Modified salter osteotomy without k-wire fixation in the treatment of developmental hip dysplasia; A new technical description

Salter innominate osteotomy has been used successfully in the treatment of developmental hip dysplasia for many years. However, this method requires K-wire fixation for the graft and control of the distal fragment. Our study aims to describe this new technique and evaluate the radiological results of modified Salter innominate osteotomy performed stably without using K-wires. The study group consisted of 74 hips of 62 patients diagnosed with developmental hip dysplasia between 2016-2019 and operated by a single surgeon. Data were analyzed retrospectively. Dislocation levels of the hips were determined from preoperative direct radiographs of the patients and grouped according to Tönnis's classification system. In addition to modified Salter osteotomy, open reduction and U-capsuloplasty were routinely performed in all patients. Femoral shortening and derotation were added as needed intraoperatively. Patients were radiologically evaluated according to preop, early postoperative and last follow-up acetabular index measurements and analyzed comparatively. Bucholz-Ogden classification was used to assess avascular necrosis of the femoral head in the postoperative period. The mean age of the patients included in the study was 24 (18-54) months. The mean follow-up period was 10 (6-26) months. According to the Tönnis classification system, four patients were classified as stage 1, 33 patients as stage 2, 11 patients as stage 3, and 26 patients as stage 4. Two patients had previously been treated with a Pavlik bandage, two patients had closed reduction, and three patients had previously undergone open reduction. Additional interventions such as femoral shortening and derotation were required in 9 hips (12.1%) to obtain a stable and compatible hip joint. Percutaneous adductor tenotomy was performed in 26 hips (35.1%). In all hips, osteotomy was achieved with an osteotome without using a gig saw. No K-wires were used for fixation of the graft placed on the osteotomy line in any of the 74 hips. The mean preop acetabular index was 41.93 ± 5.01, early postoperative 27.07 ± 3.68 and postoperative last control acetabular index measurements were 21.74 ± 3.91 degrees (p=0.001). Revision surgery was required in four hips due to subluxation development in the postoperative period. Only open reduction was applied to the revised patients, and femoral shortening and adductor tenotomy were not performed. Modified Salter osteotomy, which we applied by changing the initial direction of osteotomy level, can be used safely and effectively in the treatment of developmental hip dysplasia by eliminating the need for K-wire fixation. In this way, complications that may occur due to K-wire are avoided. Keywords: developmental hip dysplasia, salter, open reduction, osteotomy, osteotomy technique