Dr. Alaa Azmi Ahmad-Ramallah, Palestine Dr. Colin Mosely, Shriner Hospital - Los Angeles - USA
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Transcript of Dr. Alaa Azmi Ahmad-Ramallah, Palestine Dr. Colin Mosely, Shriner Hospital - Los Angeles - USA
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The Value of the Salter Osteotomy as a Routine Adjunct to Open Reduction of Developmental
Dislocation of the Hip.
The Value of the Salter Osteotomy as a Routine Adjunct to Open Reduction of Developmental
Dislocation of the Hip.
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Dr. Alaa Azmi Ahmad-Ramallah, Palestine
Dr. Colin Mosely, Shriner Hospital - Los Angeles - USA
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IntroductionIntroduction
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59 cases of established hipdislocation were detected
59 cases of established hip dislocation were detected
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All were treated by open reduction with & without salter osteotomy
All were treated by open reduction with & without salter osteotomy
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Comparison between hips managed with and without Salter osteotomy was done
Comparison between hips managed with and without Salter osteotomy was done
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Comparison between hips managed by Salter osteotomy as
primary and secondary procedure was done
Comparison between hips managed by Salter osteotomy as
primary and secondary procedure was done
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Follow up to or almost
to skeletal maturity
Follow up to or almost
to skeletal maturity
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METHODS METHODS
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We reviewed records of 59 dislocated hips with surgical treatment after 1.5 years of age between 1975- 1992
We reviewed records of 59 dislocated hips with surgical treatment after 1.5 years of age between 1975- 1992
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33 hips – without Salter osteotomy ( R )
26 hips – with primary Salter osteotomy (RS)
4 hips - with secondary Salter osteotomy ( R/S )
33 hips – without Salter osteotomy ( R )
26 hips – with primary Salter osteotomy (RS)
4 hips - with secondary Salter osteotomy ( R/S )
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Evaluation through:Acetabular index (AI)Center edge angle (CE)Sphericity of femoral headAvascular necrosis Severin classification
Evaluation through:Acetabular index (AI)Center edge angle (CE)Sphericity of femoral headAvascular necrosis Severin classification
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RESULTS
RESULTS
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3.6
9.6
4.9
11.3
0
2
4
6
8
10
12
with Salter without Salter
Mean age at 1st op. (years)
Mean radiological follow-up (years)
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Mean pre-op. acetabular index
3535.2
34.5
35
35.5
with Salter without Salter
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Subsequent surgery
23%
57.5%
0%
10%
20%
30%
40%
50%
60%
with Salter without Salter
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Mean CE angle at final follow-up
30.1
26.5
24.525
25.526
26.527
27.528
28.529
29.530
30.5
with Salter without Salter
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Mean Mose circle indices
2.4
3.8
0
0.5
1
1.5
2
2.5
3
3.5
4
with Salter without Salter
mm
mm
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Avascular necrosis incidence at final follow-up
31%
57.5%
0%
10%
20%
30%
40%
50%
60%
with Salter without Salter
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Severin grade 1,2 (good)
81%63.0%
0%
13%
25%
38%
50%
63%
76%
88%
with Salter without Salter
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Mean acetabular index pre-op.
31 37.6
0
5
10
15
20
25
30
35
40
Secondary Salterosteotomy
Primary Salterosteotomy
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SecondarySalter
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%
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ConclusionsConclusions
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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
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
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Without Salterosteotomy
With Salterosteotomy
No. of hips3326
Mean age at 1st 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%
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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.
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.
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SignificanceSignificance
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Dislocated hip
Child older than 1.5 years
Routinely including Salter osteotomy with the primary open reduction produces the best result.
Dislocated hip
Child older than 1.5 years
Routinely including Salter osteotomy with the primary open reduction produces the best result.
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Thank you