Traumatic disruption of the acetabular triradiate physeal cartilage is
an infrequent injury. When it occurs during adolescence, subsequent growth
changes in acetabular morphology and congruency of the hip joint are
unlikely. However, in younger children, especially those who are less than
ten years old, acetabular growth abnormality is a frequent complication of
this injury and may result in a shallow acetabulum similar to that seen in
patients with congenital disease of the hip. By the time of skeletal
maturity, disparate growth increases the incongruency of the hip joint and
may lead to progressively more severe subluxation of the hip. Acetabular
reconstruction may be necessary to correct the gradual subluxation of the
femoral head. Variable irregularities of growth at the proximal end of the
femur also may occur. In this series, nine patients with triradiate
physeal-cartilage injury were classified according to the degree of
displacement and the probable type of growth-plate disruption. Two main
patterns of injury occurred. The first was a shearing type-1 or 2
growth-mechanism injury, with central displacement of the distal portion of
the acetabulum. This injury pattern seems to have a favorable prognosis for
continued normal acetabular growth, although premature closure of the
triradiate physes may occur. The other pattern appeared to be a crushing
type-5 growth-mechanism injury. This type has a poor prognosis, with
premature closure of the triradiate physes occurring secondary to the
formation of a medial osseous bridge. In either pattern, the prognosis is
dependent on the age of the patient at the time of injury and on the extent
of chondro-osseous disruption.