Imaging of traumatic injuries of the paediatric pelvis and hip

Evangelia E. Vassalou, Apostolos H Karantanas, Maria Raissaki


Trauma to the paediatric hip and pelvis may cause a diverse group of acute and chronic traumatic conditions characterised by significant variations in incidence and severity. Knowledge of the morphologic and biomechanical peculiarities of the developing pelvis constitutes an essential background for understanding paediatric pelvic trauma. Imaging studies should follow a thorough clinical examination and clearly play an integral role in the assessment and management of pelvic injuries in children. The choice of the most appropriate imaging modality and accurate interpretation of imaging findings are crucial for reaching the correct diagnosis without delaying management. This pictorial essay focuses on the various causes of trauma-related hip and pelvic pain in the paediatric population. Special attention is given on pathophysiologic mechanisms, appropriate imaging work-up and imaging findings indicative of various types of this diverse group of injuries.


pelvic injuries; hip injuries; childhood; sports injuries/imaging; trauma

Full Text:



Marmor M, Elson J, Mikhail C, et al. Short-term pelvic fracture outcomes in adolescents differ from children and adults in the National Trauma Data Bank. J Child Orthop 2015; 9(1): 65-75.

Gänsslen A, Heidari N, Weinberg AM. Fractures of the pelvis in children: a review of the literature. Eur J Orthop Surg Traumatol 2013; 23(8): 847-861.

Boyd KT, Peirce NS, Batt ME. Common hip injuries in sports. Sports Med 1997; 24(4): 273-288.

Caine D, DiFiori J, Maffulli N. Physeal injuries in children’s and youth sports: reasons for concern? Br J Sports Med 2006; 40(9): 749-760.

Palmer WE, Kuong SJ, Elmadbouh HM. MR imaging of myotendinous strain. AJR Am J Roentgenol 1999; 173(3): 703-709.

DeFrancesco CJ, Sankar WN. Traumatic pelvic fractures in children and adolescents. Semin Pediatr Surg 2017; 26(1): 27-35.

Parvaresh KC, Upasani VV, Bomar JD, et al. Secondary ossification center appearance and closure in the pelvis and proximal femur. J Pediatr Orthop 2018; 38(8): 418-423.

Portinaro NM, Murray DW, Benson MK. Microanatomy of the acetabular cavity and its relation to growth. J Bone Joint Surg Br 2001; 83(3): 377-383.

Panattoni GL, D’Amelio P, Di Stefano M, et al. Ossification centers of human femur. Calcif Tissue Int 2000; 66(4): 255-258.

Paranjape M, Cziger A, Katz K. Ossification of femoral head: Normal sonographic standards. J Pediatr Orthop 2002; 22(2): 217-218.

Flecker H. Time of appearance and fusion of ossification centers as observed by roentgenographic methods. AJR Am J Roentgenol 1942; 47:97-159.

Caffey J. The ischiopubic synchondrosis in healthy children: some normal roentgenologic findings. AJR Am J Roentgenol 1956; 76(3): 488-494.

Perez-Rossello JM, Connolly SA, Newton AW, et al. Pubic ramus radiolucencies in infants: the good, the bad, and the indeterminate. AJR Am J Roentgenol 2008; 190(6): 1481-1486.

Momiy JP, Clayton JL, Villalba H, et al. Pelvic fractures in children. Am Surg 2006; 72(10): 962-965.

Micheli LJ, Fehlandt AF Jr. Overuse injuries to tendons and apophyses in children and adolescents. Clin Sports Med 1992; 11(4): 713-726.

Schlickewei W, Keck T. Pelvic and acetabular fractures in childhood. Injury 2005; 36(Suppl 1): A57-63.

Spiguel L, Glynn L, Liu D, et al. Paediatric pelvic fractures: a marker for injury severity. Am Surg 2006; 72(6): 481-484.

Chia JP, Holland AJ, Little D, et al. Pelvic fractures and associated injuries in children. J Trauma 2004; 56(1): 83-88.

Rieger H, Brug E. Fractures of the pelvis in children. Clin Orthop Relat Res 1997; 336: 226-239.

Silber JS, Flynn JM, Koffler KM, et al. Analysis of the cause, classification, and associated injuries of 166 consecutive paediatric pelvic fractures. J Pediatr Orthop 2001; 21(4): 446-450.

Prendergast NC, deRoux SJ, Adsay NV. Non-accidental paediatric pelvic fracture: a case report. Pediatr Radiol 1998; 8(5): 344-346.

Amorosa LF, Kloen P, Helfet DL. High-energy paediatric pelvic and acetabular fractures. Orthop Clin North Am 2014; 45(4): 483-500.

Heeg M, de Ridder VA. Acetabular fractures in children and adolescents. Clin Orthop Relat Res 2000; 376: 80-86.

Torode I, Zieg D. Pelvic fractures in children. J Pediatr Orthop 1985; 5(1): 76-84.

Ismail N, Bellemare JF, Mollitt DL, et al. Death from pelvic fracture: children are different. J Pediatr Surg 1996; 31(1): 82-85.

Mosheiff R, Suchar A, Porat S, et al. The “crushed open pelvis” in children. Injury 1999; 30 Suppl 2: B14-18.

Tarman GJ, Kaplan GW, Lerman SL, et al. Lower genitourinary injury and pelvic fractures in paediatric patients. Urology 2002; 59(1): 123-126.

Bucholz, Ezaki M, Ogden JA. Injury to the acetabular triradiate physeal cartilage. J Bone Joint Surg Am 1982; 64(4): 600-609.

Bent MA, Hennrikus WL, Latorre JE, et al. Role of computed tomography in the classification of paediatric pelvic fractures-revisited. J Orthop Trauma 2017; 31(7): e200-e204.

Guillamondegui OD, Mahboubi S, Stafford PW, et al. The utility of the pelvic radiograph in the assessment of paediatric pelvic fractures. J Trauma 2003; 55(2): 236-239.

Burgess AR, Eastridge BJ, Young JW, et al. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma 1990; 30(7): 848-856.

Schwarz N, Posch E, Mayr J, et al. Long-term results of unstable pelvic ring fractures in children. Injury 1998; 29(6): 431-433.

Rubel IF, Kloen P, Potter HG, et al. MRI assessment of the posterior acetabular wall fracture in traumatic dislocation of the hip in children. Pediatr Radiol 2002; 32(6): 435-439.

Boardman MJ, Herman MJ, Buck B, et al. Hip fractures in children. J Am Acad Orthop Surg 2009; 17(3): 162-173.

Beaty JH. Fractures of the hip in children. Orthop Clin North Am 2006; 37(2): 223-232.

Herrera-Soto JA, Price CT. Traumatic hip dislocations in children and adolescents: pitfalls and complications. J Am Acad Orthop Surg 2009; 17(1): 15-21.

Moon ES, Mehlman CT. Risk factors for avascular necrosis after femoral neck fractures in children: 25 Cincinnati cases and meta-analysis of 360 cases. J Orthop Trauma 2006; 20(5): 323-329.

Canale ST: Fractures of the hip in children and adolescents. Orthop Clin N Am 1990; 21(2): 341-352.

Laor T, Crawford AH. Idiopathic chondrolysis of the hip in children: early MRI findings. AJR Am J Roetgnenol 2009; 192(2): 526-531.

Jones DH. Shenton’s line. J Bone Joint Surg Br 2010; 92(9): 1312-1315.

Herring JA, McCarthy RE: Fracture dislocations of the capital femoral epiphysis. Instructional Case. J Pediatr Orthop 1986; 6(1): 112-114.

Poggi JJ, Callaghan JJ, Spritzer CE, et al. Changes on magnetic resonance images after traumatic hip dislocation. Clin Orthop Relat Res 1995; 319: 249-259.

Boyd KT, Peirce NS, Batt ME. Common hip injuries in sports. Sports Med 1997; 24(4): 273-288.

Stevens MA, El-Khoury GY, Kathol MH, et al. Imaging features of avulsion injuries. Radiographics 1999; 19(3): 655-672.

Rossi F, Dragoni S. Acute avulsion fractures of the pelvis in adolescent competitive athletes. Skeletal Radiol 2001; 30(3): 127-131.

Theologis TN, Epps H, Latz K, et al. Isolated fractures of the lesser trochanter in children. Injury 1997; 28(5-6): 363-364.

Lazović D, Wegner U, Peters G, et al. Ultrasound for diagnosis of apophyseal injuries. Knee Surg Sports Traumatol Arthrosc 1996; 3(4): 234-237.

Schneider R, Kaye JJ, Ghelman B. Adductor avulsive injuries near the symphysis pubis. Radiology 1976; 120(3): 567-569.

Loder RT, Starnes T, Dikos G, et al. Demographic predictors of severity of stable slipped capital femoral epiphysis. J Bone Joint Surg Am 2006; 88(1): 97-105.

Boles CA, el-Khoury GY. Slipped capital femoral epiphysis. Radiographics 1997; 17(4): 809-823.

Mirkopulos N, Weiner DS, Askew M. The evolving slope of the proximal femoral growth plate relationship to slipped capital femoral epiphysis. J Pediatr Orthop 1988; 8(3): 268-273.

Causey AL, Smith ER, Donaldson JJ, et al. Missed slipped capital femoral epiphysis: illustrative cases and a review. J Emerg Med 1995; 13(2): 175-189.

Klein A, Joplin RJ, Reidy JA, et al. Roentgenographic features of slipped capital femoral epiphysis. AJR Am J Roentgenol 1951; 66(3): 361-373.

Dwek J. The hip: MR Imaging of uniquely paediatric disorders. Magn Reson Imaging Clin N Am 2009; 17(3): 509-520.

Steinbach L, Fleckenstein J, Mink J. MR Imaging of muscle injuries. Semin Musculoskelet Radiol 1998; 1: 128-141.

Lee JC, Healy J. Sonography of lower limb muscle injury. AJR Am J Roentgenol 2004; 182(2): 341-351.

Fornage BD. The case for ultrasound of muscles and tendons. Semin Musculoskelet Radiol 2000; 4(4): 375-390.

Kransdorf MJ, Meis JM, Jelinek JS. Myositis ossificans: MR appearance with radiologic-pathologic correlation. AJR Am J Roentgenol 1991; 157(6): 1243-1248.

Raissaki M, Apostolaki E, Karantanas AH. Imaging of sports injuries in children and adolescents. Eur J Radiol 2007; 62(1): 86-96.

Brandser EA, El-Khoury GY, Kathol MH. Adolescent hamstring avulsions that simulate tumors. Emerg Radiol 1995; 2: 273-278.

Anderson MW, Greenspan A. Stress fractures. Radiology 1996; 199(1): 1-12.

Jaimes C, Jimenez M, Shabshin N, et al. Taking the stress out of evaluating stress injuries in children. Radiographics 2012; 32(2): 537-555.

Williams TR, Puckett ML, Denison G, et al. Acetabular stress fractures in military endurance athletes and recruits: incidence and MRI and scintigraphic findings. Skeletal Radiol 2002; 31(5): 277-281.

Fottner A, Baur-Melnyk A, Birkenmaier C, et al. Stress fractures presenting as tumours: a retrospective analysis of 22 cases. Int Orthop 2009; 33(2): 489-492.

Leffers D, Collins L. An overview of the use of bone scintigraphy in sports medicine. Sports Med Arthrosc 2009; 17(1): 21-24.

Sanchez TR, Jadhav SP, Swischuk LE. MR imaging of paediatric trauma. Magn Reson Imaging Clin N Am 2009; 17(3): 439-450.

Pathy R, Sink EL. Femoroacetabular impingement in children and adolescents. Curr Opin Pediatr 2016; 28(1): 68-78.

Ganz R, Parvizi J, Beck M, et al. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 2003; 417: 112-120.

Kolo FC, Charbonnier C, Pfirrmann CW, et al. Extreme hip motion in professional ballet dancers: dynamic and morphological evaluation based on magnetic resonance imaging. Skeletal Radiol 2013; 42(5): 689-698.

Mayer SW, Abdo JC, Hill MK, et al. Femoroacetabular impingement is associated with sports-related posterior hip instability in adolescents: A matched-cohort study. Am J Sports Med 2016; 44(9): 2299-2303.

Leunig M, Fraitzl CR, Ganz R. Early damage to the acetabular cartilage in slipped capital femoral epiphysis. Therapeutic consequences. Der Orthopade 2002; 31(9): 894-899.

Eijer H, Podeszwa DA, Ganz R, et al. Evaluation and treatment of young adults with femoro-acetabular impingement secondary to Perthes’ disease. Hip Int 2006; 16(4): 273-280.

Agricola R, Heijboer MP, Ginai AZ, et al. A cam deformity is gradually acquired during skeletal maturation in adolescent and young male soccer players: a prospective study with minimum 2-year follow-up. Am J Sports Med 2014; 42(4): 798-806.

Sutter R, Dietrich TJ, Zingg PO, et al. Femoral antetorsion: comparing asymptomatic volunteers and patients with femoroacetabular impingement. Radiology 2012; 263(2): 475-483.

Tannast M, Siebenrock KA, Anderson SE. Femoroacetabular impingement: radiographic diagnosis--what the radiologist should know. AJR American Journal of Roentgenol 2007; 188(6): 1540-1552.

Pfirrmann CW, Mengiardi B, Dora C, et al. Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology 2006; 240(3): 778-785.

Anderson LA, Gililland J, Pelt C, et al. Center edge angle measurement for hip preservation surgery: technique and caveats. Orthopedics 2011; 34(2): 86.

Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum. A cause of hip pain. J Bone Joint Surg Br 1999; 81(2): 281-288.

Leunig M, Beck M, Kalhor M, et al. Fibrocystic changes at anterosuperior femoral neck: prevalence in hips with femoroacetabular impingement. Radiology 2005; 236(1): 237-246.

Pfirrmann CW, Duc SR, Zanetti M, et al. MR arthrography of acetabular cartilage delamination in femoroacetabular cam impingement. Radiology 2008; 249(1): 236-241.

Kassarjian A, Yoon LS, Belzile E, et al. Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement. Radiology 2005; 236(2): 588-592.

Torriani M, Souto SC, Thomas BJ, et al. Ischiofemoral impingement syndrome: an entity with hip pain and abnormalities of the quadratus femoris muscle. AJR Am J Roentgenol 2009; 193(1): 186-190.

Tosun O, Algin O, Yalcin N, et al. Ischiofemoral impingement: evaluation with new MRI parameters and assessment of their reliability. Skeletal Radiol 2012; 41(5): 575-587.

Bredella MA, Azevedo DC, Oliveira AL, et al. Pelvic morphology in ischiofemoral impingement. Skeletal Radiol 2015; 44(2): 249-253.

Viala P, Vanel D, Larbi A, et al. Bilateral ischiofemoral impingement in a patient with hereditary multiple exostoses. Skeletal Radiol 2012; 41(12): 1637-1640.

Hayat Z, Konan S, Pollock R. Ischiofemoral impingement resulting from a chronic avulsion injury of the hamstrings. BMJ case reports 2014; 2014.

Patti JW, Ouellette H, Bredella MA, et al. Impingement of lesser trochanter on ischium as a potential cause for hip pain. Skeletal Radiol 2008; 37(10): 939-941.

Kassarjian A, Tomas X, Cerezal L, et al. MRI of the quadratus femoris muscle: anatomic considerations and pathologic lesions. AJR Am J Roentgenol 2011; 197(1): 170-174.

Allen WC, Cope R. Coxa Saltans: The snapping hip revisited. J Am Acad Orthop Surg 1995; 3(5): 303-308.

Winston P, Awan R, Cassidy JD, et al. Clinical examination and ultrasound of self-reported snapping hip syndrome in elite ballet dancers. Am J Sports Med 2007; 35(1): 118-126.

Katz LD, Haims A, Medvecky M, et al. Symptomatic hip plica: MR arthrographic and arthroscopic correlation. Skeletal Radiol 2010; 39(12): 1255-1258.

Papavasiliou A, Siatras T, Bintoudi A, et al. The gymnasts’ hip and groin: a magnetic resonance imaging study in asymptomatic elite athletes. Skeletal Radiol 2014; 43(8): 1071-1077.

Klontzas ME, Karantanas AH. Greater trochanter pain syndrome: a descriptive MR imaging study. Eur J Radiol 2014; 83(10): 1850-1855.

Deslandes M, Guillin R, Cardinal E, et al. The snapping iliopsoas tendon: new mechanisms using dynamic sonography. AJR Am J Roentgenol 2008; 190(3): 576-581.

Pelsser V, Cardinal E, Hobden R, et al. Extraarticular snapping hip: sonographic findings. AJR Am J Roentgenol 2001; 176(1): 67-73.

Flynn JM, Widmann RF. The limping child: evaluation and diagnosis. J Am Acad Orthop Surg 2001; 9(2): 89-98.

Ruggieri P, Angelini A, Montalti M, et al. Tumours and tumour-like lesions of the hip in the paediatric age: a review of the Rizzoli experience. Hip Int 2009; 19(6): S35-45.

Khanna G, Sato TS, Ferguson P. Imaging of chronic recurrent multifocal osteomyelitis. Radiographics 2009; 29(4): 1159-1177.


  • There are currently no refbacks.