Complications of Chiari and Salter osteotomies: a cadaver study

Previous investigations of the Chiari and Salter osteotomies showed that in traoperative vessel and nerve injuries are described repeatedly in the case of both pelvic osteotomies. The aim of our investigations was the exposure of each operation step in anatomic specimens to show the anatomic landmark s and potential risks. We performed nine Chiari osteotomies and five Salter osteotomies on formalin-fixed cadavers. The operation steps were made cons ecutively to assess the risks to the vessels and nerves as well as the dete rmination of anatomically important reference points. In both procedures an injury of the lateral femoral cutaneous nerve at the anterior access route is feasible. By ensuring that the skin including the lateral femoral cutan eous nerve is pulled medially, injury can be avoided. Additionally, too lon g retraction of the tensor fasciae latae muscle injures its nutrient vessel s. An inadequate subperiosteal approach during the pull on the Hohmann's re tractor leads to crushing and irritation of the sciatic nerve. Moreover, th ere is a risk that the superior gluteal nerve as well as the superior glute al artery may be injured. An inadequate subperiosteal application of the me dial Hohmann's retractor can endanger the obturator nerve. In the Chiari os teotomy there is a risk of injury to the articular branch of the superior g luteal nerve, which supplies parts of the ventral hip joint capsule. By ins erting the K-wire too far medially the internal oblique muscle is endangere d. Too prolonged retraction of the iliopsoas muscle in a Salter osteotomy c an lead to compression of the femoral nerve. The form of the osteotomy has an influence on the stability of the hip joint in the course of exposure of the hip joint. On account of the narrow spatial connection between the ana tomic pathways and the osteotomy area, strict subperiosteal dissection and careful use of the retractor are essential to avoid nerve and vessel injuri es.