Pediatric Pelvis

Abstract

The development of the pelvis follows a predictable pattern of ossification that involves the maturation of bone, synchondroses, and apophyses. These growth centers appear and close at distinct times during skeletal maturity and give rise to structural changes in the pelvis that can be distinctively appreciated on various imaging modalities. Accurate interpretation of radiologic images requires knowledge of skeletal development because the varying appearance of the maturing pediatric pelvis may be mistaken for pathology. In addition, many normal features within the pelvis can be erroneously perceived as injury. This article incorporates a multimodality review of normal pelvic maturation, a discussion of developmental variants, and a description of common injuries unique to the pediatric pelvis.

Keywords

pediatric pelvis - skeletal maturation - ischiopubic synchondrosis - apophyses - avulsion fractures

Publication History

Article published online:
29 July 2024

• References

• 1 Verbruggen SW, Nowlan NC. Ontogeny of the human pelvis. Anat Rec (Hoboken) 2017; 300 (04) 643-652
• 2 Yeap PM, Budak MJ. The pelvic radiograph: lines, arcs and stripes. Singapore Med J 2021; 62 (07) 333-340
• 3 Parvaresh KC, Upasani VV, Bomar JD, Pennock AT. Secondary ossification center appearance and closure in the pelvis and proximal femur. J Pediatr Orthop 2018; 38 (08) 418-423
• 4 Broome DR, Hayman LA, Herrick RC, Braverman RM, Glass RB, Fahr LM. Postnatal maturation of the sacrum and coccyx: MR imaging, helical CT, and conventional radiography. AJR Am J Roentgenol 1998; 170 (04) 1061-1066
• 5 Grissom LE, Harty MP, Guo GW, Kecskemethy HH. Maturation of pelvic ossification centers on computed tomography in normal children. Pediatr Radiol 2018; 48 (13) 1902-1914
• 6 Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat 2012; 221 (06) 537-567
• 7 Stevens MA, El-Khoury GY, Kathol MH, Brandser EA, Chow S. Imaging features of avulsion injuries. Radiographics 1999; 19 (03) 655-672
• 8 Patel K, Chapman S. Normal symphysis pubis width in children. Clin Radiol 1993; 47 (01) 56-57
• 9 Peterson H. Pelvis: triradiate cartilage. In: Peterson H. ed. Epiphyseal Growth Plate Fractures. Berlin, Germany: Springer; 2007: 755-767
• 10 Kjellin I, Stadnick ME, Awh MH. Orthopaedic magnetic resonance imaging challenge: apophyseal avulsions at the pelvis. Sports Health 2010; 2 (03) 247-251
• 11 Silva MS, Fernandes ARC, Cardoso FN, Longo CH, Aihara AY. Radiography, CT, and MRI of hip and lower limb disorders in children and adolescents. Radiographics 2019; 39 (03) 779-794
• 12 Feghali JA, Chambers G, Delépierre J, Chapeliere S, Mannes I, Adamsbaum C. New image quality and dose reduction technique for pediatric digital radiography. Diagn Interv Imaging 2021; 102 (7-8): 463-470
• 13 American College of Radiology. NCRP recommends against routine gonadal shielding. Available at: https://www.acr.org/Media-Center/ACR-News-Releases/2021/NCRP-Recommends-Against-Routine-Gonadal-Shielding. Accessed December 1, 2023
• 14 O'Dell MC, Jaramillo D, Bancroft L, Varich L, Logsdon G, Servaes S. Imaging of sports-related injuries of the lower extremity in pediatric patients. Radiographics 2016; 36 (06) 1807-1827
• 15 Hryhorczuk AL, Restrepo R, Lee EY. Pediatric musculoskeletal ultrasound: practical imaging approach. AJR Am J Roentgenol 2016; 206 (05) W62–W72
• 16 American College of Radiology. ACR Appropriateness Criteria. ACR–ASER–SCBT-MR–SPR Practice parameter for the performance of pediatric computed tomography (CT). Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/CT-Ped.pdf . Accessed December 1, 2023
• 17 Nagayama Y, Oda S, Nakaura T. et al. Radiation dose reduction at pediatric CT: use of low tube voltage and iterative reconstruction. Radiographics 2018; 38 (05) 1421-1440
• 18 Nguyen JC, Yi PH, Woo KM, Rosas HG. Detection of pediatric musculoskeletal pathology using the fluid-sensitive sequence. Pediatr Radiol 2019; 49 (01) 114-121
• 19 Carpineta L, Faingold R, Albuquerque PA, Morales Ramos DA. Magnetic resonance imaging of pelvis and hips in infants, children, and adolescents: a pictorial review. Curr Probl Diagn Radiol 2007; 36 (04) 143-152
• 20 Husum HC, Bach Hellfritzsch M, Henriksen M, Gottliebsen M, Rahbek O. MRI may be more valuable than pelvic radiographs in the assessment of paediatric borderline acetabular dysplasia. Children (Basel) 2023; 10 (04) 758
• 21 Weiss PF, Xiao R, Biko DM, Johnson AM, Chauvin NA. Detection of inflammatory sacroiliitis in children with magnetic resonance imaging: is gadolinium contrast enhancement necessary?. Arthritis Rheumatol 2015; 67 (08) 2250-2256
• 22 Chauvin NA, Khwaja A. Imaging of inflammatory arthritis in children: status and perspectives on the use of ultrasound, radiographs, and magnetic resonance imaging. Rheum Dis Clin North Am 2016; 42 (04) 587-606
• 23 Alexander KM, Laor T, Bedoya MA. Magnetic resonance imaging protocols for pediatric acute hematogenous osteomyelitis. Pediatr Radiol 2023; 53 (07) 1405-1419
• 24 Jamil K, Walker T, Onikul E, Munns CF, Little DG. A comparison of subtraction MRI with the standard contrast-enhanced imaging in Perthes' disease. J Child Orthop 2019; 13 (01) 82-88
• 25 Dillman JR, Hernandez RJ. MRI of Legg-Calve-Perthes disease. AJR Am J Roentgenol 2009; 193 (05) 1394-1407
• 26 Chan BY, Gill KG, Rebsamen SL, Nguyen JC. MR imaging of pediatric bone marrow. Radiographics 2016; 36 (06) 1911-1930
• 27 Ording Müller LS, Avenarius D, Olsen OE. High signal in bone marrow at diffusion-weighted imaging with body background suppression (DWIBS) in healthy children. Pediatr Radiol 2011; 41 (02) 221-226
• 28 Person A, Janitz E, Thapa M. Pediatric bone marrow: normal and abnormal MRI appearance. Semin Roentgenol 2021; 56 (03) 325-337
• 29 Weiss PF, Brandon TG, Bohnsack J. et al. Variability in interpretation of magnetic resonance imaging of the pediatric sacroiliac joint. Arthritis Care Res (Hoboken) 2021; 73 (06) 841-848
• 30 Chauvin NA, Xiao R, Brandon TG. et al. MRI of the sacroiliac joint in healthy children. AJR Am J Roentgenol 2019; 212 (06) 1303-1309
• 31 Bedoya MA, Jaramillo D, Chauvin NA. Overuse injuries in children. Top Magn Reson Imaging 2015; 24 (02) 67-81
• 32 McKinney BI, Nelson C, Carrion W. Apophyseal avulsion fractures of the hip and pelvis. Orthopedics 2009; 32 (01) 42
• 33 Albtoush OM, Bani-Issa J, Zitzelsberger T, Springer F. Avulsion injuries of the pelvis and hip. Rofo 2020; 192 (05) 431-440
• 34 Arnaiz J, Piedra T, de Lucas EM. et al. Imaging findings of lower limb apophysitis. AJR Am J Roentgenol 2011; 196 (03) W316-W325
• 35 Wait A, Gaskill T, Sarwar Z, Busch M. Van Neck disease: osteochondrosis of the ischiopubic synchondrosis. J Pediatr Orthop 2011; 31 (05) 520-524
• 36 Herneth AM, Philipp MO, Pretterklieber ML, Balassy C, Winkelbauer FW, Beaulieu CF. Asymmetric closure of ischiopubic synchondrosis in pediatric patients: correlation with foot dominance. AJR Am J Roentgenol 2004; 182 (02) 361-365
• 37 Sabir N, Çakmak P, Yılmaz N, Yüksel S. Osteochondrosis of ischiopubic synchondrosis: Van Neck-Odelberg disease. J Pediatr 2021; 229: 307-308