Iliac Pedicle Wedge Graft as a New Modification for Iliac Osteotomies in Young Adolescents: A Single-blind Randomized Clinical Trial

Abstract

Background: Iliac osteotomies in adolescent patients may accompany graft related difficulties such as graft absorption<br />and delayed union. A new modification of iliac osteotomies has been proposed to address these difficulties.<br />Methods: A total of 24 consecutive hip joints in 21 juvenile or adolescent patients who were candidate for salter or<br />triple pelvic osteotomy were included. A modification was performed to harvest a wedged bone graft based on a muscle<br />pedicle of Tensor Fascia Lata and inserted at pelvic osteotomy site instead of a traditional graft technique. The hips<br />were randomized into two groups. The traditional wedge graft was used in group 1, while the new modification was<br />performed in group 2. The primary outcome of this study was duration of union. The secondary outcomes were Center<br />Edge Angle (CE) Angle on pre-operation, immediately post-operation and at the end of follow-up.<br />Results: Both groups were similar statistically regarding their age, gender , estimated blood loss and the duration of<br />follow-up. However, significant differences were found in the time to complete union between the two groups (P=0.03).<br />CE angle decreased in both groups when comparing its last follow-up to its right postoperative values, but the decrease<br />was significant only in group 1(P=0.03). The type of surgery (Salter or TPO) had no significant effect on the average<br />time to union. That shows faster union in pedicle graft group and less coverage loss during follow-up period than<br />conventional graft patients.<br />Conclusion: With the modification proposed , the healing at the osteotomy site was faster and the loss of correction,<br />owing to the graft resorption, decreased. Using this pedicle wedge graft technique may improve the results of pelvic<br />osteotomies in adolescent.<br />Level of evidence: II