessed the development of the contralateral hip. We retrospectively reviewed 46 patients who underwent a unilateral Salter osteotomy at between five and seven years of age, with a mean follow-up of 10.3 years (7 to 20). The patients were divided into three groups according to the centre–edge angle (CEA) of the contralateral hip at skeletal maturity: normal (> 25°, 22 patients), borderline (20° to 25°, 17 patients) and dysplastic (<  20°, 7 patients). The CEA of the affected hip was measured pre-operatively, at eight to nine years of age, at 11 to 12 years of age and at skeletal maturity. The CEA of the affected hip was significantly smaller in the borderline and dysplastic groups at 11 and 12 years of age (p = 0.012) and at skeletal maturity (p = 0.017) than in the normal group. Severin group III was seen in two (11.8%) and four hips (57.1%) of the borderline and dysplastic groups, respectively (p < 0.001). . Limited individual development of the acetabulum was associated with an unfavourable outcome following Salter osteotomy. Cite this article: Bone Joint J 2014;96-B:1419–23

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

We have studied retrospectively 37 hips in 36 children at an average of 91 months after simultaneous open reduction and Salter innominate osteotomy for developmental hip dysplasia. At the latest review 97.3% were clinically and 83.8% radiologically good or excellent. In three hips (8%) there were signs of avascular necrosis, but only one had been symptomatic. There were no cases of recurrent posterior displacement

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