Outline the radiographic anatomy of the pelvis and proximal femur. Demonstrate the radiographic appearances of the secondary ossification centres in the pelvis and proximal femur,
with age at ossification and fusion. Outline pathology that can occur in the paediatric pelvis/hip.
The pelvis consists of three paired bones: the ilium,
ischium and pubis and the sacrum.
The primary ossification centres for the ilium ossify at 12 weeks gestational age,
and for the ischium,
this occurs at 18 and 20 weeks gestational age respectively.The sacrum is formed of five segments,
ossification occurs in a craniocaudal direction from 14 weeks gestational age. Continued osteogenesis and skeletal growth occurs at secondary ossification centres in the pelvis and proximal femur,...
Imaging findings OR Procedure Details
PERTHES DISEASE Also known as Legg-Calvé-Perthes Disease,
this is an idiopathic avascular necrosis of the proximal femoral epiphysis.
It has a peak presentation at 5-8 years and is seen more commonly in boys (4:1) and Caucasians.
It is bilateral in 10-20% of cases.
Owing to the remodeling potential of the immature skeleton,
prognosis is worse in those that present older with less ability to correct any deformities that have occurred.
It is considered a diagnosis of exclusion with other causes...
There are a number of well recognised conditions affecting the paediatric pelvis and in particular the secondary ossification centres.
Understanding the developmental anatomyand its varied appearance through age is key in recognition of pathology.
Plain film radiography remains the mainstay in imaging assessment and findings when presentare often classic for the condition.
Secondary ossification centre appearance and closure in the pelvis and proximal femur.
J Pediatr Orthop 2016. Eich GF,
Paediatric pelvis: radiographic appearance in various congenital disorders.
Radiographics 1992 12:467-484. Dillman JR,
MRI of Legg-Calve-Perthes disease.American Journal of Roentgenology 2009;193 (5): 1394-407 Donnelly LF.
Pediatric Imaging The Fundamentals.
Saunders Elsevier (2009).
Acknowledgements: Dr Bhavin Upadhyay,
Royal National Orthopaedic Hospital