is femoral retroversion a disability
[19] method -19 16 [95% CI -25 to -12] versus -19 16 [95% CI -23 to -15]; p = 0.90, respectively) (Table 5). External Tibial Torsion Much like internal tibial torsion, this condition improves in most children before or around the age of 10. The mean age was 59.5 12 years and the . Case reports: acetabular damage after mild slipped capital femoral epiphysis. 5 Femoral version, also referred to as femoral torsion, is another morphologic variable being investigated. Bali K, Railton P, Kiefer GN, Powell JN. 2019 May;477(5):1073-1083. doi: 10.1097/CORR.0000000000000610. The method of Reikers et al. A subset of patients was measured twice by two readers (FS, JRK) to assess intraobserver reproducibility and interobserver reliability. During this time period, 754 patients were diagnosed with SCFE. The femur bone is cut through a portal and an intramedullary rod is inserted into the marrow cavity of the bone. In cases where the child does not grow out of femoral retroversion, the condition may be mild enough not to cause any significant health challenges. 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. The orientation of the distal femoral condyles served as the distal reference axis for all five measurement methods. Ethical approval for this study was obtained from the institutional review board of Boston Childrens Hospital (protocol number IRB-P00018761). However, severe cases require surgical correction. (3) What is the interobserver reliability and intraobserver reproducibility of these measurement methods? The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. 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). Femoral retroversion is often a congenital condition, meaning children are born with it. J Pediatr Orthop B. The I-bars represent the corresponding 95% CI. Loder RT, Aronson DD, Greenfield ML. In severe cases, however, surgery may be needed to correct the rotation. An excessive femoral retroversion can place stress on hip and knee joints, often leading to joint pain and abnormal wear. In the axial HASTE images over the proximal and distal femur a femoral retroversion can be seen, i.e. All five methods were compared side-by-side (involved versus uninvolved hip), and comparisons among all five methods were performed using paired t-tests. Further measurement methods included the femoral head's center and differed regarding the level of landmarks for the proximal femoral reference axis. Although our findings support the association among obesity, femoral retroversion, and SCFE, it remains unclear how an increase in body weight can lead to asymmetric reduction in femoral neck version. Symptoms of femoral retroversion usually begin with the visual recognition of the rotated femur. Although external rotation of the proximal femur relative to the femoral condyles (that is, femoral retroversion) has been linked with the onset of SCFE and has been proposed to result from a rotation of the femoral epiphysis around the epiphyseal tubercle leading to femoral retroversion, femoral version has rarely been described in SCFE [24, 31]. [44], and Murphy et al. 1993;75:1141-1147. [35], Tomczak et al. 519 East 72nd St., Suite 204 FEMORAL VEIN ANATOMY. 2. 41. The five different measurement methods were applied in the same way in hips with SCFE and in healthy contralateral hips (Fig. The overall mean femoral version angles increased for hips with SCFE (range of means -19 to 0) and the contralateral side (range of means 2 to 19) using distal landmarks compared with more proximal landmarks (Fig. 35. Approach to the hip for SCFE: the North American perspective. 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. Craig's test is a passive test that is used to measure femoral anteversion or forward torsion of the femoral neck. Increased BMI leads to an increase in simulated loads across the physis [33] and may be further aggravated by retroversion of the femoral neck, which has been associated with obesity [14]. Said differently, the knee is excessively twisted inward relative to the hip. . J Bone Joint Surg Am. J Orthop Res. Your message has been successfully sent to your colleague. Thus, to assess the full extent of an SCFE deformity, femoral version measurements should consider the position of the displaced epiphysis. A labral tear, subspine and intertrochanteric impingement and femoral retroversion. (47% [95% CI 36% to 58%] and 60% [95% CI 49% to 71%], respectively [all p < 0.001]). 2014;30:1314-1325. At times, pure femoral retroversion may be the only source of hip impingement. However, a comparison of measurement methods of femoral version is lacking in patients with SCFE. The patient is a 19-year-old female who was born with a dislocated right hip. This condition is diagnosed in childhood, and is characterized by the unusual "duck feet" posture and walk that the child develops. This can cause pain and abnormal force in the hip and can lead to degeneration and arthritis. 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. 2011;31:153-158. J Bone Joint Surg Am. PMC Femoral retroversion is often a congenital condition, meaning it is present from birth and develops in the womb. 2013;95:851-854. The source of all of my pain was the retroversion of my femur. Thus, to assess the full extent of an SCFE deformity, femoral version measurements should consider the position of the displaced epiphysis. Purpose. Please try again soon. Patellofemoral joint pain is a very common knee problem physical therapists see in the clinic. [19]) compared with distal landmarks to define the femoral reference axis (47% for the method of Tomczak et al. [44]: 0 13 and Murphy et al. 212-606-1415, About Limb Lengthening & Deformity Correction, Bone Tumors: Symptoms, Treatments and Outcomes, Femoral Anteversion: Causes, Symptoms and Treatment, Femoral Retroversion: Causes, Symptoms and Treatments. In the remaining four patients with an open femoral growth plate at last clinical visit, radiographic follow-up was longer than 18 months (median 22 months, range 21 to 25), an observation period by which more than 90% of the subsequent contralateral SCFE reportedly occur [25]. Tomczak RJ, Guenther KP, Rieber A, Mergo P, Ros PR, Brambs HJ. This could theoretically affect anatomic landmark selection for femoral version measurements and corresponding femoral version angles. coronary heart disease, and other diseases due to long-term disability, bringing economic and spiritual double blows to patients and families. 1986;68:1000-1007. Therefore, quantifying femoral version in patients with SCFE should be based on a measurement technique that includes the femoral rotations center. Increasing femoral version angles with more-distal landmarks were observed in SCFE hips with and without previous in situ pinning alike (Table 5). 6 It is the angular 4. official website and that any information you provide is encrypted The state of being turned or tilted back. Isolated open or arthroscopic cam resection has been increasingly proposed as less-invasive options in patients with mild-to-moderate slips, yielding promising short-term results [6, 32, 46]. n. 1. Top-view illustrations of excessive femoral retroversion. By contrast, femoral osteotomies, most frequently performed at the intertrochanteric level, combined with femoral osteochondroplasty, allow correction of femoral retroversion especially in severe and moderate slips [3-5, 10, 32]. The vessel traverses the thigh and takes a superficial course at the femoral triangle before passing beneath the inguinal ligament into the pelvis as the external iliac vein (figure 1A-B). HHS Vulnerability Disclosure, Help The torsional deformity is corrected by re-establishing the normal rotation between the hip and the knee. The orientation of the distal femoral condyles served as the distal reference axis for all five measurement methods. 39. The data table on the chart reports the mean SD. Careers. Femoral anteversion can occur in one or both legs. Radiology. One radiology resident (6 years of experience) measured femoral version of the entire study group using five different methods. The most significant clinical implication of femoral retroversion is that it is not soft tissue-related. Clinical Orthopaedics and Related Research, Get new journal Tables of Contents sent right to your email inbox, The Association of Bone and Joint Surgeons, https://journals.lww.com/clinorthop/Fulltext/2019/05000/Differences_in_Femoral_Torsion_Among_Various.26.aspx. We found that femoral neck version is asymmetrically decreased in unilateral SCFE compared with the contralateral hip. Bob & Brad 3.9M views 5 years ago. What Is the Association Among Epiphyseal Rotation, Translation, and the Morphology of the Epiphysis and Metaphysis in Slipped Capital Femoral Epiphysis? The prevalence of femoral retroversion was higher in hips with SCFE for the proximal methods of Lee et al. 2012 Dec;470(12):3432-8. doi: 10.1007/s11999-012-2452-y. Femoral retroversion | definition of femoral retroversion by Medical dictionary femoral retroversion Also found in: Dictionary, Thesaurus, Encyclopedia. This procedure may be done for children over age 10 and adults and has a quick and reliable recovery. In hips with SCFE, we found excellent agreement (ICC > 0.80) for intraobserver reproducibility for reader 1 (ICC range 0.93 to 0.96), for reader 2 (ICC range 0.97 to 0.99), and interobserver reliability (ICC range 0.95 to 0.98) for all five measurement methods (Table 6). J Bone Joint Surg Am. CLINICAL FEATURES Symptoms Will cause out-toeing and may lead to disability and decrease physical performance. Thereby, we could confirm that leg position was neutral and symetrical (p = 0.29) between the SCFE hip (1 3) and the contralteral hip (1 3) in our study group. 31. Eur Radiol. 2019;43:2375-2382. It also appears to be related to the position of the baby as it grows in the womb. This graph shows a comparison of the different methods to measure femoral version for hips with SCFE and contralateral hips. In our institution, the method described by Murphy et al. Would you like email updates of new search results? and Murphy et al.). A subset of patients was measured twice by the first obsever as well as by a second orthopaedic resident (JRK, 2 years of experience) to assess intraobserver reproducibility and interobserver reliability. Schmaranzer F, Todorski IAS, Lerch TD, Schwab J, Cullmann-Bastian J, Tannast M. Intra-articular lesions: imaging and surgical correlation. 9. Femoral version angles did not differ between hips with and without previous in situ pinning for any of the five measurement methods (for example, Lee et al. Please enable it to take advantage of the complete set of features! Am J Sports Med. 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. In some cases, a minimally invasive version of a femoral osteotomy may be performed. We reviewed our institutional database for patients who were treated for SCFE and had undergone pelvic CT scanning for surgical planning. From proximal to distal, this included Lee et al.s [19] method, modified to include the femoral heads center with the second landmark defined as the first image on which the connection between the femoral neck and the grater trochanter is visible (Fig. [42] found higher mean femoral neck version of 9.3 in seven patients (five with obesity) with unilateral SCFE. 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. Czech. J Orthop Trauma. Basheer SZ, Cooper AP, Maheshwari R, Balakumar B, Madan S. Arthroscopic treatment of femoroacetabular impingement following slipped capital femoral epiphysis. This site needs JavaScript to work properly. Femoral anteversion causes a child's knees and feet to turn inward and have a "pigeon-toed" appearance. 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