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Secondary Ossification Center Appearance and Closure in the Pelvis and Proximal Femur

Parvaresh, Kevin C. MD*; Upasani, Vidyadhar V. MD*,†; Bomar, James D. MPH; Pennock, Andrew T. MD*,†

Journal of Pediatric Orthopaedics: September 2018 - Volume 38 - Issue 8 - p 418–423
doi: 10.1097/BPO.0000000000000836
Pelvis & Hip

Introduction: Variable ossification patterns of the pelvis in skeletally immature patients can make the interpretation of pelvic radiographs challenging. Inconsistencies among prior studies and lack of sex comparisons underscore the need for a more comprehensive characterization of the secondary ossification centers. This study evaluates the chronology and sex differences for appearance and closure of pelvic and proximal femoral secondary ossification centers using computed tomography (CT).

Methods: Patients who underwent abdominal and pelvic CT scans between January 2009 and December 2014 at 2 tertiary level 1 trauma centers were retrospectively reviewed. Patients between the ages of 2 and 32 years with adequate imaging of the pelvis and proximal femurs were included. Patients with a history of orthopaedic trauma or pathology affecting ossification were excluded. CT scans were assessed for the appearance and closure of the following secondary ossification centers: anterior inferior iliac spine (AIIS), anterior superior iliac spine (ASIS), femoral head (FH), greater trochanter (GT), iliac crest (IC), ischial tuberosity (IT), lesser trochanter (LT), posterior superior iliac spine (PSIS), symphysis pubis (SP), and triradiate cartilage (TRC). Basic descriptive statistics are reported.

Results: A total of 496 CT scans met inclusion criteria (240 males and 256 females). The order of appearance of the secondary ossification centers was: (male) GT, LT, AIIS, IT, ASIS, PSIS, IC, and SP; (female) GT, LT, IT, AIIS, PSIS, IC, ASIS, and SP. The order of closure was similar: (male) TRC, LT, FH, AIIS, GT, ASIS, PSIS, IT, IC, and SP; (female) LT, TRC, AIIS, FH, GT, ASIS, PSIS, IT, IC, and SP. Female ossification centers appeared ∼1 to 2 years before males in all locations. Female ossification centers closed ∼1 to 2 years before males in all locations except TRC, IC, and SP.

Conclusions: The appearance and closure of the pelvis and proximal femur secondary ossification centers follow a predictable pattern of development, occurring slightly earlier in females than males. Knowledge of more precise ages of development and sex differences better characterize this complex skeletal development. Future studies may use secondary ossification centers to further evaluate skeletal maturity, assess pediatric pathology, and aid surgical management.

Level of Evidence: Level III.

*Department of Orthopaedic Surgery, University of California

Department of Orthopaedic Surgery, Rady Children’s Hospital, San Diego, CA

Study conducted at Rady Children’s Hospital, San Diego.

No funding was received for this study.

The authors declare no conflicts of interest.

Reprints: Andrew T. Pennock, MD, Rady Children’s Hospital, 3030 Children’s Way, Suite 410, San Diego, CA 92123. E-mail:

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