A Salter innominate osteotomy is an operation to redirect the hip socket to provide better coverage of the femoral head in a child with residual hip dysplasia. It is one of the most common pelvic osteotomies performed in children.
An incision is made over the front of the hip. The innominate bone is cut completely and the acetabular fragment is rotated forward and outward to cover the femoral head better. A bone graft (from the iliac crest) is wedged into the osteotomy and the correction is held with one or two pins. The operation takes one and a half to two hours.
The Salter osteotomy is recommended for residual acetabular dysplasia after DDH treatment, typically in children aged 18 months to six years. It improves coverage of the femoral head, reducing the risk of subluxation and arthritis.
Observation if dysplasia is mild and improving on serial X-rays. Bracing is not effective for established bony dysplasia.
X-rays and sometimes CT to plan the correction. Pre-operative assessment.
Improved hip coverage and stability. Good long-term outcomes when performed at the appropriate age. Most children achieve a near-normal hip.
The pins may cause local discomfort and are removed at six to eight weeks.
A hip spica is usually needed for six weeks.
Temporary hip stiffness.
Risk to the femoral head blood supply.
Excessive coverage causing impingement.
Thigh numbness.
The osteotomy may fail to heal.
Wound or pin-site infection.
General anaesthesia.
Hip spica cast for six weeks. Pin removal at six to eight weeks (a minor procedure). Gradual return to normal activity over a further six to eight weeks. Children adapt remarkably quickly.
Regular X-rays until skeletal maturity to monitor hip development.
In DDH, the socket is often too shallow and faces too vertically. The Salter osteotomy rotates it to face downward and forward, providing better coverage and stability.