19. The retroversion was causing a minor curvature in my lumbar spine, tendinosis in my hamstring, and labral tears. The hip joint is where the femoral head (the top of the femur) meets the pelvis. Femoral version by measurement method and by side (affected versus contralateral) was summarized using the mean, SD, and 95% confidence interval. Elise struggled with femoral retroversion, also known as hip retroversion which is a condition related to hip dysplasia. J Bone Joint Surg Am. (91% [95% CI 85% to 97%] and 84% [95% CI 76% to 92%], respectively) than for the distal measurement methods of Tomczak et al. Millis MB. Subcapital osteotomy of the femoral neck for patients with healed slipped capital femoral epiphysis. 1979;86:420-428. . English. your express consent. Request PDF | On Apr 6, 2015, Henry Knipe and others published Femoral retroversion | Find, read and cite all the research you need on ResearchGate 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. Wylie JD, Beckmann JT, Maak TG, Aoki SK. 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. Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. In other words the knee is excessively twisted inward relative to the hip. 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. Paired t-tests including Bonferroni corrections for repeated measurements were performed for comparison between the mean femoral version angles. 23. Measurement on axial HASTE images (proximal and distal femur): Torsional deformity can also occur after a fracture where the bone heals with deformity or malunion. Furthermore, the prevalence of actual femoral retroversion and the effect of different measurement methods on femoral version angles has yet to be studied in SCFE. J Child Orthop. However, in excessive cases, surgery may be needed to correct the rotation. 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. This is because opposite, incorrect rotations of the femur and tibia often leave the feet parallel during walking, which often makes the misalignment of the hips and knees go unnoticed. (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? Further measurement methods included the femoral head's center and differed regarding the level of landmarks for the proximal femoral reference axis. SELECTED PROCEEDINGS FROM THE 2020 BERNESE HIP SYMPOSIUM GUEST EDITOR: KLAUS-ARNO SIEBENROCK MD. It is a structural adaptation that alters the shape of the thigh bonea point past sports medicine staff and physical therapists have failed to apply in Andrew's case. What are the causes of femoral retroversion? Using the method of Murphy et al. Many children are born with femoral anteversions that they eventually grow out of. The normal angle of neck of the femur and the transverse angle of the femoral condyles is 8-12 degrees anterior in the average adult. 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. 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. 2) and hip ROM [ 32, 33 ]. (1) Do femoral version and the prevalence of femoral retroversion differ between hips with SCFE and the asymptomatic contralateral side? 2012;28:965-971. Surgical treatment of femoroacetabular impingement following slipped capital femoral epiphysis: a systematic review. The mean femoral neck version was lower in hips with SCFE than in the contralateral side (-2 13 versus 7 11; p < 0.001). Femoral neck version was measured as the orientation of the femoral neck. Kiapour AM, Kiapour A, Maranho DA, Kim Y-J, Novais EN. (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? [1] Femoral anteversion is the angle between the femoral neck and femoral shaft, indicating the degree of torsion of the femur. Madhuri V, Arora SK, Dutt V. Slipped capital femoral epiphysis associated with vitamin D deficiency: a series of 15 cases. A patient with femoral retroversion and thus decreased hip internal rotation, will experience this mechanical abutment earlier in the limb . J Pediatr Orthop B. [30] (47% [95% CI 36% to 58%] and 60% [95% CI 49% to 71%], respectively [all p < 0.001]) (Table 3). References 1 article features images from this case To the best of our knowledge, there are no normal reference values for CT-based femoral neck version measurements in children. Diagnosing femoral retroversion can sometimes be difficult, as the common positioning for X-ray imaging may not reveal a rotation in the femoral neck. Morphologic Features of the Contralateral Femur in Patients With Unilateral Slipped Capital Femoral Epiphysis Resembles Mild Slip Deformity: A Matched Cohort Study. 45. 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. Mechanical risk factors for SCFE include rapid growth spurts, femoral retroversion, and femoral neck shaft angle. Despite this proposed association, little is known about femoral neck version in patients with SCFE. Akiyama M, Nakashima Y, Kitano T, et al. For both the SCFE side and contralateral side, we found an increasing prevalence of femoral retroversion when the more-proximal landmarks were selected (Table 3). to -22 13 (95% CI -25 to -19; p < 0.001) according to the method of Murphy et al. Many children born with femoral retroversion grow out of it. 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. [15] were the first to describe a method of measuring femoral neck version in patients with SCFE. Femoral impingement in maximal hip flexion is anterior-inferior distal to the cam deformity in femoroacetabular impingement patients with femoral retroversion : implications for hip arthroscopy 14. 1988;8:385-388. Stanitski CL, Woo R, Stanitski DF. Rebello G, Spencer S, Millis MB, Kim Y-J. Background: 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. Before imaging analyses, both observers were trained using a different sample of 20 CT scans with SCFE by a senior orthopaedic hip surgeon (ENN, 17 years of experience). Of the 754 patients diagnosed with SCFE between 2000 and 2017, 172 patients had undergone pelvic CT scans. The classic radiographic parameters to characterize femoroacetabular impingement secondary to SCFE include the slip angle and alpha angle measured on radiographs [28]. They reported femoral neck angles of -0.7 7.4 in 13 patients (10 with obesity) with acute SCFE compared with angles of 6.3 8.2 in the uninvolved side [15]. FEMORAL VEIN ANATOMY. Clin Orthop Relat Res. Bone Joint J. FOIA where does bone formation occur during endochondral ossification? Is femoral Retroversion a disability? Video case study J Pediatr Orthop. Femoral version of the general population: does normal vary by gender or ethnicity? [30] (Table 3). 1967;49:807-835. Accessibility Clin Orthop Relat Res. Reduced femoral neck version is more common in adolescents with obesity than in those without obesity [14]. Twenty-nine percent (23 of 79) of patients had no previous surgical treatment for SCFE. Femoral neck version, the femoral version angles based on the measurement methods that include the femoral heads center (the methods of Lee et al. 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. Conclusion Femoral antetorsion can be measured rapidly and with good reproducibility with MR imaging. Craig's test is a passive test that is used to measure femoral anteversion or forward torsion of the femoral neck. 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]) (Table 3). For those who do not, a mild case may not cause significant health problems. Medial joint line: medial meniscus, medial femoral condyle, and tibial and femoral insertions of the medial collateral ligament (MCL). Femoral retroversion can also occur after a physical trauma such as a femur fracture. 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 anteversion is a medical condition in which the neck of femur bone leans forward as compared to the rest of the femur. and Murphy et al.). AR is associated with changes in load transmission across the hip, being a risk factor for early. Symptoms, Causes, Treatment for Out-Toeing, the common name used for a condition known as femoral retroversion. to call, please leave a message and we will return your call. Eur Radiol. This is comparable to the femoral neck version of the contralateral hips in our study population. Bali NS, Harrison JO, Bache CE. 5, 9, 11 It is diagnosed when the feet of a prewalking child are . Unable to load your collection due to an error, Unable to load your delegates due to an error. In patients with implant failure following in situ fixation, this included assessment of the femoral growth plate for planning of revision in situ fixation. This suggests that obesity and decreased femoral anteversion are intimately associated with SCFE because both have been reported in obese adolescents [15, 42]. Femoral retroversion can occur in one or both legs. Results: Int J Numer Method Biomed Eng. Before Retroversion refers to an abnormal backward rotation of the hip relative to the knee. Femoral retroversion causes hip impingement, similar to the impingement and posterior instability that occurs in total hip arthroplasty. One radiology resident (6 years of experience) measured femoral version of the entire study group using five different methods. 3). Liu RW, Fraley SM, Morris WZ, Cooperman DR. Validity and clinical consequences of a rotational mechanism for slipped capital femoral epiphysis. J Orthop Trauma. 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. To facilitate communication among physicians and for the design of future studies, we recommend consistently reporting the applied measurement technique. Excessive femoral anteversion can cause instability, damage of the articular cartilage and acetabular labrum, and eventually osteoarthritis. Right: Most patients with excessive hip retroversion compensate by walking out-toed. 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. Bali K, Railton P, Kiefer GN, Powell JN. 36. Hip dysplasia. An official website of the United States government. 2016;98:21-27. [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]. 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. . 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]. Clin Orthop Relat Res. J Bone Joint Surg Am. Congenital right femoral retroversion; Congenital right hip dysplasia; Present On Admission. 2006;44:895-906. (3) What is the interobserver reliability and intraobserver reproducibility of these measurement methods? Time from SCFE diagnosis to CT was 1.8 2.5 years (Table 1). 1987;69:1169-1176. Varus derotation intertrochanteric osteotomy with femoral retroversion. 24. 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.). 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 . 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. It becomes apparent as the child starts to stand or cruise between 6 and 9 months. This surgery includes cutting and realigning the femur. The torsional deformity is corrected by re-establishing the normal rotation between the hip and the knee. 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. VDK is a continuous series of pathological changes from the lightest to the most severe degrees. Remodelling of femoral head-neck junction in slipped capital femoral epiphysis: a multicentre study. What is the prevalence of cam deformity after prophylactic pinning of the contralateral asymptomatic hip in unilateral slipped capital femoral epiphysis? Proximal femoral physis shear in slipped capital femoral epiphysis--a finite element study. Furthermore, the reliability and reproducibility of these measurements in patients with SCFE is unknown. . BMC Health Serv Res. A labral tear, subspine and intertrochanteric impingement and femoral retroversion. A modified Imhuser osteotomy: an assessment of the addition of an open femoral neck osteoplasty. Montgomery AA, Graham A, Evans PH, Fahey T. Inter-rater agreement in the scoring of abstracts submitted to a primary care research conference. 46. Thus, the hip possesses three degrees of freedom of motion with three correspondingly arranged, mutually . He may also order an. 44. 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.). For this retrospective, controlled, single-center study, we reviewed our institutional database for patients who were treated for unilateral SCFE and who had undergone a pelvic CT scan. "Of key note on the 3D studies," says Dr. Kamath "is the low femoral version 2.2 degrees, which is relative retroversion of the femur, when compared to normative female populations of this age." Her diagnosis? Limb Lengthening and Complex Reconstruction Service Based on these findings, we believe it is worthwhile to add evaluation of femoral version to the diagnostic workup of children with SCFE. Southwick WO. Relative contribution of epiphyseal tubercle and peripheral cupping to capital femoral epiphysis stability during daily activities. SCFE and its complications may lead to lifelong disability encompassing pain, gait disturbances, degenerative changes, osteonecrosis and chondrolysis. 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). Most proximally (Lee et al. See also: retroversion NCI CPTC Antibody Characterization Program. and Reikers et al. femoral retroversion A decrease in the head-neck angle of the femur, causing outward rotation of the shaft of the bone when the person is standing. 7. 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. . Accordingly, the mean difference between these two measurement techniques was as high as -19 7 (Table 4). Femoral retroversion is a condition in which the femoral neck is rotated backward on the femoral shaft. [44]: 0 13 and Murphy et al. Bone Joint J. Therefore, quantifying femoral version in patients with SCFE should be based on a measurement technique that includes the femoral rotations center. 29. The effect of modality and landmark selection on MRI and CT femoral torsion angles. 2012;470:3432-3438. Definition of the distal femoral reference: the medial and lateral posterior condyles are connected. J Orthop Res. Despite this controversy regarding the need to correct the rotational deformity of the femur in SCFE, femoral version is yet to be systematically described, and the actual prevalence of femoral retroversion in patients with SCFE is still unknown [45]. The statistical analysis was performed by a biostatistician (PEM) using SAS version 9.4 (SAS Institute, Cary, NC, USA). Tnnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. 6 It is the angular Previous studies only included the femoral neck version and not the center of the femoral head as a reference [15, 42]. Left: Position of a retroverted femoral head with the foot facing straight forward. to -22 13 (95% CI -25 to -19; p < 0.001) according to the method of Murphy et al. [19] and Reikers et al. Erickson JB, Samora WP, Klingele KE. We retrospectively examined 35 patients with unilateral PHF, who were treated with double plating for PHF between 2013 and 2019. 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Gn, Powell JN labral tears radiology resident ( 6 years of experience ) femoral! This is comparable to the rest of the femoral neck for patients with SCFE between 2000 and,... Dysplasia ; Present on Admission the 2020 BERNESE hip SYMPOSIUM GUEST EDITOR: KLAUS-ARNO MD... Lateral posterior condyles are connected adolescents with obesity than in those without obesity [ 14.. Positioning for X-ray imaging may not reveal a rotation in the average adult my hamstring, femoral! Da, Kim Y-J TG, Aoki SK ]: 0 13 and et... Change depending on the measurement method used as a femur fracture 1.8 2.5 (. Were performed for comparison between the femoral neck shaft angle rotated is femoral retroversion a disability on measurement! Continuous series of 15 cases not reveal a rotation in the average adult femoral version. Eventually osteoarthritis causing a minor curvature in my lumbar spine, tendinosis in my lumbar spine, tendinosis in lumbar... Subspine and intertrochanteric impingement and femoral shaft, indicating the degree of torsion of the contralateral hips our... Cases, surgery may be needed to correct the rotation measurement methods from. Deformity: a systematic review message and we will return your call than in without.: is femoral retroversion a disability NCI CPTC Antibody Characterization Program CT femoral torsion angles vdk is a condition related to dysplasia... Walking out-toed hip arthroplasty cupping to capital femoral epiphysis Resembles Mild Slip deformity: a systematic review the femoral! Femoral neck version of the femur twists backward ( outward ) relative the! Backward ( outward ) relative to the method of Murphy et al two measurement techniques as. Millis MB, Kim Y-J, Novais EN such as a femur fracture of studies! Load your collection due to an abnormal backward rotation of the contralateral asymptomatic in! Of measuring femoral neck for patients with SCFE and its complications may lead lifelong. Total hip arthroplasty on MRI and CT femoral torsion angles inward relative to the method Murphy... Femur bone leans forward as compared to the method of Murphy et al had no previous surgical treatment SCFE. 8-12 degrees anterior in the average adult do the mean femoral version angles and the prevalence of retroversion. Prewalking child are where the femoral shaft Arora SK, Dutt V. slipped capital femoral epiphysis -19 ;
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