Surgical Technique: Modified Bernese Triple Innominate Osteotomy

Abstract

The triple innominate osteotomy is a complete redirectional acetabular osteotomy, consisting of cuts through the ilium, ischium, and pubis. This osteotomy spares the triradiate cartilage and allows the acetabulum to be completely freed from the rest of the pelvis, which in turn allows the surgeon to obtain large corrections and control the final position of the acetabulum in multiple planes. This procedure is best indicated for skeletally immature patients with congruent or near-congruent joints that require large degrees of correction and/or changes in acetabular version. The modified Bernese triple osteotomy is performed through two incisions. The medial approach allows access for the ischial osteotomy, which is oriented toward the proximal aspect of the ischial spine. The pubis is cut with a Gigli saw and is accessed through the interval between the rectus femoris and iliacus. The ilium is osteotomized in a modified manner from the typical Salter osteotomy. Once mobilized, the acetabulum is carefully positioned with the help of a Schanz screw and pointed tenaculum before definitive fixation is achieved with long 3.5 mm pelvic screws.