Asymmetric Closure of Ischiopubic Synchondrosis in Pediatric Patients: Correlation with Foot Dominance

Abstract

Unilateral enlarged ischiopubic synchondrosis is closely correlated with foot dominance. The asymmetric ossification pattern of the ischiopubic synchondrosis indicates delayed ossification of this anatomic structure due to asymmetrically applied mechanical forces to the nondominant limb.

Groin and Medial Thigh Pain in a 17-year-old Girl

“…The etiology of this asymmetric expansion of the ischiopubic synchondrosis and why it becomes symptomatic in some patients has not been clearly answered. Some have theorized that a mechanical pull from the hamstrings causes micromotion at the ischiopubic synchondrosis causing formation of a callus leading to delayed ossification of the affected ischiopubic synchondrosis [7,9]. Herneth et al [9] theorized that van Neck-Odelberg disease arises more often in the nondominant lower extremity, as it did in our patient.…”

“…The ischiopubic synchondrosis located at the junction of the inferior pubic ramus and ischial tuberosity behaves like a primary ossification center and fuses in late childhood to early adolescence. This normal fusion process may display bony enlargement, mineralization, and lucency, which are well described [1][2][3][4][5][6][8][9][10][11][12]. Junge and Heuck [12] reported one in seven children 5 to 15 years old had ''irregular'' radiographic features of the ischiopubic synchondrosis in their series.…”

Osteocondrite de Van Neck-Odelberg: relato de 4 casos

“…Outras teorias, assim como para outras osteocondrites, seriam o microtrauma (7) , alteração consequente a infecções de vias aéreas superiores (otite e amigdalite) (7) ou resposta ao estresse mecânico com a participação de mecanismos ativos, como os músculos adutores, os gê-meos e o iliopsoas, desencadeando esforços mecânicos de solicitação local (8,9) .…”

“…O diagnóstico geralmente é realizado mediante uma história clínica de dor no quadril, na região inguinal (7) ou lombar, e claudicação, e ao exame físico cuidadoso, dor à palpação do ramo descendente do pube, com ou sem aumento de volume local (7,10) .…”

“…O espasmo muscular dos adutores pode estar presente em vários graus de intensidade; a temperatura corporal pode estar normal ou discretamente elevada e pode haver ainda moderada leucocitose (7,10) .…”