Normal Radiographic Values for Cartilage Thickness and Physeal Angle in the Pediatric Hip

Abstract

Ninety-three standing anteroposterior (AP) pelvis roentgenograms in 87 patients were measured for a total of 186 normal hips in children aged 1-17 years. For each hip, the physeal angle relative to the floor, the physeal angle relative to the pelvis, the cartilage thickness perpendicular to the floor, and the cartilage thickness perpendicular to the physis were measured and recorded. The physeal angle varied from ages 1-7 years, stabilizing at age 8 at a mean of 23 degrees . Physeal angle is best measured relative to the floor because pelvic obliquity introduces significant variability to the measurements. Cartilage thickness ("joint space") declined after age 7 years, with measurements in three statistically distinct groups. There was a statistically significant difference between cartilage-thickness measurements of boys versus girls, with girls showing a slightly smaller cartilage thickness than boys. Cartilage thickness measured perpendicular to the floor was not statistically significantly different from that measured perpendicular to the physis. We describe and recommend standard measurement techniques for physeal angle and cartilage thickness. These established normal values may be helpful in the diagnosis and evaluation of coxa vara and chondrolysis, and in identifying the head at risk for slipped capital femoral epiphysis or Legg-Calvé-Perthes disease.

Magnetic resonance imaging is the preferred method to assess treatment-related skeletal changes in children with brain tumors

“…Because of evidence of altered skeletalgenesis demonstrated in preclinical models using VEGF‐targeted therapies , we prospectively monitored our patients for cartilaginous growth plate abnormalities using both knee radiographs and MRI. We found changes in growth plates to be uncommon after the use of vandetanib with and without dasatinib.…”

“…These are normal structures in newborns providing nutritional support to the cartilaginous femoral head via an extensive network of blood vessels throughout the cartilaginous femoral head . These canals gradually regress and eventually disappear as the secondary center of ossification which becomes the femoral head enlarges and the articular cartilage thickens . Thus far, the exact point of maturation at which these canals disappear is uncertain.…”

Avaliação radiográfica na epifisiolise: possíveis preditores de bilateralidade?

“…5,21,22 The second hypothesis is that the patients have hips with slight anatomical alterations, which can increase the risk of epiphysiolysis, and these alterations can be detected by measuring angles in simple radiographs. 6,9,10,15 …”

“…The parameters of comparison between the groups were: skeletal maturity, based on the situation of the ossification centers of the pelvis and of the proximal femoral region (Oxford method); 18 Southwick angle (AP and Lauenstein); 6,7 and posterior sloping angle of the proximal physis of the femur (or physeal angle, in the AP view) 9 and posterior sloping angle of the proximal physis of the femur (Lauenstein). 15 …”

“…Subsequent studies determined the Southwick angle found in normal children. 6,8 The physeal angle (evaluated in relation to the ground), correlated with the risk of epiphysiolysis, 9-11 is also helpful in the characterization of congenital coxa vara. 12-14 In the lateral view, the posterior sloping angle may be related to the risk of bilaterality.…”