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