In these situations, a surgical procedure known as a. may be used. We could show that assessing the femoral necks orientation alone underestimates the degree of external rotation subsequent to displacement of the epiphysis by 13 9 (Table 4). Methods: This condition can affect patients of all ages and leads to abnormal stress in the low back, hip and knee, as well as an abnormal gait (walking stance). The I-bars represent the corresponding 95% CI. , and. Fifty-one percent (40 of 79) of patients presented with severe SCFE based on the head-shaft angle described by Southwick [40] (< 30 mild, 30 to 60 moderate, and > 60 severe) measured on preoperative frog-leg lateral views. Balakumar B, Flatt E, Madan S. Moderate and severe SCFE (slipped capital femoral epiphysis) arthroscopic osteoplasty vs open neck osteotomy-a retrospective analysis of results. One radiology resident (FS) with 6 years of experience in hip imaging measured femoral version bilaterally using five previously described methods (Table 1). A turning or tilting backward. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. However, in some cases, this may be difficult to identify, especially if femoral retroversion is combined with a separate rotation deformity such as tibial torsion. Limb Lengthening and Complex Reconstruction Service
Retrotorsion is a pathologic decrease in the torsion angle; ie it is less than 8 degrees. To rule out any subsequent SCFE of the contralateral hip, we further assessed the status of the femoral growth plate at the time of CT and at latest follow-up. Akiyama M, Nakashima Y, Kitano T, et al. However, in some cases, this may be difficult to identify, especially if femoral retroversion is combined with a separate rotation deformity such as tibial torsion. Kiapour AM, Kiapour A, Maranho DA, Kim Y-J, Novais EN. This condition can affect patients of all ages and leads to abnormal stress in the low back, hip and knee and abnormal gait. A subset of patients was measured twice by the first observer and by a second orthopaedic resident (2 years of experience) to assess intraobserver reproducibility and interobserver reliability; for this assessment, we used intraclass correlation coefficients. 2020;14:98-105. The minimum slice thickness was 2 mm. He may also order an. 38. Wylie JD, McClincy MP, Uppal N, et al. Clin Orthop Relat Res. A preoperative 3D-CT-scan was performed for 3D simulation of hip impingement ( Fig. These methods differ regarding the definition of the second reference point to determine the proximal reference line (Table 2). Email is the best way to reach out for an appointment. Millis MB. (1) Do femoral version and the prevalence of femoral retroversion differ between hips with SCFE and the asymptomatic contralateral side? Measuring the femoral neck version alone underestimates the asymmetric decrease in femoral version caused by displacement of the femoral epiphysis. Conclusion Femoral antetorsion can be measured rapidly and with good reproducibility with MR imaging. 2018 Apr;476(4):890-899. doi: 10.1007/s11999.0000000000000127. 2012;28:965-971. Femoral retroversion (also known as hip retroversion) is a rotational or torsional deformity in which the femur (thighbone) twists backward (outward) in relation to the knee. The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. The Lisbon agreement on femoroacetabular impingement imaging-part 1: overview. Symptoms of femoral retroversion may include: If femoral retroversion is suspected, a doctor will do a physical examination of the legs and hips in addition to a thorough medical, developmental and family history. The condition is usually congenital, meaning children are born with it. femoral retroversion (___ degrees), femoral retroversion (physical finding), femoral retroversion, Femoral retroversion. [35]; range, -53 to 15) to 100 (Murphy et al. Reduced femoral neck version is more common in adolescents with obesity than in those without obesity [14]. Femoral retroversion is also often called hip retroversion. Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. [19] and Tomczak et al. Initial diagnosis of unilateral SCFE was based on an absence of radiographic signs of SCFE and of pain at clinical examination. Careers. Journal of Clinical Medicine. You may be trying to access this site from a secured browser on the server. 212-606-1415| 212-606-1550| 212-606-1637 | 212-606-1097. Interrater reliability was assessed across raters using an ICC (2,2) model and intrarater reliability was assessed using an ICC (3,1) model [39]. Finite-element studies have demonstrated that shear forces across the capital femoral physis increase with reduced femoral anteversion and increased BMI [13, 33]. Novais EN, Hosseinzadeh S, Emami SA, Maranho DA, Kim YJ, Kiapour AM. This study has several limitations. Femoral retroversion causes hip impingement, similar to the impingement and posterior instability that occurs in total hip arthroplasty. (1) Do femoral version and the prevalence of femoral retroversion differ between hips with SCFE and the asymptomatic contralateral side? Hip/Femoral Anteversion: Causes, Symptoms, Treatment There are 2 types of femoral version: Femoral Anteversion; Femoral Retroversion AR is associated with changes in load transmission across the hip, being a risk factor for early osteoarthrosis. Despite increasing evidence that SCFE reflects a rotation of the femoral epiphysis around the epiphyseal tubercle leading to femoral retroversion [23], femoral version has rarely been reported, and the prevalence and degree of femoral retroversion is currently unknown in this population. The mean age was 15 4 years, 48% (38 of 79) of the patients were male, and 56% (44 of 79) were obese (defined as a BMI > 95th percentile (mean BMI 34 9 kg/m2). Clinical outcomes after arthroscopic psoas lengthening: the effect of femoral version. 2002;2:8. P1BEP3_181643, CHF 46000. 3). 37. The mean age at the time of CT was 15 4 years. In some cases, hip/femoral retroversion may be combined with a separate torsional deformity, such as a rotation in the tibia. Varus derotation intertrochanteric osteotomy with femoral retroversion. References 1 article features images from this case Czech. Because the lower part of the femur is connected to the knee, this also means that the knee is twisted outward relative to the hip. One radiology resident (6 years of experience) measured femoral version of the entire study group using five different methods. After applying prespecified inclusion and exclusion criteria, we included 79 patients. femoroacetabular impingement. Most proximally (Lee et al. femoral retroversion synonyms, femoral retroversion pronunciation, femoral retroversion translation, English dictionary definition of femoral retroversion. 2019;43:2375-2382. This could theoretically affect anatomic landmark selection for femoral version measurements and corresponding femoral version angles. Thus, this should not jeopardize the results of our study to a relevant degree. Mascarenhas VV, Castro MO, Rego PA, et al. A pathological increase in angle of torsion is called femoral anteversion, and a pathological decrease in the angle or reversal of torsion is known as femoral retroversion. 4. to -22 13 (95% CI -25 to -19; p < 0.001) according to the method of Murphy et al. This position keeps the femoral head within the socket which minimizes pain. The mean femoral neck version was lower in hips with SCFE than in the contralateral side (-2 13 versus 7 11; p < 0.001). Femoral anteversion is a medical condition in which the neck of femur bone leans forward as compared to the rest of the femur. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Montgomery AA, Graham A, Evans PH, Fahey T. Inter-rater agreement in the scoring of abstracts submitted to a primary care research conference. This graph shows a comparison of the different methods to measure femoral version for hips with SCFE and contralateral hips. Doing so may better inform surgeons as they contemplate when to use isolated offset correction or perform an addional femoral osteotomy for SCFE correction based on the severity of the slip and the rotational deformity. Psychol Bull. (47% [95% CI 36% to 58%] and 60% [95% CI 49% to 71%], respectively [all p < 0.001]). The patient is a 19-year-old female who was born with a dislocated right hip. (2) These formulae facilitate preparation of computer programs and tables for the routine clinical determination of the anteversion and cervico-diaphyseal angles. 2020:296:381-390. 5, 9, 11 It is diagnosed when the feet of a prewalking child are . New York, NY 10021
CORR Insights: How Common Is Femoral Retroversion and How Is it Affected by Different Measurement Methods in Unilateral Slipped Capital Femoral Epiphysis? This yielded a mean side-by side difference of -8 11 (95% CI -11 to -6; p < 0.001) and a higher prevalence of femoral retroversion in hips with SCFE (58% [95% CI 47% to 69%]; p < 0.001) than on the contralateral side (29% [95% CI 19% to 39%]). J Pediatr Orthop B. Since the range of femoral version angles is wide, no general prediction regarding the degree of rotational deformity can be made on an individual basis. [44]: 0 13 and Murphy et al. [18] reported normal femoral neck version of 8.8 9.7 in 328 hips without radiographic signs of osteoarthritis. Thus, we compared femoral version angles and the prevalence of femoral retroversion in hips with SCFE with the unaffected contralateral side and among different measurement techniques. This procedure may be done for children over age 10 and adults and has a quick and reliable recovery. The mean femoral neck version was lower on the SCFE side than on the contralateral side (-2 13 versus 7 11; p < 0.001) (Table 3). . After applying prespecified inclusion and exclusion criteria, we included 79 patients. You may notice that your child is walking with the toes turned inward. Fourth, although we compared our observations in SCFE hips with the unaffected contralateral side, we note that these hips may not reflect a normal population. In many cases, the abnormal rotation of the femur develops while the fetus is growing in the womb. Further measurement methods included the femoral heads center and differed regarding the level of landmarks for the proximal femoral reference axis. These differences between hips with SCFE and the contralateral side were higher and ranged from -17 11 (95% CI -20 to -15; p < 0.001) based on the method of Tomczak et al. This yielded a mean side-by-side difference of -8 11 (95% CI -11 to -6; p < 0.001) and a higher prevalence of femoral retroversion on the SCFE side of 58% (95% CI 47% to 69%) than on the contralateral side (29% [95% CI 19% to 39%]; p < 0.001) (Table 3). The hip joint is where the femoral head (the top of the femur) meets the pelvis. 45. The doctor will also observe the patients gait (manner of walking) to look for signs of out-toeing or gait compensation. Using the four alternative measurement techniques that are based on the center of the femoral head as a proximal reference, the mean differences between the affected and contralateral side were higher. J Pediatr Orthop. We also compared isolated femoral neck version with aligning the orientation of the femoral neck with the femoral head center to define the proximal reference, as described by Reikers et al. All measurement methods are based on true axial images and a line connecting the femoral condyles as the distal reference axis. Eur Radiol. Medial joint line: medial meniscus, medial femoral condyle, and tibial and femoral insertions of the medial collateral ligament (MCL). FOIA Various methods to measure femoral version have been described that differ regarding the selection of anatomic landmarks to define the proximal reference axis [19, 30, 35, 36, 44]. First, we included patients who had previous in situ fixation and presented with a symptomatic SCFE deformity as well as patients who had not undergone any surgical treatment for SCFE. 44. To facilitate communication among physicians and for the design of future studies, we recommend consistently reporting the applied measurement technique. Interobserver reliability and intraobserver reproducibility were high (ICC values > 0.80) for all five measurement methods (Table 6). Femoral anteversion causes the child's knees and feet to turn inward, or have what is also known as a "pigeon-toed" appearance. Before Out-toeing is the common name used for a condition known as femoral retroversion. Please try after some time. In other words the knee is excessively twisted inward relative to the hip. Seventy-two percent of the patients in our cohort were overweight or obese. The remaining four measurement methods use the femoral heads center as the most proximal reference.
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