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Modified Angulated Innominate Osteotomy Using Cortical Screw Fixation for Developmental Dysplasia of the Hip: A
Yuta Tsukagoshi1, Hiroshi Kamada1, Yohei Tomaru1
1Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Introduction:
Salter innominate osteotomy (SIO) is a well-established surgical procedure for the treatment of developmental dysplasia of the hip (DDH). Despite generally favorable outcomes, loss of correction before bone union remains a clinically relevant concern, particularly when fixation strength is insufficient. Angulated innominate osteotomy without bone grafting has been introduced to improve stability and reduce surgical invasiveness; however, fixation strategies for this technique have largely remained unchanged and continue to rely on Kirschner wires (K-wires), which may provide limited rigidity and be associated with implant-related complications.
Methods:
We describe a modified angulated innominate osteotomy using 3.5-mm solid cortical screw fixation. The osteotomy was performed according to the angulated technique described by Morita et al., eliminating the need for bone grafting. Provisional fixation was achieved using 2.5-mm K-wires, which were subsequently exchanged for 3.5-mm cortical screws along the same trajectory without additional drilling. A retrospective review was conducted of seven consecutive female patients with DDH who underwent isolated SIO using this technique. Radiographic parameters were evaluated preoperatively, immediately postoperatively, and at 6 months postoperatively.
Results:
The mean age at surgery was 5.0 years (range: 3.5-6.1 years), and the mean operative time was 90 minutes. Two cortical screws were used in four cases and three screws in three cases. No perioperative complications, correction loss, screw breakage, or implant-related failures were observed. Radiographic parameters demonstrated maintained correction at 6 months postoperatively in all hips. Full weight-bearing was achieved at a mean of 6.9 weeks, and implant removal was uncomplicated, with a mean operative time of 17 minutes.
Conclusions:
This study demonstrates the feasibility and safety of cortical screw fixation in angulated innominate osteotomy. This technique provided stable fixation during the bone-healing phase without increasing surgical complexity and appears to be a reliable option for fixation.