Salter, Clin Orthop Relat Res 1961 - The Classic. Innominate Osteotomy in the Treatment of Congenital Dislocation and Subluxation of the Hip by Robert B. Salter, J. Bone Joint Surg. (Brit) 43B:3:518, 1961 - Article Summary

The Classic. Innominate Osteotomy in the Treatment of Congenital Dislocation and Subluxation of the Hip by Robert B. Salter, J. Bone Joint Surg. (Brit) 43B:3:518, 1961

Salter·Clin Orthop Relat Res·1961·64 citations·Case series

Salter tested whether dividing the ilium to redirect the whole misdirected acetabulum as one unit corrects post-reduction instability in congenital hip dislocation and subluxation in children over 18 months. Technique description and early case series of 25 hips, assessed by Severin radiographic grade and femoral head avascular necrosis (AVN).

Key Findings

Instability came from a globally misdirected acetabulum facing too far anterolaterally. The head was uncovered anteriorly in extension and laterally in adduction, which is the walking position.
The triradiate cartilage locks the three acetabular parts together. An iliac cut lets the whole socket rotate as a unit, hinging at the symphysis pubis, preserving acetabular shape and capacity, unlike acetabuloplasty.
By Severin's method all hips were excellent or good: excellent (Type I) in 80% and good in 20%, with no poor results or failures. The two Type III results were both hips of one girl aged 5.5 years.
Single incision, about 1 hour, blood loss 100 to 200 mL. AVN in 4% (1/25 hips).
Significance: Introduced the Salter innominate osteotomy, a redirectional pelvic osteotomy that reorients the existing acetabulum rather than reshaping it, as primary treatment of congenital dislocation and subluxation of the hip.

Board PearlThe Salter innominate osteotomy cuts the ilium and rotates the entire acetabulum through the symphysis pubis, with a primary indication of developmental hip dislocation at age 18 months to 6 years and subluxation up to early adult life.