Acquired Hip Disorders in Children and Adolescents Sarah D. Bixby Department of Radiology Boston Children s Hospital Boston, MA
Don t Miss Acquired Hip Disorders SCFE Posterior Hip Dislocation Osteoid Osteoma Pelvic Osteomyelitis Misc. 2
14 yo male with anterior hip pain x 1 month
Slipped Capital Femoral Epiphysis THE Don t Miss diagnosis! Most common adolescent hip disorder Salter I fracture Risk factors: Obesity Hypothyroidism Growth spurt
Slipped Capital Femoral Epiphysis MRI helpful to evaluate for pre-slip Physeal widening Metaphyseal marrow edema Joint effusion Synovitis 5
Missed SCFE? 15 year old male with chronic hip pain 6
SCFE Mild stable SCFE In situ screw fixation Unstable/moderate/severe SCFE 7
SCFE In situ screw fixation Modified Dunn osteotomy 8
SCFE Modifed Dunn osteotomy 26% risk of AVN Technically challenging (compared to in situ pinning). Tertiary care centers Avascular Necrosis 9
14 year old football player; left hip pain after tackle 10
14 year old football player; left hip pain after tackle 2 years later, persistent limp 11
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Posterior Hip Dislocation 13
Posterior Hip Dislocation 14
Posterior Hip Dislocation with Labral Entrapment 15
Posterior Hip Dislocation with Labral Entrapment 16
Posterior Hip Dislocation with Labral Entrapment 17
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
Posterior Hip Dislocation with Labral Entrapment 19
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
Prior Dislocation? 21
Prior Dislocation? 22
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
Synovial Osteochondromatosis 24
Synovial Osteochondromatosis 25
13 year old female with right hip pain 26
13 year old female with right hip pain T2 fs T2 fs 27
Osteoid Osteoma Radiolucent nidus Central calcification Geographic marrow edema Thickened medial retinaculum Joint effusion 28
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):353-7. 29
Companion Case: 14 year old female with left hip pain 30
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Osteoid Osteoma 32
Delayed Diagnosis Example 1 Initial MR Diagnosis: Stress Fracture 33
Delayed Diagnosis-Example 2 Initial PE and radiographs c/w FAI 34
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
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
Metaphyseal Equivalents Pelvis 37
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
Pelvic Osteomyelitis Iliac Crest * * ASIS * * 39
Pelvic Osteomyelitis Pubic symphysis 40
Pelvic Osteomyelitis (Ischiopubic Synchondrosis) 41
Iliac Osteomyelitis? 42
Neuroblastoma Metastases 43
Pyogenic Sacro-iliitis History of antecedent trauma common Often misdiagnosed as muscle strain Osteomyelitis usually secondary 44
Misc. 45
Ganglion Cysts 17 year old female with right hip pain 46
Ganglion Cysts 47
Epiphyseal Osteomyelitis 4 year old female with left hip pain 48
LCH 49
Thank you 50