Our pelvic osteotomy applications in children

Our Pelvic Osteotomy Applications in ChildrenSalter pelvic osteotomies (SPO) and Pemberton pelvic osteotomies (PPO) aresafe and successful methods which are used in the treatment acetabular dysplasia. Theaim of the study was to evaluate the clinical and radiological results of the patients withSPO and PPO in the light of literatüre.Forty-six hips of 36 patients to whom either Salter or Pemberton pelvicosteotomies were done in Fırat University Faculty of Medicine Department ofOrthopaedics and Travmatology between 1997 and 2004 were included in this study.Forty-three hips of 33 developmental dysplasia of the hip patients, two hips of 2 Legg-Calve-Perthes disease (LCP) patients and one hip of travmatic hip dislocation patientwere examined. Mean age was 46 months and mean follow-up time was 36 months inpatients with SPO. Whereas mean age was 27 months and mean follow-up time was 33months in patients with PPO.Correction of acetabular index was 21º and mean central-edge angle was 31.3º inSPO patients. Correction of acetabular index was 21.4º and mean central-edge anglewas 28.1º in PPO patients. Although PPO decreases acetabular index more than SPO,technically proper SPO corrects acetabular index as much as PPO (p>0.05).Sum of good and very good was 90.4% according to Severin?s radiologicalcriteria after SPO and it was 93.8 % according to modified McKay clinical criteria.These results were 78.6% and 78.6% after PPO respectively. In our study, radiologicaland clinical results of both osteotomies were successful and there was no statisticalsignificance (p>0.05).There was no statistical significance of pelvic osteotomy results according toSeverin?s radiological criteria in both patients between 18 and 48 months and patientsolder than 48 months (85.7%, 90.9%, p>0.05). Very good and good results weresignificantly more in patients between 18 and 48 months according to clinicalassessment with modified McKay criteria (91.4%, 81.5%, p<0.05). In both age groupsacetabular index angle and central-edge angle changes were successful, however thedifference of correction angles was not significant (p>0.05).Avascular necrosis of femoral head is the most important and frequentcomplication that affects the success in developmental dysplasia of the hip of treatment.In our study, avascular necrosis was the most frequent complication (18%) and Type IIavascular necrosis was the most common type among these (87.5%). The effect of ageat operation and type of pelvic osteotomy (Salter and Pemberton) was not significant onthe risk of avascular necrosis.In both osteotomies, mean loss of graft height was similar statistically, howevergraft resorption was mostly seen after Salter osteotomy (80%). We conclude thatmechanical forces mostly affect Salter osteotomy and technical errors increase thiseffect.Between iliac and femoral grafts, loss of femoral grafts height was less than iliacgrafts height (p<0.05). This difference shows that mechanical burden on the graft is welltolerated by the compact bone. Besides patient age, type of pelvic osteotomy andautograft did not affect graft healing time. We suggest the use of femur diaphyseal graftin especially patients for whom femoral shortening is planned if their age group is smallas well.On the other hand, pelvic osteotomies are successful techniques for anterolateralclosure of femur head in LCP patients with hip subluxation and rarely in travmaticconditions causing acetabular dysplasia.In conclusion, SPO and PPO are safe and successful methods in the treatment ofdevelopmental dysplasia of the hip, LCP disease, extrophia vesica and rarely travmaticacetabular dysplasia. Aim of hip dysplasia treatment is to obtain enough functional andclinical results with the achievement of stability, anatomical and concentric reduction ofhip joint. Thus, we many keep the patients away from hip prosthesis operations withdecreasing the possible risk of coxarthrosis which may developed in the followingyears.Key Words: Salter pelvic osteotomy, Pemberton pelvic osteotomy,Developmental dysplasia of the hip, Legg-Calve-Perthes disease, Travmatic hipdislocation.