This diagnostic image is an anteroposterior (AP) pelvic radiograph demonstrating the outcome of a left-sided Periacetabular Osteotomy (PAO), a surgical procedure for hip dysplasia. The radiograph shows the pelvic girdle, proximal femurs, and sacrum. On the left hip, evidence of surgical intervention includes three large cortical screws utilized for internal fixation of the acetabular fragment into the ilium. The reconstructed acetabulum shows improved femoral head coverage. Detailed orthopedic measurements are overlaid on the image to quantify postoperative alignment, including the Center-Edge (CE) angle (38.0°), Acetabular Index (AI) angle (-0.5°), and Sharp angle (36.5°). Additional metrics include the Hip Lateralization Index (HLI = D/C, 0.56), Anterior Hip Index (AHI = A/(A+B) x 100, 91.4), and the Caput-Collum-Diaphyseal (CCD) angle (137.4°). A positive 'crossing-over sign' is noted, indicating acetabular retroversion or specific rim morphology post-correction. This clinical image serves as an educational tool for evaluating acetabular orientation and surgical success in pelvic osteotomy procedures.

This composite of four clinical photographs displays a three-dimensional anatomical bone model of the human pelvis, specifically illustrating the technique for an Interlocking Pelvic Triple Osteotomy used in treating hip dysplasia. The images show the pelvic girdle from multiple orientations (lateral, posterior-oblique, anterior, and superior-oblique views) to highlight the three specific osteotomy sites required to mobilize the acetabulum. Key surgical cuts include: 1) a three-sided iliac osteotomy extending from the iliac crest towards the acetabulum; 2) an ischial osteotomy performed through the sub-cotyloid groove near the obturator foramen; and 3) a superior pubic ramus osteotomy. The model demonstrates how these strategic bone cuts allow for the reorientation of the acetabular fragment to improve lateral femoral head coverage and correct anteversion. The sacrum and pelvic landmarks such as the iliac crest, acetabulum, and pubic symphysis are clearly visible, providing anatomical context for the orthopedic procedure.

This diagnostic image displays a side-by-side comparison of two anteroposterior (AP) view radiographs of the pelvis, illustrating the progression and healing following a periacetabular osteotomy (PAO) for hip dysplasia. Radiograph (a) shows the immediate post-operative state with surgical hardware in situ. Multiple metallic cortical screws are visible, oriented from the superior ilium into the acetabular fragments to provide internal fixation across the osteotomy sites. The surgical cuts (osteotomies) around the acetabulum are visible as faint radiolucent lines. Radiograph (b) demonstrates the same pelvis at a later stage after hardware removal. The acetabular fragments have successfully united, evidenced by the absence of osteotomy lines and the presence of smooth cortical remodeling. The pelvic ring is intact, and the hip joints show improved femoral head coverage. This comparison illustrates the typical healing sequence from internal stabilization to complete bony consolidation after surgical correction of acetabular morphology.

This figure presents a side-by-side comparison of anteroposterior (AP) pelvic radiographs demonstrating the surgical management of developmental dysplasia of the hip (DDH). Image (a) shows the preoperative state with bilateral acetabular dysplasia, characterized by a shallow acetabular roof and insufficient coverage of the femoral head. Image (b) displays the postoperative result following a periacetabular osteotomy (PAO) of the right hip. The acetabulum has been surgically reoriented to increase the lateral center-edge angle (LCEA) and improve superior femoral head coverage. Internal fixation is visible in the right ilium, consisting of four metallic Kirschner wires (K-wires) that are bent at their proximal ends and recessed into the iliac crest to secure the osteotomized fragment. A large, spherical radiopaque marker or artifact is visible over the pelvic midline in the postoperative view. This diagnostic comparison highlights the anatomical corrections achieved through reorientation osteotomy and the use of unthreaded K-wires as an alternative fixation method to traditional screws.

Clinical photograph of a pediatric patient demonstrating postoperative lower limb functional mobility following a Salter's innominate osteotomy (SIO) for developmental dysplasia of the hip (DDH). The subject is shown in a seated kneeling position, often used for clinical assessment in certain cultures. The image illustrates the 'tashahhud I' position, which is a component of the Bhatti Functional Scoring System (BFSS) used to evaluate clinical outcomes after pelvic osteotomies. Key visible features include the ability to achieve significant knee flexion and hip stability necessary for this specific kneeling posture. This clinical documentation is used to assess the range of motion, hip joint stability, and the success of surgical reconstruction in restoring functional activities of daily living in a pediatric orthopedic context. The patient's symmetrical posture and bilateral limb alignment are indicative of a successful surgical outcome and effective postoperative rehabilitation.

This medical visual compares the structural changes following two common pediatric pelvic osteotomies for developmental dysplasia of the hip (DDH): the Salter and Pemberton procedures. The content consists of 3D CT reconstructions of a pediatric pelvis in six panels (A–F). Panels A–C demonstrate the Salter innominate osteotomy. Panel A shows a complete horizontal osteotomy line extending from the sciatic notch to the anterior inferior iliac spine. Panel B (anteroposterior) and C (lateral) show the resulting complete separation and downward/forward rotation of the distal pelvic fragment, creating a visible gap above the acetabulum typically filled with a bone graft. Panels D–F demonstrate the Pemberton pericapsular osteotomy. Panel D shows an incomplete osteotomy line curving from the ilium toward the triradiate cartilage. Panels E (anteroposterior) and F (lateral) illustrate that the posterior column remains intact; the acetabular roof is hinged downward through the triradiate cartilage, altering the acetabular shape and volume with a less pronounced pelvic contour change compared to the Salter method. These models highlight the different biomechanical approaches to increasing acetabular coverage of the femoral head.