Assessing the fusion of the ischiopubic synchondrosis using predictive modeling

Abstract

Flaring of the ischiopubic synchondrosis at the time of fusion is a common clinical observation in pediatrics and represents a normal physiological process in skeletal maturation. When presenting unilaterally, this flaring can mimic a range of serious pathological conditions such as osteomyelitis, osteal tumors, and traumatic injury. An improved understanding of ischiopubic synchondrosis fusion is therefore critical to avoid potential misdiagnosis. Retrospective multi-slice computed tomography pelvic scans of Australian individuals aged neonate to 24 years (n = 184) were assessed using a novel five stage morphological classification system of the maturation and fusion of the ischiopubic synchondrosis. Maturation scoring was conducted using both multiplanar formatting views and volume-rendered reconstructions in OsiriX™. Maturational stage was strongly related to age (P < 0.001) with fusion of the ischiopubic synchondrosis observed between the ages of 4 and 9 years in females and 7 and 13 years for males. The highest probability of fusion in our Queensland Australian population based on multinomial regression predictive modeling was between 7 and 10 years of age. We documented three variants of fusion: pubic and ischial outgrowths, appearance of a secondary ossification center, and a fusiform-shaped enlargement. This study provides the first predictive modeling of the timing of fusion of the ischiopubic synchondrosis using a reliable morphological classification system. The significant variation in timing and progression of fusion of the ischiopubic synchondrosis reported in this study, will aid in minimizing misdiagnosis and unnecessary treatment in children presenting with asymmetrical or delayed ischiopubic synchondrosis anomalies. Clin. Anat. 32:851-859, 2019.

Can forensic radiological skeletal age estimation be performed by examining ischiopubic-ilioischial-iliopubic synchondrosis in computed tomography images?

“…In a recent study by Gregory et al on CT images, ischiopubic ramus synchondrosis closure was very important in age determination. It has been shown that ischiopubic ramus synchondrosis begins and continues at age 7–13 in boys and 4–9 years in girls [ 28 , 29 ].…”

Invasive diagnostic and therapeutic measures are unnecessary in patients with symptomatic van Neck–Odelberg disease (ischiopubic synchondrosis): a retrospective single-center study of 21 patients with median follow-up of 5 years

“…The fusion of the IPS has been shown to be strongly age-related and usually occurs in girls between the age of 4 and 9 years and in boys between the age of 7 and 13 years (Gregory et al 2019 ). Although our findings are in general similar, we found a VND in a 22-year-old female patient with a 5-month history of left-sided groin pain and the referral diagnosis of a primary bone tumor ( Figure 6 ).…”

Van Neck-Odelberg Disease: A Rare Cause of Pediatric Hip Pain

“…Usually, the ischium and pubic bone fuse without any clinical symptoms. Fusion is typically observed between the ages of 4 and 9 years in females and 7 and thirteen in males [ 3 ]. However, some children may experience pain and limitation of movement associated with enlargement of the IPS and delayed fusion of the ischium and pubis [ 4 ].…”