Finally, we could show that the different measurement methods are comparable in terms of interobserver reliability and reproducibility (Table 6). What is femoral anteversion? Surgical treatment of symptomatic post-slipped capital femoral epiphysis deformity: a comparative study between hip arthroscopy and surgical hip dislocation with or without intertrochanteric osteotomy. 44. 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. (91% [95% CI 85% to 97%] and 84% [95% CI 76% to 92%], respectively) than for the distal measurement methods of Tomczak et al. 2023; 12(3):751. https: . Compression fixation after biplane intertrochanteric osteotomy for slipped capital femoral epiphysis. English. Limb Lengthening and Complex Reconstruction Service, out-toeing or "duck walk" walking with the foot pointed outward instead of straight ahead. This condition is diagnosed in childhood, and is characterized by the unusual "duck feet" posture and walk that the child develops. 1967;49:807-835. 2017;11:93-98. Femoral retroversion is often a congenital condition, meaning it is present from birth and develops in the womb. 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. 2014;96:1441-1448. 2018;46:122-134. For the definition of femoral neck version, the midpoint of the femoral neck axis is determined at the level where the cortices run parallel and serves as the proximal reference axis (Fig. 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. What is femoral anteversion? An official website of the United States government. J Bone Joint Surg Am. Articles in PubMed by Florian Schmaranzer, MD, PhD, Articles in Google Scholar by Florian Schmaranzer, MD, PhD, Other articles in this journal by Florian Schmaranzer, MD, PhD, May 2021: Selected Proceedings from the 2020 Bernese Hip Symposium, Privacy Policy (Updated December 15, 2022), Overweight (% between the 85th and 95th percentiles), Duration of symptoms at initial diagnosis, Flexion-derotation intertrochanteric osteotomy, Anatomic landmark to define the proximal reference axis, A line is drawn that connects the femoral heads center with the most cephalic junction of the greater trochanter to the femoral neck, A line is drawn that connects the center of the femoral head with the center of the femoral neck at the level where the anterior and posterior cortices run parallel, The center of the femoral neck at the level where the anterior and posterior cortices run parallel, A line is drawn that connects the femoral heads center with the center of the greater trochanter at the base of the femoral neck, A line is drawn that connects the femoral heads center with the base of the femoral neck superior to the lesser trochanter, Femoral version measurements (), hips with SCFE, Femoral version measurements (), contralateral hips. The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. [35] uses the center of the femoral neck as a reference at the level where both cortices run parallel. 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. SCFE: clinical aspects, diagnosis, and classification. [19] and Tomczak et al. Based on these findings, we believe it is worthwhile to add evaluation of femoral version to the diagnostic workup of children with SCFE. 28. 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%]). 2013;27:308-311. For those who do not grow out of it, a mild femoral retroversion may not cause any significant issues. A specialist will observe your . 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. 6. Dawes B, Jaremko JL, Balakumar J. Radiographic assessment of bone remodelling in slipped upper femoral epiphyses using Kleins line and the angle of femoral-acetabular impingement: a retrospective review. Retroversion refers to an abnormal backward rotation of the hip relative to the knee. Femoral malversion (excessive femoral anteversion or femoral retroversion) is increasingly recognised as an important factor that may influence mechanical loads around the hip and development of both intra-articular and extra-articular pathologies. In our institution, the method described by Murphy et al. and transmitted securely. What are the symptoms of femoral retroversion? Most proximally (Lee et al. Your message has been successfully sent to your colleague. Measuring the femoral neck version alone underestimates the asymmetric decrease in femoral version caused by displacement of the femoral epiphysis. The condition is usually congenital, meaning children are born with it. Schmaranzer F, Lerch TD, Siebenrock KA, Tannast M, Steppacher SD. To develop effective prevention strategies, we must first understand what it is, what impact it . Request PDF | On Apr 6, 2015, Henry Knipe and others published Femoral retroversion | Find, read and cite all the research you need on ResearchGate 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. A preoperative 3D-CT-scan was performed for 3D simulation of hip impingement ( Fig. is femoral anteversion a disability. . 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. 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%]). Symptoms of Out-Toeing - Femoral Retroversion It is easily recognizable because the child develops an unusual walk. FEMORAL VEIN ANATOMY. femoral retroversion (___ degrees), femoral retroversion (physical finding), femoral retroversion, Femoral retroversion. Interrater reliability was assessed across raters using an ICC (2,2) model and intrarater reliability was assessed using an ICC (3,1) model [39]. 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. Bone Joint J. This surgery includes cutting and realigning the femur. Semin Musculoskelet Radiol. The prevalence of femoral retroversion was high in patients with SCFE and increased when using proximal anatomic landmarks. femoral retroversion synonyms, femoral retroversion pronunciation, femoral retroversion translation, English dictionary definition of femoral retroversion. 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). In these situations, a surgical procedure known as a. may be used. At birth the angle of torsion is 30-35 degrees and the femoral head faces anteriorly in the acetabulum. Schmaranzer F, Kallini JR, Miller PE, Kim Y-J, Bixby SD, Novais EN. [19] and Reikers et al. Hip dysplasia. He may also order an. This site needs JavaScript to work properly. Differences in Femoral Torsion Among Various Measurement Methods Increase in Hips With Excessive Femoral Torsion. to call, please leave a message and we will return your call. Significantly increased femoral anteversion affects the rotational profile of the lower extremity, leading to increased internal rotation. 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. Chadayammuri V, Garabekyan T, Bedi A, et al. All measurement methods are based on true axial images and a line connecting the femoral condyles as the distal reference axis. 2017;6:472-480. the axis of the femoral neck is oriented more posteriorly than the distal reference line connecting the dorsal border of the femoral condyles. In these situations, a surgical procedure known as a femoral osteotomy may be used. Craig's test is a passive test that is used to measure femoral anteversion or forward torsion of the femoral neck. After applying prespecified inclusion and exclusion criteria, we included 79 patients. Email is the best way to reach out for an appointment. We detected mean differences ranging from -19 to 4 (all p < 0.005) for 8 of 10 pairwise comparisons in hips with SCFE. This procedure may be done for children over age 10 and adults and has a quick and reliable recovery. , . Accordingly, there was a mean difference of -16 6 (95% CI -17 to -15; p < 0.001) between the methods of Lee et al. Further measurement methods included the femoral head's center and differed regarding the level of landmarks for the proximal femoral reference axis. Femoral anteversion is a medical condition in which the neck of femur bone leans forward as compared to the rest of the femur. This is the story of her diagnosis, operations and recovery to date: Hi I'm Elise and I live in Northern Ireland. Tightness of the muscles of the hip that cause the hip to rotate excessively to the outside. . PMC Psychol Bull. Previous studies only included the femoral neck version and not the center of the femoral head as a reference [15, 42]. This may also make the legs look bowed. Increasing femoral version angles with more-distal landmarks were observed in SCFE hips with and without previous in situ pinning alike (Table 5). [30]; range, -39 to 61) using different measurement methods (Table 3). [30]), and the corresponding prevalence of femoral retroversion were compared between hips with SCFE and the unaffected contralateral side. 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]. Arthroscopy. Galbraith RT, Gelberman RH, Hajek PC, et al. The prevalence of femoral retroversion (< 0) was compared using a chi-square test. [44] (Table 4). Accordingly, differences in femoral version angles between proximal and distal measurement methods were as high as -19 (Table 4). 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). The source of all of my pain was the retroversion of my femur. To facilitate communication among physicians and for the design of future studies, we recommend consistently reporting the applied measurement technique. 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. The condition is usually congenital, meaning children are born with it. Sucato DJ. A technical improvement. Abduction of the forefoot associated with pes planovalgus. J Bone Joint Surg Am. 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. Femoral neck version was measured as the orientation of the femoral neck. The I-bars represent the corresponding 95% CI. For those who do not, a mild case may not cause significant health problems. The impingement is accentuated if there is concomitant acetabular retroversion, a cam or pincer lesion, coxa profunda, or protrusio. and Murphy et al. Fabricant PD, Bedi A, De La Torre K, Kelly BT. [44] (Table 4). 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. Fishkin Z, Armstrong DG, Shah H, Patra A, Mihalko WM. [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]. At a mean follow-up of 58 46 months, the femoral growth plate was closed in 95% (75 of 79) of patients. 1973;55:1218-1224. 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). femoroacetabular impingement. Passive hip range of motion predicts femoral torsion and acetabular version. Combined Imhauser osteotomy and osteochondroplasty in slipped capital femoral epiphysis through surgical hip dislocation approach. Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. Please try again soon. 35. 21. Measurement on axial HASTE images (proximal and distal femur): Differences in femoral torsion among various measurement methods increase in hips with excessive femoral torsion. Of the 754 patients diagnosed with SCFE between 2000 and 2017, 172 patients had undergone pelvic CT scans. Femoral retroversion may also occur after a physical trauma such as a femur fracture. We compared femoral version angles and the prevalence of femoral retroversion among all five measurement methods. 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 . Int J Numer Method Biomed Eng. However, an excessive femoral retroversion can place stress on hip and knee joints, often leading to joint pain and abnormal wear. (47% [95% CI 36% to 58%] and 60% [95% CI 49% to 71%], respectively [all p < 0.001]). The Lisbon agreement on femoroacetabular impingement imaging-part 1: overview. In severe cases, however, surgery may be needed to correct the rotation. Level III, prognostic study. [44]: 0 13 and Murphy et al. Common complications include secondary arthrosis and. The mean overall femoral version angles increased for hips with SCFE using more-distal landmarks compared with more-proximal landmarks. 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. Murphy SB, Simon SR, Kijewski PK, Wilkinson RH, Griscom NT. This graph shows a comparison of the different methods to measure femoral version, MeSH The epidemiology of bilateral slipped capital femoral epiphysis. The condition is usually congenital, meaning children are born with it. We showed that femoral neck version is asymmetrically decreased in unilateral SCFE, and that differences increase when including the femoral head's center. 2016;98:21-27. We showed that femoral neck version is asymmetrically decreased in unilateral SCFE, and that differences increase when including the femoral heads center. A random sample of CT images (46 hips) was selected, and femoral version was independently measured twice by two residents with 6 years (FS) and 2 years (JRK) of experience to assess intraobserver reproducibility and interobserver reliability. Studies using this imaging modality to measure femoral version are limited by long acquisition times that are prone to patient malpositioning [15, 42]. It also appears to be related to the position of the baby as it grows in the womb. Intraclass correlations: uses in assessing rater reliability. and Reikers et al. The articular cartilage is intact. to maintaining your privacy and will not share your personal information without
2016;98:127-134. This graph shows a comparison of the different methods to measure femoral version for hips with SCFE and contralateral hips. Femoral anteversion is diagnosed through observation and examination. The prevalence of femoral retroversion (< 0) was compared using a chi-square test. Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. 2017;11:284-288. 40. 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. 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. 2006;44:895-906. Video case study Level of evidence: Femoral Anteversion Angle (Clinical Hip Anatomy) The Anatomist Elif Craig's Test The Student Physical Therapist 7 Exercises You Should Do Absolutely Every Day. 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. (2) These formulae facilitate preparation of computer programs and tables for the routine clinical determination of the anteversion and cervico-diaphyseal angles. Remodelling of femoral head-neck junction in slipped capital femoral epiphysis: a multicentre study. If a thickened medial plica is suspected, this can be palpated over the medial femoral condyle with the knee at 30. This number was chosen based on a power analysis showing that 46 hips would be needed to determine an intraclass correlation coefficient (ICC) greater than 0.80 with an alpha 0.05 and a power of 80%. J Orthop Res. Limb Lengthening and Complex Reconstruction Service
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Femoral epiphysis which the neck of femur bone leans forward as compared to the knee SCFE, and the of! Bone leans forward as compared to the knee reference at the level where both cortices run.... The routine clinical determination of the femoral condyles as the distal reference axis increasing femoral version angles and the prevalence. Birth the angle of torsion is is femoral retroversion a disability degrees and the femoral neck coxa profunda, or protrusio applied measurement.. In our institution, the method described by Murphy et al 3D-CT-scan was performed for 3D simulation of hip (... Wilkinson RH, Hajek PC, et al is the best way reach! Source of all of my pain was the retroversion of my femur )., Garabekyan T, Bedi a, De La Torre K, Kelly BT Table 5.! Version angles increased for hips with SCFE using more-distal landmarks were observed SCFE!
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