The Innominate osteotomy was first introduced into the treatment of congenital dislocation and subluxation of the hip by ROBERT B. SALT~ of Toronto, Canada, in 1960. Our short experience with this procedure at the Orthopaedic Clinic of Istanbul University, made us to believe that, this is a great achievement in solving the problem of instability of the hip joint.
The social conditions of our country do not allow the early diagnosis of the congenital dis]ocation of the hip. Most cases are usually diagnosed after the children have learned to walk, even some cases remain undiagnosed until much older age. For this reason, the potential for spontaneous devclopement of the acetabulum and femoral head from their cartilage models is considerably reduced at the time we receive the patients for the treatment. Since, the stability of the hip joint mainly depends on the formation of the acetabulum, we have to deal with the instability problem quite often.
In the ease of insuficient acetabulum, we extented the period of immobilisation and faced with considerable joint stiffness, eontraetures and atrophy of the muscles. We have done around 400 of shelf operations by various conventional techniques, and we are familiar with the difficulty of maintaining the reduction, if the roof of the acetabulnm is inadequate. Placing the bony shelf at the edge of the acetabulum was not always satisfactory and could not be done on children less than 6 years old. We tried more extended acetabuloplasty procedures and ended up with stiff joints and narrow pelvis.
Because of the great need we felt for a better operation, we decided to try the innominate osteotomy. The idea of turning the whole acetabulum to cover the femoral head in functional position sounded like reasonable. Also, by doing this, the overall shape of the acetabulum is not changed and this operation does not narrow the pelvis. The applicability of this procedure to both congenital dislocation and subluxation of the hip, in young children as well as older ones, looked most attractive. We used this operation in our clinic on 15 patients with 3 main indications :
- As the primary treatment of the congenital dislocation of the hip, Innominate osteotomy with open reduction:
Our first operation in this group, was done on a 3 years old girl. The closed reduction was not succesfull in this case, despite of previous skin traction. After arthrographic evidence of hour glass deformity of the joint capsule, was decided on a open reduction. During this operation, reduction of the hip found to be