Muhammed Yusuf Afacan, MD | Burak Ozturk, MD | Ahmet Burak Demirdas, MD | Yavuz Han, MD | Ali Seker, MD

Orthopaedics and Traumatology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Orthopaedics and Traumatology, Orthopaedics and Traumatology, Istanbul University-Cerrahpasa

General surgical preparations were completed. Sterile draping conditions were ensured. The patient received 450 mg IV clindamycin prophylaxis. Surgery commenced on a patient diagnosed with developmental hip dysplasia, indicated for a left pelvic triple osteotomy. The procedure began with the patient in the right lateral decubitus position.

The distinctive feature of this surgical technique is that, unlike conventional triple osteotomies where the patient is re-prepped and re-draped after the posterior approach, in our technique, we transitioned the patient from the lateral decubitus position to the supine position without the need for re-draping. This significantly reduced the duration of the surgery.

A transverse incision approximately 10 cm long was made towards the greater trochanter, starting from the posterior aspect of the left hip where the ischial tuberosity was palpated. The skin and subcutaneous tissues were incised. The fascia was incised, and through the gluteal muscles, the ischial column was reached. The periosteum of the ischial column was stripped using a periosteal elevator and osteotomized with the help of an osteotome. The position of the osteotomy line was confirmed using fluoroscopy. The incision was irrigated thoroughly with saline. The skin and subcutaneous tissues were closed anatomically.

The patient was then placed in the supine position, and surgery continued with a bikini incision approximately 15 cm long, extending from the anterior superior iliac spine (ASIS) to the inguinal region on the anterior aspect of the left hip. The skin and subcutaneous tissues were incised. At the distal end of the incision, near the pubis, the femoral artery and vein were palpated medially. The pubic column (ramus pubis superior) was reached through blunt dissection between the muscles. The periosteum was stripped, and the pubic column (ramus pubis superior) was osteotomized with the help of an osteotome. The position of the osteotomy line was confirmed using fluoroscopy. The incision was extended proximally. The lateral femoral cutaneous nerve was identified and preserved. Dissection continued deep between the sartorius and tensor fascia lata muscles, reaching the origin of the sartorius at the ASIS. The sartorius muscle was detached from its attachment at the ASIS. The periosteum and apophysis were stripped along the anterior and posterior aspects of the iliac wing with the help of a periosteal elevator, exposing the ilium. Two Hohmann retractors were placed medially and laterally on the ischial spine to protect the sciatic nerve, and a full-thickness iliac osteotomy was performed from anterior to posterior, reaching the ischial spine with a saw. The position of the osteotomy line was confirmed using fluoroscopy. A 3mm K-wire was inserted as a joystick into the distal fragment remaining below the osteotomy line. The acetabulum was directed anteriorly and laterally to cover the femoral head, using the Kirschner wire. It was confirmed with fluoroscopy that the coverage of the femoral head was adequate. Three pelvic screws (1 x 80 mm, 1 x 85 mm, 1 x 90 mm) were placed from the proximal to the distal fragment to secure the distal fragment.

Adequate hemostasis was achieved. All incisions were irrigated thoroughly with saline. The apophysis, skin, and subcutaneous tissues were closed anatomically. The patient, who did not experience any perioperative or early postoperative complications, was transferred to the inpatient ward.