Top

Journal of Children's Orthopaedics

Published in:

Open Access 01-06-2016 | Original Clinical Article

The ‘triradiate bump’: a novel radiographic sign that may confound assessment of acetabular retroversion

Authors: William Z. Morris, Ryan T. Li, Raymond W. Liu

Published in: Journal of Children's Orthopaedics | Issue 3/2016

Abstract

Purpose

The triradiate cartilage transiently projects medially within the pelvic brim around the time of triradiate closure, mimicking the ischial spine sign. The purpose of this study was to characterize this newly identified radiographic sign using a longitudinal radiographic study.

Methods

We identified 72 subjects from a longitudinal radiographic study of healthy adolescents, each with at least four consecutive, annual anterior−posterior radiographs of the left hip, including physeal closure. Images were reviewed to identify the presence of the triradiate bump, the year it was most prominent, and the number of years relative to triradiate closure after which it had completely remodeled.

Results

The transient medial projection of the triradiate cartilage (triradiate bump) was identified in 26/40 (65 %) females and 22/32 (69 %) males (p = 0.74). The medial projection of the triradiate cartilage was most prominent at 10.8 ± 0.8 years of age in females and 12.6 ± 0.7 years of age in males (p < 0.001). The triradiate cartilage projected medially a mean of 4.7 ± 0.8 or 5.1 ± 1.4 mm for females and males, respectively (p = 0.29), but remodeled completely in all cases around triradiate closure.

Conclusions

The transient medial projection of the triradiate cartilage within the pelvic brim, the ‘triradiate bump sign’, is a common radiographic finding in healthy adolescents around the time of closure of the triradiate cartilage that may mimic the ischial spine sign. These two signs can be distinguished as the projection of the ischial spine is located more inferiorly within the pelvic brim and the triradiate bump has a horizontal limb of radiolucency extending to its medial border.

Kapron AL, Anderson AE, Aoki SK et al (2011) Radiographic prevalence of femoroacetabular impingement in collegiate football players: AAOS exhibit selection. J Bone Jt Surg Am 93(19):e1111–e11110CrossRef

Kapron AL, Peters CL, Aoki SK et al (2015) The prevalence of radiographic findings of structural hip deformities in female collegiate athletes. Am J Sports Med 43(6):1324–1330CrossRefPubMed

Siebenrock KA, Ferner F, Noble PC, Santore RF, Werlen S, Mamisch TC (2011) The cam-type deformity of the proximal femur arises in childhood in response to vigorous sporting activity. Clin Orthop Relat Res 469(11):3229–3240CrossRefPubMedPubMedCentral

Siebenrock KA, Kaschka I, Frauchiger L, Werlen S, Schwab JM (2013) Prevalence of cam-type deformity and hip pain in elite ice hockey players before and after the end of growth. Am J Sports Med 41(10):2308–2313CrossRefPubMed

Agricola R, Bessems JH, Ginai AZ et al (2012) The development of Cam-type deformity in adolescent and young male soccer players. Am J Sports Med 40(5):1099–1106CrossRefPubMed

Agricola R, Heijboer MP, Ginai AZ et al (2014) A cam deformity is gradually acquired during skeletal maturation in adolescent and young male soccer players: a prospective study with minimum 2-year follow-up. Am J Sports Med 42(4):798–806CrossRefPubMed

Siebenrock KA, Schoeniger R, Ganz R, 2003 . Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Jt Surg Am. 85-A(2): 278−86

Reynolds D, Lucas J, Klaue K (1999) Retroversion of the acetabulum. A cause of hip pain. J Bone Jt Surg Br 81(2):281–288CrossRef

Myers SR, Eijer H, Ganz R (1999) Anterior femoroacetabular impingement after periacetabular osteotomy. Clin Orthop Relat Res 363:93–99CrossRefPubMed

10.

Jamali AA, Mladenov K, Meyer DC et al (2007) Anteroposterior pelvic radiographs to assess acetabular retroversion: high validity of the “cross-over-sign”. J Orthop Res 25(6):758–765CrossRefPubMed

11.

Kalberer F, Sierra RJ, Madan SS, Ganz R, Leunig M (2008) Ischial spine projection into the pelvis: a new sign for acetabular retroversion. Clin Orthop Relat Res 466(3):677–683CrossRefPubMedPubMedCentral

12.

Nelson S, Hans MG, Broadbent BH Jr, Dean D (2000) The brush inquiry: an opportunity to investigate health outcomes in a well-characterized cohort. Am J Hum Biol 12(1):1–9CrossRefPubMed

13.

van der Bom MJ, Groote ME, Vincken KL, Beek FJ, Bartels LW (2011) Pelvic rotation and tilt can cause misinterpretation of the acetabular index measured on radiographs. Clin Orthop Relat Res 469(6):1743–1749CrossRefPubMedPubMedCentral

14.

Tannast M, Zheng G, Anderegg C et al (2005) Tilt and rotation correction of acetabular version on pelvic radiographs. Clin Orthop Relat Res 438:182–190CrossRefPubMed

15.

Bittersohl B, Freitas J, Zaps D et al (2013) EOS imaging of the human pelvis: reliability, validity, and controlled comparison with radiography. J Bone Jt Surg Am 95(9):e581–e589CrossRef

16.

Kakaty DK, Fischer AF, Hosalkar HS, Siebenrock KA, Tannast M (2010) The ischial spine sign: does pelvic tilt and rotation matter? Clin Orthop Relat Res 468(3):769–774CrossRefPubMed

17.

Cicchetti DV, Sparrow SA (1981) Developing criteria for establishing interrater reliability of specific items: applications to assessment of adaptive behavior. Am J Ment Defic 86(2):127–137PubMed

18.

Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86(2):420–428CrossRefPubMed

19.

Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA (2003) Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 417:112–120PubMed

20.

Van Houcke J, Yau WP, Yan CH et al (2015) Prevalence of radiographic parameters predisposing to femoroacetabular impingement in young asymptomatic Chinese and white subjects. J Bone Jt Surg Am 97(4):310–317CrossRef

21.

Schmitz MR, Bittersohl B, Zaps D, Bomar JD, Pennock AT, Hosalkar HS (2013) Spectrum of radiographic femoroacetabular impingement morphology in adolescents and young adults: an EOS-based double-cohort study. J Bone Jt Surg Am 95(13):e90CrossRef

22.

Siebenrock KA, Kalbermatten DF, Ganz R (2003) Effect of pelvic tilt on acetabular retroversion: a study of pelves from cadavers. Clin Orthop Relat Res 407:241–248CrossRefPubMed

23.

Clohisy JC, Carlisle JC, Beaule PE et al (2008) A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Jt Surg Am 90(Suppl 4):47–66CrossRef

24.

Fabricant PD, Hirsch BP, Holmes I et al (2013) A radiographic study of the ossification of the posterior wall of the acetabulum: implications for the diagnosis of pediatric and adolescent hip disorders. J Bone Jt Surg Am 95(3):230–236CrossRef

25.

Acheson RM (1957) The Oxford method of assessing skeletal maturity. Clin Orthop 10:19–39PubMed

26.

Morris WZ, Chen JY, Cooperman DR, Liu RW (2015) Characterization of ossification of the posterior rim of acetabulum in the developing hip and its impact on the assessment of femoroacetabular impingement. J Bone Jt Surg Am 97(3):e11CrossRef

27.

Liu RW, Armstrong DG, Levine AD, Gilmore A, Thompson GH, Cooperman DR (2013) An anatomic study of the epiphyseal tubercle and its importance in the pathogenesis of slipped capital femoral epiphysis. J Bone Jt Surg Am 95(6):e341–e348CrossRef

28.

Liu RW, Armstrong DG, Levine AD, Gilmore A, Thompson GH, Cooperman DR (2013) An anatomic study of the distal femoral epiphysis. J Pediatr Orthop 33(7):743–749CrossRefPubMed

29.

Morris WZ, Weinberg DS, Gebhart JJ, Cooperman DR, Liu RW (2016) Capital femoral growth plate extension predicts cam deformity in a longitudinal radiographic study. J Bone Joint Surg Am. (Fully accepted and in press)

Title: The ‘triradiate bump’: a novel radiographic sign that may confound assessment of acetabular retroversion
Authors: William Z. Morris
Ryan T. Li
Raymond W. Liu
Publication date: 01-06-2016
Publisher: Springer Berlin Heidelberg
Published in: Journal of Children's Orthopaedics / Issue 3/2016
Print ISSN: 1863-2521
Electronic ISSN: 1863-2548
DOI: https://doi.org/10.1007/s11832-016-0737-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The ‘triradiate bump’: a novel radiographic sign that may confound assessment of acetabular retroversion

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2016

Correlation between the Gait Deviation Index and gross motor function (GMFCS level) in children with cerebral palsy

Defining occult injuries of the distal forearm and wrist in children

Correction of ankle valgus by hemiepiphysiodesis using the tension band principle in patients with multiple hereditary exostosis

Malunion of the distal radius in children: accurate prediction of the expected remodeling

Laboratory predictors for risk of revision surgery in pediatric septic arthritis

Primary subacute hematogenous osteomyelitis in children: a clearer bacteriological etiology