The neonatal ilium-metaphyseal drivers and vascular passengers

At birth the newborn is equipped with a developing locomotor apparatus, which will ultimately become involved in load transfer from the period when the child adopts a sitting posture through to the attainment of a bipedal gait. This load transfer has been considered to influence trabecular bone structural organization by setting up forces, which remodel the internal architecture into a functionally optimized form. However, during the neonatal developmental period the locomotor apparatus is nonweight bearing and instead only supports reflexive movements. Surprisingly, a structural organization has been identified within the internal trabecular architecture and external cortical morphology of the neonatal ilium, which appears to mimic the structural composition of the more mature bone. This study aims to build upon previous qualitative and quantitative investigation of this apparently precocious patterning by further examining structural data obtained from selected volumes of interest within the ilium. Analysis has revealed statistically significant differences in regional trabecular and cortical bone characteristics, which have formed the basis of a possible growth model for the ilium. Volumetric comparison has demonstrated the presence of three progressive "growth regions" and three "restricted growth regions," which appear to relate to metaphyseal and nonmetaphyseal borders of the ilium. Therefore, the structural data and statistical analysis presented in this study challenge the current concept of implied centrifugal ossification within the human ilium and present evidence of an alternative pattern of ossification that is largely dictated and controlled by vascular distribution and growth plate position.