Acquired Hip Disorders in Children and Adolescents. Sarah D. Bixby Department of Radiology Boston Children s Hospital Boston, MA

Transcription

1 Acquired Hip Disorders in Children and Adolescents Sarah D. Bixby Department of Radiology Boston Children s Hospital Boston, MA

2 Don t Miss Acquired Hip Disorders SCFE Posterior Hip Dislocation Osteoid Osteoma Pelvic Osteomyelitis Misc. 2

3 14 yo male with anterior hip pain x 1 month

4 Slipped Capital Femoral Epiphysis THE Don t Miss diagnosis! Most common adolescent hip disorder Salter I fracture Risk factors: Obesity Hypothyroidism Growth spurt

5 Slipped Capital Femoral Epiphysis MRI helpful to evaluate for pre-slip Physeal widening Metaphyseal marrow edema Joint effusion Synovitis 5

6 Missed SCFE? 15 year old male with chronic hip pain 6

7 SCFE Mild stable SCFE In situ screw fixation Unstable/moderate/severe SCFE 7

8 SCFE In situ screw fixation Modified Dunn osteotomy 8

9 SCFE Modifed Dunn osteotomy 26% risk of AVN Technically challenging (compared to in situ pinning). Tertiary care centers Avascular Necrosis 9

10 14 year old football player; left hip pain after tackle 10

11 14 year old football player; left hip pain after tackle 2 years later, persistent limp 11

12 12

13 Posterior Hip Dislocation 13

14 Posterior Hip Dislocation 14

15 Posterior Hip Dislocation with Labral Entrapment 15

16 Posterior Hip Dislocation with Labral Entrapment 16

17 Posterior Hip Dislocation with Labral Entrapment 17

18 Posterior Hip Dislocation with Labral Entrapment Presence of entrapped labrum changes management Surgical dislocation may be necessary to repair labrum If posterior dislocation clinically suspected, MRI to evaluate for both osseous and soft tissue injury 18

19 Posterior Hip Dislocation with Labral Entrapment 19

20 Complications of Posterior Hip Dislocation Arthrosis Most common complication (up to 24%) Related to chondrocyte damage at time of injury Avascular Necrosis Increased risk with >6 hours to reduction Rare in children Sciatic Nerve Injury 20

21 Prior Dislocation? 21

22 Prior Dislocation? 22

23 Synovial Osteochondromasis Cartilaginous metaplasia of the synovium Cartilaginous nodules grow in the synovium and often break free and become loose. More rarely, the nodules adhere to the synovium and do not form loose bodies May be treated arthroscopically 23

24 Synovial Osteochondromatosis 24

25 Synovial Osteochondromatosis 25

26 13 year old female with right hip pain 26

27 13 year old female with right hip pain T2 fs T2 fs 27

28 Osteoid Osteoma Radiolucent nidus Central calcification Geographic marrow edema Thickened medial retinaculum Joint effusion 28

29 Osteoid Osteoma Klontzas ME et al. Osteoid osteoma of the femoral neck: use of the half-moon sign in MRI diagnosis. Am J Roentgenol 2015;205(2):

30 Companion Case: 14 year old female with left hip pain 30

31 31

32 Osteoid Osteoma 32

33 Delayed Diagnosis Example 1 Initial MR Diagnosis: Stress Fracture 33

34 Delayed Diagnosis-Example 2 Initial PE and radiographs c/w FAI 34

35 Delayed Diagnosis- Example 3 Initial w/u for knee pain (negative) Hip MRI 9 months later c/w synovitis. Treated for inflammatory arthritis with no relief 35

36 Delayed Diagnosis- Example 3 Initial w/u for knee pain (negative) Hip MRI 9 months later c/w synovitis. Treated for inflammatory arthritis with no relief 36

37 Metaphyseal Equivalents Pelvis 37

38 Pelvic Osteomyelitis Hip effusion often absent Older patients (early adolescent) M>F Antecedent trauma common Elusive diagnosis Nonspecific history Fever may be absent Consider the diagnosis in children with prolonged MSK complaints, gait abnormality, or nonlocalized pain/fever 38

39 Pelvic Osteomyelitis Iliac Crest * * ASIS * * 39

40 Pelvic Osteomyelitis Pubic symphysis 40

41 Pelvic Osteomyelitis (Ischiopubic Synchondrosis) 41

42 Iliac Osteomyelitis? 42

43 Neuroblastoma Metastases 43

44 Pyogenic Sacro-iliitis History of antecedent trauma common Often misdiagnosed as muscle strain Osteomyelitis usually secondary 44

45 Misc. 45

46 Ganglion Cysts 17 year old female with right hip pain 46

47 Ganglion Cysts 47

48 Epiphyseal Osteomyelitis 4 year old female with left hip pain 48

49 LCH 49

50 Thank you 50