Van Neck-Odelberg disease: A rare cause of pain in pediatric pelvis

van Neck-Odelberg disease: a common but poorly known and often misdiagnosed condition

van Neck-Odelberg disease, a condition involving the ischiopubic synchondrosis in children, is a commonly encountered but poorly known ailment, which is now considered a normal variant. Symptoms can include pain, discomfort, and fever, leading to van Neck-Odelberg disease often being discovered in the context of patients presenting with non-specific clinical manifestations. In this essay, we describe what is currently known about van Neck-Odelberg disease and illustrate the condition using images acquired from multiple patients, with some using multiple imaging techniques from the same patients. Awareness of van Neck-Odelberg disease is essential for radiologists who are involved in the treatment of children, as well as for paediatricians, to prevent misdiagnosis and unnecessary invasive procedures for what is a benign and self-resolving condition.

Van Neck-Odelberg Disease: A Rare Cause of Pediatric Hip Pain

Introduction

Synchondrosis ischiopubic syndrome (SIS), also known as Van Neck-Odelberg disease, is a benign skeletal abnormality in children due to delayed closure in the ischiopubic synchondrosis (IPS). Patients may present with vague groin, hip, or buttock pain that can cause limitation of hip movement or limp. Few descriptions of this disorder exist, and it can easily be mistaken for other pathologies, including stress fracture, osteomyelitis, or tumor.

Case Report

We report the case of a 9-year-old female gymnast presenting with right hip pain who was diagnosed with SIS. She was managed conservatively by the pediatric orthopedist.

Conclusion

Van Neck-Odelberg disease is a rare cause of pediatric hip pain that can be mistaken for other more serious pathologies. The ability to recognize the disease early allows for effective treatment and the avoidance of unnecessary procedures.

Bilateral Van Neck-Odelberg Disease: A Case Report

Van Neck-Odelberg disease, also known as ischiopubic osteochondritis, is a rare cause of buttock or groin pain in the pediatric age group. The challenge in its diagnosis is due to its radiologic similarity. Ischiopubic synchondrosis occurs in childhood and is seen before the fusion of the pubis and ischium. With the advancement of age toward skeletal maturity, ischiopubic synchondrosis reduces in size and gradually vanishes due to synostosis or bony union. Here, we report the case of a 13-year-old girl who came to our outpatient department with complaints of bilateral groin pain for one year. After a thorough evaluation, she was diagnosed with a case of bilateral Van Neck-Odelberg disease, or ischiopubic osteochondritis, and conservative management was planned. Closure of ischiopubic synchondrosis varies with age and is usually finished before puberty. In a typical scenario, such fusion of the pubis and ischium does not lead to any clinical symptoms. However, in a few instances, children may experience some pain in the groin, hip, or gluteal region, which results in restricted movements at the hip joint and can lead to limping while walking. Van Neck-Odelberg disease is rare in children, causing pain in the groin region. As it is a rare condition, diagnosis is often missed. The radiological appearance suggests many differential diagnoses, such as a stress fracture, neoplasm, or infection. Prompt diagnosis and treatment can relieve the symptoms.

OSTEOCHONDROSES IN CHILDREN'S SPORTS PRACTICE - A RARE CASE OF VAN NECK-ODELBERG DISEASE

Background

Osteochondroses are a set of conditions concerning the ossification of the developing bone. Higher intensity in sports activities can increase its occurrence in children. There is no consensus on its etiology, with multiple factors being involved. Van Neck-Odelberg disease is a rare osteochondrosis located in ischiopubic synchondrosis. Treatment is mainly conservative, with activity suspension. Addressing and correcting the predisposing factors is crucial to these injuries.

Case report

We present a case of a 6-year-old futsal player who experienced mechanical inguinal moderate pain during sports practice. After performing physical examination, laboratory tests, and radiographic evaluation, the patient was diagnosed with Van Neck-Odelberg disease. Sports activities were suspended while a conservative treatment was performed, with subsequent follow-up over 3.5 years. No symptom recurrence was reported.

Conclusion

Increased intensity of sports activities is associated with overuse injuries in children, especially before completing the ossification process. Preventive measures must remain the primary concern in children's sports practice.

Osteochondritis Lesions of the Ischiopubic Area in Young Adolescents

Osteochondritis of the ischiopubic area is a rare disease of children that presents with hip pain and limping. Careful examination and appropriate investigations are essential to establish a definite diagnosis. We report a case series of four children, ages 10–14-year-old, with osteochondritis of the ischiopubic area. Plain X-ray examination showed an area of diffuse irregular calcification of the ischium in two of the children, while in the other two there was an asymmetrical enlargement of the ischiopubic synchondrosis. MRI investigation was the most helpful examination. Bone edema was found in all four children. A calcified mass separated from the host ischium was found in the first two children. The cortex was normal, without irregular destruction. Bone edema of both the ischium and pubic alongside the synchondrosis was found in the following two children, with intact cortices and asymmetrical enlargement. Osteochondritis lesions of the ischium and the ischiopubic area have radiological findings similar to several severe diseases. Bone edema on MRI investigation in children must be properly evaluated. Appropriate radiological examination enabled us to confirm the diagnosis of the osteochondritis and to avoid unnecessary procedures. We want to draw attention to the rare diagnosis of osteochondritis of the ischiopubic area, and the clinical significance, as a cause of hip pain and limping in children.