1. The Value of the Salter Osteotomy as a Routine Adjunct to Open Reduction of Developmental Dislocation of the Hip.

2. Dr. Alaa Azmi Ahmad-Ramallah, Palestine Dr. Colin Mosely, Shriner Hospital - Los Angeles - USA

3. Introduction

4. 59 cases of established hip dislocation were detected

5. All were treated by open reduction with & without salter osteotomy

6. Comparison between hips managed with and without Salter osteotomy was done

7. Comparison between hips managed by Salter osteotomy as primary and secondary procedure was done

8. Follow up to or almost to skeletal maturity

9. METHODS

10. We reviewed records of 59 dislocated hips with surgical treatment after 1.5 years of age between 1975- 1992

11. 33 hips –without Salter osteotomy ( R ) 26 hips –with primary Salter osteotomy (RS) 4 hips -with secondary Salter osteotomy ( R/S )

12. Evaluation through: Acetabular index (AI) Center edge angle (CE) Sphericity of femoral head Avascular necrosis Severin classification

13. RESULTS

15. Mean pre-op. acetabular index

16. Subsequent surgery

17. Mean CE angle at final follow-up

18. Mean Mose circle indices mm

19. Avascular necrosis incidence at final follow-up

20. Severin grade 1,2 (good)

21. Mean acetabular index pre-op.

22. Secondary Salter osteotomy Primary Salter osteotomy Mean CE angle at final outcome 3430.1 Mean Mose circle indices2.5mm2.4mm Avascular necrosis at final follow-up 50%31% Severin grade 1,2 (good)75%81%

23. Conclusions

24. Effects of primary Salter osteotomy compared to no Salter osteotmy: 1- Femoral head is better 2- Acetabulum provided better coverage 3- Avascular necrosis is less 4- higher good results according to Severin classification

25. Without Salter osteotomy With Salter osteotomy No. of hips3326 Mean age at 1 st op. (years)4.93.6 Mean radiological follow-up (years)11.39.6 Mean pre-op. acetabular index3535.2 Subsequent surgery57.5%23% Mean CE angle at final follow-up26.530.1 Mean Mose circle indices3.8mm2.4mm Avascular necrosis incidence at final follow-up 57.5%31% Severin grade 1 or 2 (good)63%81%

26. In comparing results of primary and secondary Salter osteotomy: Better end results for primary Salter osteotomy, even though this group was more dysplastic at the start.

27. Significance

28. Dislocated hip Child older than 1.5 years Routinely including Salter osteotomy with the primary open reduction produces the best result.

29. Thank you