Iliac apophyseal displacement: an alternative in pediatric pelvic osteotomies

The traditional surgical exposure for a Salter or Chiari pelvic osteotomy involves splitting the iliac apophysis to facilitate subperiosteal separation of the muscles of the inner and outer table of the ilium. With healing, the iliac crest frequently becomes broad and prominent, and the iliac wing hypoplastic. We addressed this issue by separating the whole iliac apophysis laterally at the junction of cartilage and bone and displacing it medially. The ilium was then exposed by subperiosteal dissection of the inner and outer table musculature. From February 1988 to June 2000, twenty-five pelvic osteotomies were performed utilizing this approach. Satisfactory exposure was achieved in each case. All osteotomies healed without iliac growth disturbances, leaving excellent cosmetic results. Resuturing the previously elevated external oblique abdominus over the iliac apophysis further improved contour and appearance, Iliac apophyseal displacement rather than splitting provided appropriate access and consistently good function and cosmesis.