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Advances in Adult Dysplasia
Published in K. Mohan Iyer, Hip Joint in Adults: Advances and Developments, 2018
The triradiate cartilage, that appears as a T-shaped structure at the sixteenth week of gestational age, is responsible for the development, growth and depth of the acetabulum [23,24]. The triradiate cartilage usually closes during the ages between 14 and 16 years [25]. However, secondary growth centres appear in the rim of the acetabulum, which would shape the final acetabulum. For example, os acetabular is an epiphyseal centre adjacent to the pubis, which appears at seven years of age and is closed at nine years of age [24]. It is responsible for the formation of the entire anterior wall of the acetabulum. Other secondary epiphyseal growth plates of the acetabulum close up to 18 years of age [25].
Paediatric orthopaedic disorders
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
The Bernese periacetabular osteotomy is a pelvic osteotomy for adolescent hip dysplasia that is effective in significantly improving the radiographic parameters, the mechanical environment and the functional outcome, and possibly prolonging the life of the joint. It is a complex surgical procedure that results in freeing the acetabular socket with multiple osteotomies and reorientating it in a manner to enhance coverage and redistribute pressures within the hip joint. It can only be performed in skeletally mature patients whose triradiate cartilage has fused. Other pelvic osteotomies can be performed in younger patients with hip dysplasia who are still skeletally immature. The goal of these osteotomies is to enhance stability, improve coverage and contact between the acetabulum and the femoral head, and facilitate the reciprocal effect that the femoral head and the acetabulum have on each other’s growth and remodelling.
Pediatric Orthopedic Trauma: Spine and pelvis trauma
Published in David E. Wesson, Bindi Naik-Mathuria, Pediatric Trauma, 2017
Jaclyn F. Hill, Alysia K. Robertson
The pelvic ring is formed from the fusion of three major ossification centers: the ilium, ischium, and pubis (Figure 20.2.18). By the age of 7 years, the pubis and ischium fuse to form the inferior pubic rami. Between the age of 13 and 16 years, the three ossification centers fuse through the triradiate cartilage. Secondary ossification centers exist at the iliac crest, ischial apophysis, anterior inferior iliac spine, pubic tubercle, ischial spine, and lateral wing of the sacrum. The time to closure varies, but ranges from 13 to 25 years on average. Muscular attachments at each site are prone to avulsion fractures due to weak cartilaginous attachment to underlying bone [30, 31] (Figure 20.2.19).
Femoral and pelvic osteotomies for severe hip displacement in nonambulatory children with cerebral palsy: a prospective population-based study of 31 patients with 7 years’ follow-up
Published in Acta Orthopaedica, 2019
For the pelvic osteotomy, a modification of the incomplete transiliac Dega osteotomy was performed (Grudziak and Ward 2001) through a transverse anterior incision approximately 2 cm distal to the superior anterior iliac spine. The anterior part of the iliac apophysis was split and the inner and outer tables of the ilium were subperiosteally exposed. The osteotomy was performed with curved osteotomes. It started just above the anterior inferior iliac spine and proceeded posteriorly, keeping about 1.5 cm above the attachment of the joint capsule. The direction of the osteotomy was medially and inferiorly and ended just above the horizontal limb of the triradiate cartilage, leaving the posterior part of the cortex at the sciatic notch intact. A broad osteotome was used to lever open the osteotomy laterally and anteriorly. The bone graft from the femoral shortening was inserted in the open wedge (Figure 1).
Overgrowth of the lower limb after treatment of developmental dysplasia of the hip: incidence and risk factors in 101 children with a mean follow-up of 15 years
Published in Acta Orthopaedica, 2020
Chan Yoon, Chang Ho Shin, Dong Ook Kim, Moon Seok Park, Won Joon Yoo, Chin Youb Chung, In Ho Choi, Tae-Joon Cho
Little has been reported on the incidence and risk factors of LLD by overgrowth in patients with DDH. In the current study, more than 40% of patients treated by closed reduction (CR) or open reduction (OR) had LLD exceeding 10 mm. LLD of 10 mm may not have a considerable influence on normal hips (Song et al. 1997). However, in patients with DDH, a small amount of overgrowth might compromise development of the acetabulum, which is already dysplastic, by increased mechanical compression of the growth plate of the acetabular cartilage complex and Hueter–Volkmann law (Ponseti 1978, Stokes 2002). It can break the balance between the growth of the acetabular and triradiate cartilages, which is important for normal acetabular development to occur as the pelvis enlarges (Ponseti 1978).
The influence of musculoskeletal forces on the growth of the prenatal cortex in the ilium: a finite element study
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Peter J. Watson, Michael J. Fagan, Catherine A. Dobson
Information on the material properties of prenatal pelvic bone is scarce, therefore the Young’s modulus (E) of cortical bone was defined as 7.02 GPa (Kim et al. 2016), with a Poisson’s Ratio (ν) of 0.3. The modulus of trabecular bone was estimated using the non-linear relationship ETrabecular = 1.24 ETissue (BV/TV)1.8 (Yang et al. 1998), where ETissue was set equal to ECortical. The BV/TV calculated previously for this specimen was 28.31% (Cunningham and Black 2009b), therefore ETrabecular was estimated to be 898 MPa (ν = 0.2). Triradiate cartilage was defined as E = 25 MPa (ν = 0.4) (Dong et al. 2013).