This document provides information on the Salter osteotomy procedure for treating developmental dysplasia of the hip. It describes the characteristics of the procedure, including that it is a rotational osteotomy of the innominate bone using a wedge graft to redirect the acetabulum. The document outlines the pre-requisites for the procedure, limitations, steps for performing it, potential tips, and pitfalls or complications. It concludes with contact information for the author.

1. Pelvic osteotomies workshop
Salter osteotomy:
N.Hamdi
Sept 20, 2014

2. Road Map
• Characteristics
• Pre-requisites
• Limitations
• Workshop
• Tips
• Pitfalls /complications

3. Characteristics
• First published: JBJS 1961,43B:518-39
• For mal-directed acetabulum : ( Acet. Faces
more anteriorly & laterally than normal) .
• Hinge on the flexible symphysis pubis .
• Provides hyaline cartilage (physiological) cover
• Doesn't disturb acetabular growth

4. Outcome at Forty-five Years After Open
Reduction and Innominate Osteotomy for Late-
Presenting Developmental Dislocation of the Hip
• 60 patients
- THR 19 Pt.
- Died 3 Pt.
- Study 38 Pt.
• This method achieves a 54% rate of survival of
the hip at 45 years
• ⅔ of the surviving hips have an excellent prognosis 40-48
years after the index procedure
Robert B. Salter, MD, FRCS(C)
JBJS-A.2007,Vol.89-A, No.11,2341-50

5. Pre-requisites
• Age 18m-9yrs
• Good range of motion = Congruent joint
• Concentric reduction (present / achievable)
• Degree of coverage 25°Ant.,15°lat
• X-ray in abduction,flexion,and internal
rotation shows improved cover
• No posterior wall deficiency

6. Limitations
• Severe acetabular dysplasia ( AI > 40° )
• Straight acetabulum ( Saucer shaped )
• Posterior wall deficiency
• Coxa magna :
- Salter’s osteotomy doesn't enlarge acet.
- May cause posterior uncoverage

7. Pelvic osteotomies workshop
Salter osteotomy:
• It is a rotational osteotomy.
• Position the patient supine and the affected hip is elevated by support.
•Mark the greater trochanter and the anterior superior iliac spine and then make
the skin incision runs between them
• Dissect till you reach iliopsoas and cut the tendeniousious part only to allow
later healing.
• Cut the iliac apophysis in the middle , subperiosteal dissection till the sciatic
notch

8. • Pass the Giggly saw through the sciatic notch with help of stitch
passed through the holes.
• Do the osteotomy just above the anterior inferior iliac spine
straight one cut directed vertically and at right angle to iliac bone
• Cut the graft of enough size from the ASIS.
• Shape the graft till it take the shape of wedge with angle of 30 deg.

9. • Open the osteotomy site by grasping the distal segment and pulling it
downward then fit the graft in place
•If the osteotomy is done alone without open reduction of the hip you can
open the osteotomy by crossing the leg of the affected limb in a figure of 4
and forcing it in abduction.
• Pass 2 thick threaded pins in the osteotomy from proximal through the graft
to end with sufficient length in the distal part.
• To do post op X-R for the pelvis, put a towel under the back just to resume
the lumbar lordosis in the standing AP pelvic view.

16. Tips
• The aim is to rotate the acetabulum :
- Avoid excessive traction on the distal
fragment ( may break)
- Add lateral shift to distal fragment to increase
lateral cover
• Position of pins : best medial to acetabulum

17. Pitfalls /Complications
• Open osteotomy at
sciatic notch
- Unstable
- Loss of correction
• Miss-placed K. wires
- Unstable : loss of
correction
•Intra-articular in the hip
joint : Chondrolysis

18. Pitfalls / Complications
• Operating on children below 18 months :
- Too thin innominate bone and graft →
Displacement of graft and osteotomy
• Failure to perform tenotomy of Psoas/Add :
- Cause incomplete rotation of acetabulum
- Increases pressure on femoral head→ AVN

19. Pitfalls / Complications
• Careful when posterior
wall deficient

20. Thank you
Any comments or suggestion for the salter’
osteotomy.
Would be greatly appreciated
Nhamdi@kfshrc.edu.sa