Salter's 1961 landmark paper describes the design, rationale, technique, and early results of innominate osteotomy for congenital dislocation and subluxation of the hip. The procedure was created to solve post-reduction instability in children over 18 months by redirecting the entire misdirected acetabulum into a functional weight-bearing position. The paper addresses why the hip redislocates after reduction and proposes a mechanistically grounded operative solution.
Before this paper, surgeons treated the dysplastic hip as a roof problem — building shelves or bending the acetabular roof down (acetabuloplasty) to cover an uncovered femoral head. Salter reframed the problem: it is not a focal roof defect but a globally misdirected socket, and patching the roof leaves the underlying misdirection uncorrected.
When you see a child aged 18 months to 6 years with congenital hip dislocation who cannot be definitively managed conservatively, the Salter innominate osteotomy is the index procedure. It redirects the whole acetabulum, restores stability in the walking position, and allows early weight bearing without a femoral osteotomy.
For subluxation, the upper age limit extends to early adult life. The principle that drove development of the Bernese periacetabular osteotomy (Ganz, 1988) for adolescents and adults. The Severin classification and Wiberg CE angle, used here as outcome measures, remain the standard radiographic language for acetabular dysplasia assessment in the literature today.
Salter's 1961 landmark paper describes the design, rationale, technique, and early results of innominate osteotomy for congenital dislocation and subluxation of the hip. The procedure was created to solve post-reduction instability in children over 18 months by redirecting the entire misdirected acetabulum into a functional weight-bearing position. The paper addresses why the hip redislocates after reduction and proposes a mechanistically grounded operative solution.
Before this paper, surgeons treated the dysplastic hip as a roof problem — building shelves or bending the acetabular roof down (acetabuloplasty) to cover an uncovered femoral head. Salter reframed the problem: it is not a focal roof defect but a globally misdirected socket, and patching the roof leaves the underlying misdirection uncorrected.
When you see a child aged 18 months to 6 years with congenital hip dislocation who cannot be definitively managed conservatively, the Salter innominate osteotomy is the index procedure. It redirects the whole acetabulum, restores stability in the walking position, and allows early weight bearing without a femoral osteotomy.
For subluxation, the upper age limit extends to early adult life. The principle that drove development of the Bernese periacetabular osteotomy (Ganz, 1988) for adolescents and adults. The Severin classification and Wiberg CE angle, used here as outcome measures, remain the standard radiographic language for acetabular dysplasia assessment in the literature today.