Relative overgrowth of the greater trochanter and trochanteric-pelvic impingement syndrome in children: causes and X-ray anatomical characteristics

Abstract

Background. The formation of multiplanar deformities of the proximal femur, in most cases combined with hypertrophy of the greater trochanter (relative overgrowth of the greater trochanter (ROGT)) and its high position relative to the femoral head, up to the development of pelvic and pelvic spine syndrome (trochanteric-pelvic impingement), has been considered one of the most common problems in the treatment of children with hip joint pathology of various etiologies.
 Aim. The aim of this study was to determine the causes of and characterize the X-ray anatomical changes in children with ROGT.
 Materials and methods. This study is based on an analysis of the survey results of 350 children 3 to 17 years old with an emerging high position of the greater trochanter due to various diseases of the hip joint. Details of the radiological indicators characterizing the change in the growth of the greater trochanter relative to the head and neck of the thigh were examined in 68 of these children (112 joints).
 Results. Most often, hypertrophy of the greater trochanter was observed in children with the sequele of ischemic disorders that occurred during the conservative treatment of hip dysplasia and developmental hip dislocation, as well as due to previous hematogenous osteomyelitis. It was revealed that in the affected hip joints, there was a regular decrease in the articulo-trochanteric distance index; simultaneously, TTD values, which characterize the isolated growth of the greater trochanter, were almost the same in normal and pathological conditions (p 0.05).
 Conclusion. Damage to the growth plates of the pineal gland and neck of the femur of various etiologies was the reason for ROGT formation. The X-ray anatomical changes include progressive shortening of the femoral neck. Moderately pronounced in preschool-age children, they progress with the childs growth and become the cause of chronic trauma injuries of the components of the hip joint.

Outcomes of the Greater Trochanter Epiphysiodesis in Treatment of Children with Hip Pathology

“…Later on, this leads to weakness of hip abductors and femoro-acetabular impingement. Clinically this will result in limping and hip pain [1] The most common causes of this development are hip dislocation and Perthes disease. Post septic hip, trauma, and problems such coxa vara in infants are less prevalent causes.…”

“…The femoral neck becomes short, thick and develops a varus deformity which may cause leg length discrepancy as a result of complete growth arrest. 1 In general, there are three surgical procedures for greater trochanter overgrowth management. By epiphyseodesis, lateral displacement of the greater trochanter, or a complex osteotomy including distal displacement of the greater trochanter with concomitant femoral neck lengthening.…”