Quadruple and juxta-articular pelvic osteotomy in children using anterior approach: technique and results

The traditional indications of pelvic osteotomy in children are Salter's osteotomy in young patients and triple osteotomy in older patients. We performed the juxta-articular pelvic osteotomy with a single anterior approach. Our population included a group of young children necessitating a high degree of reorientation. In elder children a quadruple osteotomy of the ischium, pubis, ilium and ischial spine was achieved to release the sacrospinal ligament. Between 1993 and 2003, 30 osteotomies have been carried out on 26 patients. The mean age was 6.7 years, 10 patients were younger than 5 years, with 6 years of follow-up. The indications included acetabular dysplasia (15 cases), Perthes disease (14 cases) and one caput valgum. When compared with preoperative clinical examination, the postoperative flexion was decreased by 14 degrees, extension increased by 7 degrees, external rotation increased by 5 degrees, internal rotation decreased by 5 degrees. Radiographic assessment demonstrated an average angle of correction by 20 degrees for the acetabular angle of Sharp, 32 degrees for the center edge angle and 18 degrees for the slope of sourcil. We concluded that lateral coverage must be achieved in a frontal plan, avoiding the figure-of-four maneuvers and displacement in a transverse plan. Despite the significant reorientation of the acetabulum, we did not observe excessive external rotation. The quadruple osteotomy allowed important acetabular displacement in older patients. The single approach avoided prone position and permitted a simpler postoperative management.