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

Assessing the fusion of the ischiopubic synchondrosis using predictive modeling

“…The ischiopubic ramus is an important attachment site for the hip adductor muscles including the adductor magnus, adductor brevis and gracilis (Moore, ), therefore the location of the IPS means that it is susceptible to mechanical stress arising from muscle strain and local loading patterns during physical activity (largely hip adduction and hip flexion) (Herneth et al, ). Herneth et al () demonstrate that the incidence of unilateral enlarged IPS was consistently correlated with the non‐dominant limb in all children in their study where the higher stresses on the non‐dominant or standing limb may have delayed the finalization of fusion and resulted in the characteristic “fusiform” appearance reported in multiple reports of unilateral IPS enlargement (Beyitler and Kavukcu, ; Chaudhari et al, ; Iqbal et al, ; Macarini et al, ; Morse and Lin, ). However, Herneth's non‐dominant limb theory (Herneth et al, ) is not consistently supported by reported cases of unilateral IPS enlargement, where Beyitler and Kavukcu () report a single case of unilateral enlargement of the IPS in the dominant limb, and Morse and Lin () report a single case of unilateral enlargement of the IPS in the non‐dominant limb.…”

“…Herneth et al () demonstrate that the incidence of unilateral enlarged IPS was consistently correlated with the non‐dominant limb in all children in their study where the higher stresses on the non‐dominant or standing limb may have delayed the finalization of fusion and resulted in the characteristic “fusiform” appearance reported in multiple reports of unilateral IPS enlargement (Beyitler and Kavukcu, ; Chaudhari et al, ; Iqbal et al, ; Macarini et al, ; Morse and Lin, ). However, Herneth's non‐dominant limb theory (Herneth et al, ) is not consistently supported by reported cases of unilateral IPS enlargement, where Beyitler and Kavukcu () report a single case of unilateral enlargement of the IPS in the dominant limb, and Morse and Lin () report a single case of unilateral enlargement of the IPS in the non‐dominant limb. Limb dominance was not recorded for the patients in our study, and therefore we cannot conclude whether the asymmetry present in our population was correlated with limb dominance.…”

“…The ischiopubic synchondrosis has been the topic of much clinical discussion due to the concomitant presentation of asymmetrical synchondrosis irregularities and clinical symptoms of inguinal and gluteal pain in children. This presents the clinician with a range of differential diagnoses including osteomyelitis, stress fracture, enchondroma, Ewings sarcoma, osteosarcoma, fibrous dysplasia, eosinophilic granuloma, bone cyst, or osteochondrosis (Morse and Lin, ) and may result in unnecessary invasive investigative surgery (Herneth et al, ) in the absence of an appreciation of the normal physiological presentation of ischiopubic fusion. The flaring or enlargement of the synchondrosis often associated with fusion is a benign physiological process, however has been described as a “disease” by Odelberg and Van Neck independently in 1923 and 1924, respectively, coining the term Van Neck–Odelberg disease or ischio‐pubic osteochondritis (Herneth et al, ).…”

“…Therefore, the range of variation displayed by the IPS as evidenced in our study and its mimicry of a number of serious pathological conditions when presenting unilaterally, presents a serious clinical dilemma in pediatric practice. Whilst in most cases the appearance of a unilateral enlarged IPS is a typical non‐pathological feature of ischiopubic fusion, the clinician may be justified in requesting blood work (Kloiber et al, ) and/or histology (Morse and Lin, ) to confirm a diagnosis due to the severity of possible alternate diagnoses.…”

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

“…Although the VND in this case was most likely just an incidental finding, this case suggests that not all patients experience complete radiographic resolution of VND after skeletal maturation. Likewise, Morse and Lin ( 2016 ) have previously reported a VND case in a 17-year-old female patient with radiographic progression around the IPS during 4-month follow-up leading to a biopsy that confirmed the benign entity. We therefore conclude that physicians should be aware of VND as a possible differential diagnosis in adolescents and young adults, rather than just in prepubertal children.…”