title: [Modified PemberSal osteotomy technique with lyophilized human allograft].
abstract: OBJECTIVE
  PemberSal osteotomy to improve femoral head coverage by rotating the acetabular roof ventrally and laterally.
  
  
  METHODS
  Insufficient coverage of the femoral head, and can be combined with other surgical procedures such as femoral intertrochanteric varus-derotation osteotomy and open reduction for developmental dysplasia and dislocation of the hip or to improve sphericity and containment in Legg-Calvé-Perthes disease. This specific acetabuloplasty can only be performed in patients with an open epiphyseal growth-plate.
  
  
  METHODS
  Increased bleeding tendency (e.g., inherited or iatrogenic); elevated anesthetic risk such as in cerebral palsy, arthrogryposis multiplex congenital, trisomies; syndromes require explicit interdisciplinary clarification to reduce perioperative risks; infections as in other elective surgeries; diseases/deformities making postoperative spica casting impossible or impractical (e.g., deformities of spinal cord or urogenital system, hernias requiring treatment); closed epiphyseal plate requires complex three-dimensional corrections of the acetabular roof (e.g., triple/periacetabular osteotomy).
  
  
  METHODS
  Osteotomy from the iliac bone to the posterior ilioischial arm of the epiphyseal growth-plate cartilage; controlled fracture of the cancellous bone without breaking the medial cortex of the iliac bone for ventrocaudal rotation of the acetabular roof. To refill and stabilize the osteotomy site, an allogenic bone-wedge is interponated and secured by a resorbable screw or kirschner wire. This method also allows more complex reconstructions of the acetabular roof, e.g., by including the pseudo-cup in a modified Rejholec technique.
  
  
  METHODS
  A spica cast is applied to immobilize the hip for 6 weeks. Afterwards physiotherapy can be performed under weight-bearing as tolerated. Radiographic check-ups every 6 months.
authors.affiliation: Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Druschel
authors.affiliation: Schwerpunkt Kinder- und Neuroorthopädie Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland.
authors.forename: K
authors.initials: K
authors.lastname: Heck
authors.affiliation: Klinik für Orthopädie, Unfall- und Handchirurgie, Helios Klinikum Krefeld, Krefeld, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Kraft
authors.affiliation: Schwerpunkt Kinder- und Neuroorthopädie Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland. richard.placzek@ukb.uni-bonn.de.
authors.forename: R
authors.initials: R
authors.lastname: Placzek
mesh_terms: D000077:Acetabulum / Q000002:abnormalities* / Q000601:surgery*; D064591:Allografts; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015925:Cryopreservation / Q000379:methods; D019317:Evidence-Based Medicine; D005612:Freeze Drying / Q000379:methods; D006618:Hip Dislocation, Congenital / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D010027:Osteotomy / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods; D014184:Transplantation, Homologous / Q000379:methods; D016896:Treatment Outcome
keywords: Acetabuloplasty; Congenital hip dislocation; Hip dysplasia; Legg–Calvé–Perthes disease; Perthes disease