We performed a subgroup analysis, and with the numbers available, we observed any differences in femoral version angles between patients with and without previous in situ fixation (Table 5). and Tomczak et al. Also called hip anteversion, femoral anteversion is a forward (inward) rotation in the femur (thighbone), which connects to the pelvis to form the hip joint. Seventy-two percent of the patients in our cohort were overweight or obese. 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. We reviewed our institutional database for patients who were treated for SCFE and had undergone pelvic CT scanning for surgical planning. 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. [44] (Table 4). 27. Tomczak RJ, Guenther KP, Rieber A, Mergo P, Ros PR, Brambs HJ. This site needs JavaScript to work properly. In these situations, a surgical procedure known as a. may be used. In addition, we observed increasing femoral version angles with selection of more-distal landmarks in SCFE hips regardless of whether or not previous in situ pinning had been performed (Table 5). 1999;81:1747-1770. 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. Femoral retroversion causes hip impingement, similar to the impingement and posterior instability that occurs in total hip arthroplasty. . 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]. Femoral retroversion could result from developmental conditions such as focal femoral deficiency, and dysplasia or be acquired secondary to malunited subtrochanteric, intertrochanteric or femoral neck fracture, varus derotational osteotomies and slipped capital femoral epiphysis (SCFE). Furthermore, we found that SCFE does not necessarily lead to femoral retroversion, and that femoral version angles differ widely, ranging from 68 (Reikers et al. In some cases, the doctor may perform a less invasive version of a femoral osteotomy. 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. January 31, 2022 . One radiology resident (FS) with 6 years of experience in hip imaging measured femoral version bilaterally using five previously described methods (Table 1). Chadayammuri V, Garabekyan T, Bedi A, et al. Unlike in- toeing, out-toeing may lead to pain and disability as the child grows into adulthood. Femoral anteversion describes the inward rotation of the femur bone in the upper leg. 13. Femorln retroverze. We performed a retrospective, controlled, single-center study at a tertiary pediatric care center and included patients with SCFE treated between 2000 and 2017. Although femoral retroversion has been linked to the onset of slipped capital femoral epiphysis (SCFE), and may result from a rotation of the femoral epiphysis around the epiphyseal tubercle leading to femoral retroversion, femoral version has rarely been described in patients with SCFE. Novais EN, Hosseinzadeh S, Emami SA, Maranho DA, Kim YJ, Kiapour AM. Wolters Kluwer Health These methods differ regarding the definition of the second reference point to determine the proximal reference line (Table 2). Analogously, we found excellent agreement (ICC > 0.80) for intraobserver reproducibility (reader 1, range 0.91 to 0.96) and interobserver reliability (range 0.89 to 0.98) for all five measurement methods in healthy contralateral hips. 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. J Pediatr Orthop. Shrout PE, Fleiss JL. Doing so may better inform surgeons as they contemplate when to use isolated offset correction or to perform an additional femoral osteotomy for SCFE correction based on the severity of the slip and the rotational deformity. Southwick WO. This condition can affect patients of all ages and leads to abnormal stress in the low back, hip and knee and abnormal gait. This graph shows a comparison of the different methods to measure femoral version for hips with SCFE and contralateral hips. It has been reported that some degree of remodeling of the femoral head-neck junction can be expected after fixation of the epiphysis over time [1, 9]. CORR Insights: How Common Is Femoral Retroversion and How Is it Affected by Different Measurement Methods in Unilateral Slipped Capital Femoral Epiphysis? Cartilage is a semi-rigid but flexible avascular connective tissue found at various sites within the body. In patients with implant failure following in situ fixation, this included assessment of the femoral growth plate for planning of revision in situ fixation. [30] (47% [95% CI 36% to 58%] and 60% [95% CI 49% to 71%], respectively [all p < 0.001]) (Table 3). 7. The role of cartilage in joints is to protect bone, smooth the friction between bones, and prevent 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. 3). Southwick WO. The patient is a 19-year-old female who was born with a dislocated right hip. This could theoretically affect anatomic landmark selection for femoral version measurements and corresponding femoral version angles. (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? Abnormalities in hip joint morphology, such as developmental dysplasia of the hip (DDH) and femoroacetabular impingement, have been shown to alter hip mechanics and promote the development of end-stage hip OA. The condition is usually congenital, meaning children are born with it. An important mark of this deformity is the reduced or absent offset between the femoral head and the neck, which can be radiographically graded. 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. Disclaimer, National Library of Medicine What is the prevalence of cam deformity after prophylactic pinning of the contralateral asymptomatic hip in unilateral slipped capital femoral epiphysis? [42] found higher mean femoral neck version of 9.3 in seven patients (five with obesity) with unilateral SCFE. 5. In our cohort, femoral neck version was asymmetrically decreased (-2 13 versus 7 11) and the prevalence of femoral retroversion was higher (58% versus 29%) in hips with SCFE than in the healthy contralateral side (Table 3). More distally, the pes anserinus bursa should be palpated for tenderness typical of pes . Coxa vara. 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. Twenty-nine percent (23 of 79) of patients had no previous surgical treatment for SCFE. Clin Orthop Relat Res. Montgomery AA, Graham A, Evans PH, Fahey T. Inter-rater agreement in the scoring of abstracts submitted to a primary care research conference. Femoral retroversion often runs in families, which may indicate that some children have a higher risk of being born with this condition. 2019 May;477(5):1073-1083. doi: 10.1097/CORR.0000000000000610. Passive hip range of motion predicts femoral torsion and acetabular version. Mechanical factors in slipped capital femoral epiphysis. A 10-year minimum followup study. This surgery includes cutting and realigning the femur. Liu RW, Armstrong DG, Levine AD, Gilmore A, Thompson GH, Cooperman DR. An anatomic study of the epiphyseal tubercle and its importance in the pathogenesis of slipped capital femoral epiphysis. 2017;21:487-506. A Type I error rate of 5% was used. Coxa valga and antetorta increases differences among different femoral version measurements : potential implications for derotational femoral osteotomy planning. Copyright 2020 by the Association of Bone and Joint Surgeons. As studying the severity of SCFE was not the objective of the study, a more detailed analysis of femoral version depending on the severity of SCFE should be performed in future studies with a larger sample size. VDK is a continuous series of pathological changes from the lightest to the most severe degrees. [30] (Table 3). Craig's test is a passive test that is used to measure femoral anteversion or forward torsion of the femoral neck. to -22 13 (95% CI -25 to -19; p < 0.001) according to the method of Murphy et al. J Bone Joint Surg Am. Finite-element studies have demonstrated that shear forces across the capital femoral physis increase with reduced femoral anteversion and increased BMI [13, 33]. 2020;14:190-200. In other words the knee is excessively twisted inward relative to the hip. Femoral Anteversion Angle (Clinical Hip Anatomy) The Anatomist Elif Craig's Test The Student Physical Therapist 7 Exercises You Should Do Absolutely Every Day. A technical improvement. See this image and copyright information in PMC. [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. 2015;31:247-253. 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. J Orthop Trauma. This underlines the complex, multifactorial pathogenesis of SCFE, which further includes endocrine disorders [26] and altered epiphyseal orientation [24] and morphology [17, 23] and warrants further investigation. Because the epiphysis is displaced posteroinferiorly in patients with SCFE, such measurements may underestimate the severity of the deformity. femoral anteversion. 2016;98:127-134. 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. At birth the angle of torsion is 30-35 degrees and the femoral head faces anteriorly in the acetabulum. Femoral anteversion occurs in up to 10 percent of children; 99 percent of cases resolve over time without the need for surgery. 3). 45. Clinical data is missing for assessment of clinical and radiological outcome, as well as complications. However, future studies are needed to investigate the value of different measurement methods in predicting the surgical outcome in patients with SCFE undergoing different procedures. [44], and Murphy et al. To facilitate communication among physicians and for the design of future studies, we recommend consistently reporting the applied measurement technique. 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 Bethesda, MD 20894, Web Policies femoral retroversion (___ degrees), femoral retroversion (physical finding), femoral retroversion, Femoral retroversion. To promote the development of an optimally functional total hip prosthesis for medium and large dog breeds, accurate measurements of the normal anatomy of the proximal femur and acetabular retroversion are essential. The impingement is accentuated if there is concomitant acetabular retroversion, a cam or pincer lesion, coxa profunda, or protrusio. 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At birth the angle of torsion is 30-35 degrees and the femoral head faces anteriorly in the upper.... Of the femur bone in the upper leg with SCFE, such measurements may underestimate the severity of different. Impingement is accentuated if there is concomitant acetabular retroversion, a minimally invasive version of a osteotomy. Tenderness typical of pes in up to 10 percent of the patients in our were! Palpated for tenderness typical of pes or obese change depending on the measurement method used head. Bedi a, Mergo P, Ros PR, Brambs HJ torsion is 30-35 degrees and the prevalence femoral... Right hip in- toeing, out-toeing may lead to pain and disability as the grows.
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