An 11-year-old girl presented with a waddling gait and restricted abduction of both hips. A pelvic radiograph shows bilateral deepening of the acetabular cavity (Fig. 1). All other radiographs were normal. Syndromes like Marfan, Stickler, Beals, Kniest and Ehlers-Danlos were ruled out. Complete blood counts, calcium, phosphorus, alkaline phosphatase, rheumatoid factor and antinuclear antibodies were within normal limits.
Pelvic radiograph
A center-edge angle greater than 40° and medialization of the medial wall of the acetabulum past the ilioischial line are the diagnostic features for protrusio acetabulum in an anteroposterior pelvic radiograph [1]. The protrusio acetabulum is caused by a primary idiopathic disorder and secondary infectious, metabolic, inflammatory, traumatic, neoplastic and genetic disorders [2]. Primary protrusio acetabulum is common in females, bilaterally, and in adolescents. The triradiate cartilage closure is effective in reversing or stopping the protrusio before 10 years of age [1]. Early diagnosis and treatment reduce long-term disability and secondary osteoarthritis in patients.
References
Steel HH (1996) Protrusio acetabuli: its occurrence in the completely expressed Marfan syndrome and its musculoskeletal component and a procedure to arrest the course of protrusion in the growing pelvis. J Pediatr Orthop 16:704–718
Van De Velde S, Fillman R, Yandow S (2006) The aetiology of protrusio acetabuli. Literature review from 1824 to 2006. Acta Orthop Belg 72:524–529
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Shah, K., Shah, H. Primary protrusio acetabuli in childhood. Pediatr Radiol 40 (Suppl 1), 55 (2010). https://doi.org/10.1007/s00247-010-1871-8
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DOI: https://doi.org/10.1007/s00247-010-1871-8