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. 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. Schmaranzer F, Lerch TD, Siebenrock KA, Tannast M, Steppacher SD. In severe cases, however, surgery may be needed to correct the rotation. Definition of the distal femoral reference: the medial and lateral posterior condyles are connected. We compared femoral version angles and the prevalence of femoral retroversion among all five measurement methods. FOIA Careers. Disclaimer, National Library of Medicine 2016;98:127-134. The minimum slice thickness was 2 mm. J Bone Joint Surg Am. All five methods were compared side-by-side (involved versus uninvolved hip), and comparisons among all five methods were performed using paired t-tests. 39. (3) What is the interobserver reliability and intraobserver reproducibility of these measurement methods? 1986;68:1000-1007. We detected mean differences ranging from -19 to 4 (all p < 0.005) for 8 of 10 pairwise comparisons in hips with SCFE. An official website of the United States government. The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. Right: Most patients with excessive hip retroversion compensate by walking out-toed. Koerner JD, Patel NM, Yoon RS, Sirkin MS, Reilly MC, Liporace FA. References 1 article features images from this case AJR Am J Roentgenol. 5 Femoral version, also referred to as femoral torsion, is another morphologic variable being investigated. 6 It is the angular A subset of patients was measured twice by two readers (FS, JRK) to assess intraobserver reproducibility and interobserver reliability. It also appears to be related to the position of the baby as it grows in the womb. 35. Interrater reliability was assessed across raters using an ICC (2,2) model and intrarater reliability was assessed using an ICC (3,1) model [39]. Akiyama M, Nakashima Y, Kitano T, et al. Retroversin femoral. 20. Imhauser G. Pathogenesis and therapy of hip dislocation in youth [in German]. Further measurement methods included the femoral head's center and differed regarding the level of landmarks for the proximal femoral reference axis. femoral retroversion. External tibial torsion. Arthroscopy. J Bone Joint Surg Am. 1979;86:420-428. Measuring the femoral neck version alone underestimates the asymmetric decrease in femoral version caused by displacement of the femoral epiphysis. Many children are born with femoral anteversions that they eventually grow out of. A Type I error rate of 5% was used. Psychol Bull. We detected mean differences ranging from -19 to 4 (all p < 0.005) for 8 of 10 pairwise comparisons in hips with SCFE. Some error has occurred while processing your request. Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. Femoroacetabular impingement patients with decreased femoral version have different impingement locations and intra- and extraarticular anterior subspine FAI on 3D-CT-based impingement simulation: implications for hip arthroscopy. 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]. Femoral retroversion often runs in families, which may indicate that some children have a higher risk of being born with this condition. Pain in the hip has been present for over 1 year, limiting activities. Among 10 possible pairwise combinations, we detected differences for 8 pairwise comparisons in hips with SCFE (Table 4). Further measurement methods included the femoral heads center and differed regarding the level of landmarks for the proximal femoral reference axis. Femoral version of the general population: does normal vary by gender or ethnicity? Berryman F, Pynsent P, McBryde C. A semi-automated method for measuring femoral shape to derive version and its comparison with existing methods. A labral tear, subspine and intertrochanteric impingement and femoral retroversion. 24. Femoral anteversion occurs in up to 10 percent of children. In many cases, the child may grow out of it. Interobserver reliability and intraobserver reproducibility were high (ICC values > 0.80) for all five measurement methods (Table 6). and most-distal methods (Tomczak et al. 47. (91% [95% CI 85% to 97%] and 84% [95% CI 76% to 92%], respectively) than for the distal measurement methods of Tomczak 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. The doctor will also observe the patients gait (manner of walking) to look for signs of out-toeing or gait compensation. The ischiofemoral distance was evaluated for patients with increased FV on preoperative MRI and was lower (17 5 mm, range 12-25) compared to the reported normal ischiofemoral distance [ 46] of 30.6 mm. Forty-eight percent (38 of 79 patients) were male, and 72% (57 of 79) were overweight (13 patients [17%] with a BMI between the 85th and 95th percentiles) or obese (44 patients [56%] with a BMI above the 95th percentile). 2009;467:724-731. 15 - 17 Furthermore, it can cause a decrease in the length of the abductor lever arm, 18 posterior extra-articular impingement, 9 and ischiofemoral impingement. However, the association between reduced femoral anteversion and SCFE has yet to be fully elucidated because early studies were small and based on two-dimensional CT scans. Recognizing this impairment and its impact on a patient's function is . 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. [44] (Table 4). Z Orthop Ihre Grenzgeb. Hip dysplasia. The prevalence of femoral retroversion (< 0) was compared using a chi-square test. your express consent. 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. Symptoms of femoral retroversion may include: 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. Elise struggled with femoral retroversion, also known as hip retroversion which is a condition related to hip dysplasia. Finally, we could show that the different measurement methods are comparable in terms of interobserver reliability and reproducibility (Table 6). It becomes apparent as the child starts to stand or cruise between 6 and 9 months. Femoral retroversion is common in early infancy and is caused by external rotation contracture of the hip secondary to intrauterine packing. Level of evidence: and Murphy et al. 2012;470:3432-3438. 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. The prevalence of femoral retroversion was higher in hips with SCFE for the proximal methods of Lee et al. All measurement methods are based on true axial images and a line connecting the femoral condyles as the distal reference axis. Oduwole KO, de SA D, Kay J, et al. 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. Femoral retroversion is often a congenital condition, meaning it is present from birth and develops in the womb. In these situations, a surgical procedure known as a femoral osteotomy may be used. From proximal to distal, this included the most-proximal methods (Lee et al. We found that femoral neck version is asymmetrically decreased in unilateral SCFE compared with the contralateral hip. We showed that femoral neck version is asymmetrically decreased in unilateral SCFE, and that differences increase when including the femoral heads center. Accordingly, differences in femoral version angles between proximal and distal measurement methods were as high as -19 (Table 4). (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? Liu RW, Fraley SM, Morris WZ, Cooperman DR. Validity and clinical consequences of a rotational mechanism for slipped capital femoral epiphysis. Baraka MM, Hefny HM, Thakeb MF, et al. Level III, prognostic study. A technical improvement. 11. Your message has been successfully sent to your colleague. The most significant clinical implication of femoral retroversion is that it is not soft tissue-related. Differences in femoral torsion among various measurement methods increase in hips with excessive femoral torsion. 1999;81:1747-1770. Femoral retroversion causes hip impingement, similar to the impingement and posterior instability that occurs in total hip arthroplasty. This surgery includes cutting and realigning the femur. These methods differ regarding the definition of the second reference point to determine the proximal reference line (Table 2). 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. 2019;43:2375-2382. 3). The statistical analysis was performed by a biostatistician (PEM) using SAS version 9.4 (SAS Institute, Cary, NC, USA). 2006;44:895-906. At times, pure femoral retroversion may be the only source of hip impingement. 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. 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. Lerch TD, Todorski IAS, Steppacher SD, et al. [19] and Reikers et al. Methods: Arthroscopic treatment of mild to moderate deformity after slipped capital femoral epiphysis: intra-operative findings and functional outcomes. What are the symptoms of femoral retroversion? 34. Clipboard, Search History, and several other advanced features are temporarily unavailable. Craig's test is a passive test that is used to measure femoral anteversion or forward torsion of the femoral neck. This may also make the legs look bowed. Out-toeing is the common name used for a condition known as femoral retroversion. (47% [95% CI 36% to 58%] and 60% [95% CI 49% to 71%], respectively [all p < 0.001]). What are the causes of femoral retroversion? More recently, femoral osteochondroplasty sometimes has been performed first to correct a secondary cam deformity, followed by intraoperative ROM testing to determine whether an additional proximal femoral osteotomy is needed [4, 34, 43]. Wolters Kluwer Health
Third, because of the studys retrospective design, we cannot rule out a selection bias since the decision to perform a CT was not standardized and evolved over time in the practices of the different surgeons. Bone Joint J. [30] is the preferred routine measurement because it most closely reflects the true anatomic femoral version [7, 30] and does not underestimate excessively high femoral version [37]. J Pediatr Orthop B. Femoral retroversion can also occur after a physical trauma such as a femur fracture. He may also order an X-ray or CT scan to look for possible deformities. The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. J Child Orthop. 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]. Loder RT, Aronson DD, Greenfield ML. Schmaranzer F, Lerch TD, Siebenrock KA, Tannast M, Steppacher SD. Treatment of chronic, stable slipped capital femoral epiphysis via surgical hip dislocation with combined osteochondroplasty and Imhauser osteotomy. Femoral antetorsion was significantly higher in patients with pincer-type FAI than in those with cam-type FAI for reader 1 (18.3 9.8 vs 10.0 9.1, P = .02) and reader 2 (18.7 10.5 vs 11.6 8.8, P = .04). Significantly increased femoral anteversion affects the rotational profile of the lower extremity, leading to increased internal rotation. Accordingly, there was a mean difference of -16 6 (95% CI -17 to -15; p < 0.001) between the methods of Lee et al. Please enable it to take advantage of the complete set of features! My doctors would not treat me unless I had surgery to fix the retroversion. However, a comparison of measurement methods of femoral version is lacking in patients with SCFE. 8600 Rockville Pike [1] Femoral anteversion is the angle between the femoral neck and femoral shaft, indicating the degree of torsion of the femur. [44]: 0 13 and Murphy et al. 18. This graph shows a comparison of the different methods to measure femoral version for hips with SCFE and contralateral hips. Am J Sports Med. J Bone Joint Surg Am. The condition is usually congenital, meaning children are born with it. This condition is diagnosed in childhood, and is characterized by the unusual "duck feet" posture and walk that the child develops. This site needs JavaScript to work properly. J Pediatr Orthop. 31. Femoral anteversion is an inward twisting of the thigh bone (femur). 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]. femoral retroversion synonyms, femoral retroversion pronunciation, femoral retroversion translation, English dictionary definition of femoral retroversion. The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. Purpose. 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. Int Orthop. CORR Insights: How Common Is Femoral Retroversion and How Is it Affected by Different Measurement Methods in Unilateral Slipped Capital Femoral Epiphysis? 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. the axis of the femoral neck is oriented more posteriorly than the distal reference line connecting the dorsal border of the femoral condyles. The Lisbon agreement on femoroacetabular impingement imaging-part 1: overview. (3) What is the interobserver reliability and intraobserver reproducibility of these measurement methods? This means thehip is twisted backward (posteriorly) in relation to the knee. Clin Orthop Relat Res. 1988;8:385-388. If you prefer
In healthy contralateral hips, we found differences for 9 of 10 pairwise comparisons (Table 4). 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. Routinely measuring femoral version might help surgeons better identify which part of an abnormal femur (cam deformity and/or externally rotated femur) should be corrected. The aim of the current study was to obtain precise normal values of the femoral anteversion angle using computed tomography on cadavers of mature dogs with normal hip joints of . Bone Joint J. FEMORAL VEIN ANATOMY. We performed further subgroup analysis between hips with and without previous in situ fixation to assess whether femoral version measurements might be affected by postoperative remodeling or potential previous partial reduction. Femoral retroversion can occur in one or both legs. Following exclusion of a total of 36% (44 patients), the final cohort consisted of 79 patients (Table 1). where does bone formation occur during endochondral ossification? BMC Health Serv Res. 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. In many cases, the abnormal rotation of the femur develops while the fetus is growing in the womb. femoral anteversion decreases on average 25 degrees during this time as well Presentation Symptoms anterior knee pain caused by patellofemoral malalignment Physical Exam thigh-foot axis measurement best way to evaluate tibial torsion average during infancy is 5 degrees internal rotation, that slowly derotates J Pediatr Orthop. Femoral retroversion often runs in families, which may indicate that some children have a higher risk of being born with this condition. method), we used the most cephalic junction of the greater trochanter as the landmark and, most distally, we used the center base of the femoral neck superior to the lesser trochanter (Murphy et al.). official website and that any information you provide is encrypted Bone Joint J. For the diagnosis of this condition, conventional AP pelvic radiographs may represent a reliable, easily available diagnostic modality as they can be obtained with a reproducible technique allowing the anterior and posterior acetabular rims to be visible for assessment. The prevalence of femoral retroversion (< 0) was compared using a chi-square test. , and. Retroversion refers to an abnormal backward rotation of the hip relative to the knee. Journal of Clinical Medicine. These side-by-side differences increased up to -22 (according to the method of Murphy et al. The prevalence of femoral retroversion was higher in hips with SCFE for the proximal methods of Lee et al. In some cases, hip/femoral retroversion may be combined with a separate torsional deformity, such as a rotation in the tibia. Request PDF | On Apr 6, 2015, Henry Knipe and others published Femoral retroversion | Find, read and cite all the research you need on ResearchGate By continuing to use this website you are giving consent to cookies being used. Wylie JD, McClincy MP, Uppal N, et al. [30]), and the corresponding prevalence of femoral retroversion were compared between hips with SCFE and the unaffected contralateral side. Bethesda, MD 20894, Web Policies Unable to load your collection due to an error, Unable to load your delegates due to an error. 2012;28:965-971. This is the story of her diagnosis, operations and recovery to date: Hi I'm Elise and I live in Northern Ireland. 2013;95:851-854. PMC This graph shows a comparison of the different methods to measure femoral version, MeSH Any treatment of my symptoms was going to be ineffective due to the alignment still being off. The data table on the chart reports the mean SD. The prevalence of femoral retroversion was high in patients with SCFE and increased when using proximal anatomic landmarks. 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). Novais EN, Millis MB. 2017;6:472-480. J Orthop Trauma. Seventy-one percent (56 of 79) of patients in whom previous in situ pinning had been performed as the initial treatment of SCFE presented with a symptomatic SCFE deformity. Additionally, can femoral anteversion cause pain? grip" deformity) and relative retroversion of the femoral head were dened as the cause of cam-type FAI, with worse long-term clinical and radiographic results. to maintaining your privacy and will not share your personal information without
Femoral anteversion. 1987;5:523-528. SCFE and its complications may lead to lifelong disability encompassing pain, gait disturbances, degenerative changes, osteonecrosis and chondrolysis. . Millis MB. Femoral anteversion is usually most noticeable in children between the ages of 4 and 6. This study has several limitations. [19] and Tomczak et al. (3) What is the interobserver reliability and intraobserver reproducibility of these measurement methods? 5. Femoral anteversion causes a child's knees and feet to turn inward and have a "pigeon-toed" appearance. 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. When comparing different measurement techniques, we found a higher prevalence of femoral retroversion for the proximal methods (91% for Lee et al.s [19] method) than for the more-distal measurement methods (47% for Tomczak et al.s [44] method) (Table 3). Copyright 2020 by the Association of Bone and Joint Surgeons. Montgomery AA, Graham A, Evans PH, Fahey T. Inter-rater agreement in the scoring of abstracts submitted to a primary care research conference. P1BEP3_181643, CHF 46000. [35] yielded the lowest mean femoral version angles (-19 16 and -15 14, respectively), while the methods that use more-distal definitions of the proximal reference yielded higher (all p < 0.005) femoral version angles (Tomczak et al. Despite this proposed association, little is known about femoral neck version in patients with SCFE. In this type of surgery, the femur bone is cut through a portal and an intramedullary rod is inserted into the marrow cavity of the bone. The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. From birth to 6 yrs. Femoral version in acute slipped capital femoral epiphysis. 3). 1). 1996;5:74-76. The association of femoral retroversion with slipped capital femoral epiphysis. 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). More distally, the pes anserinus bursa should be palpated for tenderness typical of pes . Children with femoral anteversion may trip and fall more than their peers, but the condition is rarely painful. This could theoretically affect anatomic landmark selection for femoral version measurements and corresponding femoral version angles. Would you like email updates of new search results? Results: 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). Theoretically, hip flexion/abduction could affect femoral version measurements. To facilitate communication among physicians and for the design of future studies, we recommend consistently reporting the applied measurement technique. Femoral retroversion | definition of femoral retroversion by Medical dictionary femoral retroversion Also found in: Dictionary, Thesaurus, Encyclopedia. 9. Please try after some time. 2). 45. 3). Congenital right femoral retroversion; Congenital right hip dysplasia; Present On Admission. Based on these findings, we believe it is worthwhile to add evaluation of femoral version to the diagnostic workup of children with SCFE. 30. In patients with newly diagnosed SCFE, this included the decision to perform in situ fixation or intertrochanteric flexion-derotation osteotomy with or without cam resection, or to perform a modified Dunn procedure. 2016;98:21-27. Obesity and decreased femoral anteversion in adolescence. Fishkin Z, Armstrong DG, Shah H, Patra A, Mihalko WM. Lerch TD, Boschung A, Todorski IAS, et al. Federal government websites often end in .gov or .mil. Schmaranzer F, Kallini JR, Miller PE, Kim Y-J, Bixby SD, Novais EN. Previous studies only included the femoral neck version and not the center of the femoral head as a reference [15, 42]. Int Orthop. 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. The mean femoral neck version was lower in hips with SCFE than in the contralateral side (-2 13 versus 7 11; p < 0.001). Radiology. Gelberman RH, Cohen MS, Shaw BA, Kasser JR, Griffin PP, Wilkinson RH. 41. Stanitski CL, Woo R, Stanitski DF. The https:// ensures that you are connecting to the Paired t-tests including Bonferroni corrections for repeated measurements were performed for comparison between the mean femoral version angles. Tomczak RJ, Guenther KP, Rieber A, Mergo P, Ros PR, Brambs HJ. The femoral vein is the major deep vein of the lower extremity. In these situations, a surgical procedure known as a. may be used. Erickson JB, Samora WP, Klingele KE. 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. A specialist will observe your . and Reikers et al.) In some cases, a minimally invasive version of a femoral osteotomy may be performed. 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. Murphy SB, Simon SR, Kijewski PK, Wilkinson RH, Griscom NT. 2018;38(suppl 1):S5-S12. 3. Femoral anteversion can occur in one or both legs. 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. Relative contribution of epiphyseal tubercle and peripheral cupping to capital femoral epiphysis stability during daily activities. Video case study Fabricant PD, Bedi A, De La Torre K, Kelly BT. Retrotorsion is a pathologic decrease in the torsion angle; ie it is less than 8 degrees. 32. You may notice that your child is walking with the toes turned inward. to call, please leave a message and we will return your call. 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. [15] were the first to describe a method of measuring femoral neck version in patients with SCFE. Pritchett JW, Perdue KD. and Murphy et al.). January 31, 2022 . Accordingly, the methods of Lee et al. What is the prevalence of cam deformity after prophylactic pinning of the contralateral asymptomatic hip in unilateral slipped capital femoral epiphysis? Acta Orthop Scand. Kiapour AM, Kiapour A, Maranho DA, Kim Y-J, Novais EN. One radiology resident (6 years of experience) measured femoral version of the entire study group using five different methods. 3D femoral neck anteversion measurements based on the posterior femoral plane in ORTHODOC system. This work was performed at the Department of Orthopaedic Surgery, Boston Childrens Hospital, Harvard Medical School, Boston, MA, USA. . and most-distal methods (Tomczak et al. However, Koerner et al. Finite-element studies have demonstrated that shear forces across the capital femoral physis increase with reduced femoral anteversion and increased BMI [13, 33].
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