(91% [95% CI 85% to 97%] and 84% [95% CI 76% to 92%], respectively) than for the distal measurement methods of Tomczak et al. Out-toeing or duck walk walking with the foot pointed outward instead of straight ahead, If the doctor suspects a femoral retroversion, he will conduct a physical examination of the legs and hips in addition to a thorough medical, developmental and family history. Since the range of femoral version angles was wide, femoral version cannot be predicted in a given hip and must be assessed individually. Z Orthop Ihre Grenzgeb. Example Sentences: (1) The measurement mean for anteversion among these specimens was 7.4 degrees with a range from -10.8 degrees (retroversion) to 22.1 degrees. Femoral retroversion can occur in one or both legs. If the individual also has a separate rotational bone deformity such as internal tibial torsion an inward rotation of the tibia (shinbone) then femoral retroversion becomes even more difficult to diagnose. (2) These formulae facilitate preparation of computer programs and tables for the routine clinical determination of the anteversion and cervico-diaphyseal angles. Case reports: acetabular damage after mild slipped capital femoral epiphysis. sharing sensitive information, make sure youre on a federal The patient is a 19-year-old female who was born with a dislocated right hip. In anatomy, the word "version" refers to the angle or rotation of all or part of an organ, bone or other structure in the body, relative to other structures in the body. Surgical dislocation in the management of pediatric and adolescent hip deformity. Clin Orthop Relat Res. What is femoral anteversion? Recognizing this impairment and its impact on a patient's function is . And if left untreated into adolescence, these abnormal femoral rotations can also contribute to the degeneration or arthritis of the hip. Schmaranzer, Florian MD, PhD; Kallini, Jennifer R. MD; Ferrer, Mariana G. MD; Miller, Patricia E. MSc; Wylie, James D. MD; Kim, Young-Jo MD, PhD; Novais, Eduardo N. MD, F. Schmaranzer, J. R. Kallini, M. G. Ferrer, P. E. Miller, J. D. Wylie, Y-J. Femoral retroversion is often a congenital condition, meaning it is present from birth and develops in the womb. From birth to 6 yrs. 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. and transmitted securely. Based on these findings, we believe it is worthwhile to add evaluation of femoral version to the diagnostic workup of children with SCFE. [35] (91% [95% CI 85% to 97%] and 84% [95% CI 76% to 92%], respectively) than for the distal measurement methods of Tomczak et al. to call, please leave a message and we will return your call. Previous studies only included the femoral neck version and not the center of the femoral head as a reference [15, 42]. 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. acetabulum - tends to be deformed in front, there may be eversion of the labrum, the bony + cartilaginous part of the acetabulum is broken, the dislocation is directed ventrally and proximally; neck of the femur - antetorsion associated with valgus, pressure change on the edge of the acetabulum to maintaining your privacy and will not share your personal information without and Reikers et al. The prevalence of femoral retroversion was high in SCFE and increased with measurement methods that are based on proximal landmarks (91% for the method of Lee et al. 2). Symptoms of femoral retroversion usually begin with the visual recognition of the rotated femur. Femoral retroversion is often a congenital condition, meaning children are born with it. NCI CPTC Antibody Characterization Program. [35], Tomczak et al. The Hip Disability and Osteoarthritis Outcome Score (HOOS) (Klassbo et al., 2003; Nilsdotter et al., 2003), was administered to determine level of hip-specific functional disability in the CHJP group. 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. The retroversion was causing a minor curvature in my lumbar spine, tendinosis in my hamstring, and labral tears. The torsional deformity is corrected by re-establishing the normal rotation between the hip and the knee. Also called hip anteversion, femoral anteversion refers to a forward (inward) rotation in the femur (thigh bone and knee) which connects to the pelvis to form the hip joint. When comparing hips with SCFE with the unaffected contralateral side, we found higher differences (range of mean differences -22 to -17) with measurements that consider the femoral heads center than for the method of femoral neck version (mean difference -8) (Fig. 2023; 12(3):751. https: . To facilitate communication among physicians and for the design of future studies, we recommend consistently reporting the applied measurement technique. Conclusion Femoral antetorsion can be measured rapidly and with good reproducibility with MR imaging. Among these, the greatest differences were between the most-proximal methods and the more-distal methods, with a mean difference of -19 7 (95% CI -21 to -18; p < 0.001), comparing the methods of Lee et al. Int J Numer Method Biomed Eng. The condition is somewhat more common in girls than boys. J Pediatr Orthop. The prevalence of femoral retroversion was high in patients with SCFE and increased when using proximal anatomic landmarks. Level of evidence: Diagnosing femoral retroversion can sometimes be difficult, as the common positioning used for X-ray imaging may not reveal a rotation in the femoral neck. 30. 2015;31:247-253. 2012;28:965-971. External tibial torsion. and Reikers et al. BMC Health Serv Res. 2017;11:284-288. 2016;98:127-134. Fishkin Z, Armstrong DG, Shah H, Patra A, Mihalko WM. What Is the Association Among Epiphyseal Rotation, Translation, and the Morphology of the Epiphysis and Metaphysis in Slipped Capital Femoral Epiphysis? Please try again soon. In anatomy, the word version refers to the angle or rotation of all or part of an organ, bone or other structure in the body, relative to other structures in the body. and most-distal methods (Tomczak et al. 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. 2016;98:21-27. 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). The femur bone is cut through a portal and an intramedullary rod is inserted into the marrow cavity of the bone. Would you like email updates of new search results? 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. During the period in question, the general indication for obtaining a CT scan was to define the surgical strategy based on the assessment of deformity severity in patients with newly diagnosed SCFE or with previous in situ fixation. 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%]). 2019:47:3120-3132. Femoral anteversion occurs in up to 10 percent of children; 99 percent of cases resolve over time without the need for surgery. This highlights the need for an individual analysis of femoral version and precludes any generalized recommendation about surgical correction of femoral version when a femoral osteotomy is planned. 39. 40. The doctor will also observe the patients gait (manner of walking) to look for signs of out-toeing or gait compensation. 2019;37:1571-1579. After applying prespecified inclusion and exclusion criteria, we included 79 patients. Wylie JD, Beckmann JT, Maak TG, Aoki SK. 25. Schmaranzer F, Todorski IAS, Lerch TD, Schwab J, Cullmann-Bastian J, Tannast M. Intra-articular lesions: imaging and surgical correlation. Femoral anteversion is an inward twisting of the thigh bone, also known as the femur (the bone that is located between the hip and the knee). Lerch TD, Todorski IAS, Steppacher SD, et al. The prevalence of femoral retroversion (< 0) was compared using a chi-square test. CORR Insights: How Common Is Femoral Retroversion and How Is it Affected by Different Measurement Methods in Unilateral Slipped Capital Femoral Epiphysis? Tightness of the muscles of the hip that cause the hip to rotate excessively to the outside. More specifically, the prevalence of femoral retroversion was higher in hips with SCFE for the proximal methods of Lee et al. The institution of one or more of the authors (FS) has received, during the study period, funding from the Swiss National Science Foundation, Switzerland, Grant No. Measurement of femoral version has been recommended in patients eligible for hip preservation surgery [27, 38] because of the high prevalence of abnormal femoral version in patients with hip pain [21, 22] and its effect on ROM [8, 20] and the outcome of surgery for femoroacetabular impingement [11, 12]. Bali NS, Harrison JO, Bache CE. Loder RT, Aronson DD, Greenfield ML. Please try after some time. 1979;86:420-428. Reduced femoral neck version is more common in adolescents with obesity than in those without obesity [14]. 212-606-1415| 212-606-1550| 212-606-1637 | 212-606-1097. 1996;5:74-76. (3) What is the interobserver reliability and intraobserver reproducibility of these measurement methods? The epidemiology of bilateral slipped capital femoral epiphysis. 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. Berryman F, Pynsent P, McBryde C. A semi-automated method for measuring femoral shape to derive version and its comparison with existing methods. 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. Second, we did not compare femoral version between different severity grades of SCFE because most patients had a severe slip. This is comparable to the femoral neck version of the contralateral hips in our study population. 479(5):960-961, May 2021. 19. For those who do not grow out of it, a mild femoral retroversion may not cause any significant issues. Psychol Bull. Beckmann JT, Maak TG, Aoki SK the diagnostic workup of children with SCFE and increased using! Reference [ 15, 42 ] children are born with a dislocated right hip intraobserver reproducibility of these measurement in... Measurement methods, Schwab J, Cullmann-Bastian J, Cullmann-Bastian J, M.... Programs and tables for the proximal methods of Lee et al it is present from birth and develops the. 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