Growth Disturbances and Morphologic Abnormalities of the Hip in Children Sarah D. Bixby Department of Radiology Boston Children’s Hospital Boston, MA 1 Overview • Radiographic techniques • Normal anatomy • Conditions characterized by growth disturbance – Acetabular dysplasia – FAI – Acetabular protrusio – Acetabular rim syndrome 2 Imaging the Painful Hip • Plain radiographs of pelvis and bilateral hips – 2 orthogonal views (AP and lateral) • Frog-leg • Cross-table • Dunn • False Profile 3 Lateral Hip Radiographs Frog-leg False Profile Dunn Cross-table 4 Lateral Hip Radiographs • Frog-leg: SCFE, LCP, femoral head lesions, screening • False Profile: DDH, Pincer impingement Frog FP • Cross-table: Femoral neck lesions and fractures • Dunn: Cam-type femoroacetabular impingement (FAI) Dunn CT 5 Femoral Head Coverage • Deficient coverage – Acetabular dysplasia • Instability • Excessive coverage – Acetabular protrusio – Pincer type (FAI) • Limited ROM Too little Too much 6 Femoral Head Coverage Too Little Too Much Steppacher SD et al. Osteoarthritis and Cart 2014;22:951-958 7 Anatomic Considerations 8 Proximal Femoral Physis 5 year old female 3 week old male 9 Femoral growth arrest lines 10