During this time period, 754 patients were diagnosed with SCFE. However, Koerner et al. Accordingly, there was a mean difference of -16 6 (95% CI -17 to -15; p < 0.001) between the methods of Lee et al. The doctor will also observe the patients gait (manner of walking) to look for signs of out-toeing or gait compensation. Disclaimer, National Library of Medicine 2016;36:239-246. Clinical data is missing for assessment of clinical and radiological outcome, as well as complications. She was treated with an open reduction and bracing in infancy. In hips with SCFE, we found excellent agreement (intraclass correlation coefficient [ICC] > 0.80) for intraobserver reproducibility (reader 1, ICC 0.93 to 0.96) and interobserver reliability (ICC 0.95 to 0.98) for all five measurement methods. Lee YS, Oh SH, Seon JK, Song EK, Yoon TR. 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. Conclusion Femoral antetorsion can be measured rapidly and with good reproducibility with MR imaging. See also: retroversion 2. [19]) compared with distal landmarks to define the femoral reference axis (47% for the method of Tomczak et al. I've recently turned 18 and I want to share my experience of femoral retroversion. 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. The patient is a 19-year-old female who was born with a dislocated right hip. J Bone Joint Surg Am. Lerch TD, Boschung A, Todorski IAS, et al. Significantly increased femoral anteversion affects the rotational profile of the lower extremity, leading to increased internal rotation. [44] (Table 4). [1] Femoral anteversion is the angle between the femoral neck and femoral shaft, indicating the degree of torsion of the femur. To develop effective prevention strategies, we must first understand what it is, what impact it . 39. 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 axis of the femoral neck is oriented more posteriorly than the distal reference line connecting the dorsal border of the femoral condyles. 30. 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. Level of evidence: In many cases, the child may grow out of it. The method of Reikers et al. It is typically detected when the child is 4 years to 6 years old. Kiapour AM, Kiapour A, Maranho DA, Kim Y-J, Novais EN. 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. Arthroscopic treatment of mild to moderate deformity after slipped capital femoral epiphysis: intra-operative findings and functional outcomes. 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. Psychol Bull. Out-toeing is the common name used for a condition known as femoral retroversion. This could theoretically affect anatomic landmark selection for femoral version measurements and corresponding femoral version angles. 37. Differences in femoral torsion among various measurement methods increase in hips with excessive femoral torsion. J Bone Joint Surg Am. 44. 22. The https:// ensures that you are connecting to the J Child Orthop. The remaining four measurement methods use the femoral heads center as the most proximal reference. J Bone Joint Surg Am. Passive hip range of motion predicts femoral torsion and acetabular version. Bob & Brad 3.9M views 5 years ago. Hip/Femoral Anteversion: Causes, Symptoms, Treatment There are 2 types of femoral version: Femoral Anteversion; Femoral Retroversion AR is associated with changes in load transmission across the hip, being a risk factor for early osteoarthrosis. and Reikers et al.) 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 P1BEP3_181643, CHF 46000. retroversion, reduced thoracic kyphosis (TK), increased knee flexion, and increased pelvic shift to balance the SVA, indicat-ing that other sagittal parameters influence sagittal align-ment.9,10 Additionally, cervical sagittal parameters relate to HRQoL and disability, stressing the importance of considering 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). 13. 3). Lerch TD, Todorski IAS, Steppacher SD, et al. Children with femoral anteversion may trip and fall more than their peers, but the condition is rarely painful. Despite this proposed association, little is known about femoral neck version in patients with SCFE. [44] and Murphy et al. The effects of simulated microgravity on the static and dynamic properties of large arteries are still mostly unknown. J Bone Joint Surg Am. Femoral retroversion can occur in one or both legs. 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. 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. For those who do not, a mild case may not cause significant health problems. 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. For more information, please refer to our Privacy Policy. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. Treatment of chronic, stable slipped capital femoral epiphysis via surgical hip dislocation with combined osteochondroplasty and Imhauser osteotomy. Based on these findings, we believe it is worthwhile to add evaluation of femoral version to the diagnostic workup of children with SCFE. 519 East 72nd St., Suite 204 The classic radiographic parameters to characterize femoroacetabular impingement secondary to SCFE include the slip angle and alpha angle measured on radiographs [28]. 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. 1988;8:385-388. Definition of the distal femoral reference: the medial and lateral posterior condyles are connected. We reviewed our institutional database for patients who were treated for SCFE and had undergone pelvic CT scanning for surgical planning. Analogously, we found excellent agreement (ICC > 0.80) for intraobserver reproducibility for reader 1 (ICC 0.91 to 0.96) and reader 2 (ICC 0.92 to 0.99) and interobserver reliability (ICC 0.89 to 0.98) for all five measurement methods in the healthy contralateral hips (Table 6). Journal of Clinical Medicine. CORR Insights: How Common Is Femoral Retroversion and How Is it Affected by Different Measurement Methods in Unilateral Slipped Capital Femoral Epiphysis? 35. This yielded a mean difference of -19 7 (95% CI -21 to -18; p < 0.001) between the methods of Lee et al. To facilitate communication among physicians and for the design of future studies, we recommend consistently reporting the applied measurement technique. CLINICAL FEATURES Symptoms Will cause out-toeing and may lead to disability and decrease physical performance. Femorln retroverze. [30]; range, -39 to 61) using different measurement methods (Table 3). 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. [15] were the first to describe a method of measuring femoral neck version in patients with SCFE. 2013;37:2331-2336. 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. Therefore, quantifying femoral version in patients with SCFE should be based on a measurement technique that includes the femoral rotations center. [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. 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. The five different measurement methods were applied in the same way in hips with SCFE and in healthy contralateral hips (Fig. Femoral retroversion is often a congenital condition, meaning children are born with it. 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. Studies using this imaging modality to measure femoral version are limited by long acquisition times that are prone to patient malpositioning [15, 42]. CT images of 123 patients included the femoral condyles and were further screened for the inclusion criteria: age 10 to 30 years with a diagnosis of unilateral SCFE that was untreated at the time of imaging or treated with previous in situ fixation. 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. From proximal to distal, this included the most-proximal methods (Lee et al. 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]. [19] method -19 16 [95% CI -25 to -12] versus -19 16 [95% CI -23 to -15]; p = 0.90, respectively) (Table 5). One radiology resident (6 years of experience) measured femoral version of the entire study group using five different methods. J Child Orthop. 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. The prevalence of femoral retroversion was high in patients with SCFE and increased when using proximal anatomic landmarks. However, in excessive cases, surgery may be needed to correct the rotation. (1) Do femoral version and the prevalence of femoral retroversion differ between hips with SCFE and the asymptomatic contralateral side? In some cases, the doctor may perform a less invasive version of a femoral osteotomy. FOIA This procedure may be done for children over age 10 and adults and has a quick and reliable recovery. At times, pure femoral retroversion may be the only source of hip impingement. Limb Lengthening and Complex Reconstruction Service 17. 40. Elise struggled with femoral retroversion, also known as hip retroversion which is a condition related to hip dysplasia. This causes rotation of the legs inwards leading to twisting of the knee and foot towards the midline of the body (center of the body). 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). Video case study 2017;11:284-288. 2020;14:98-105. The doctor will also observe the patients gait (manner of walking) to look for signs of out-toeing or gait compensation. Thus, the hip possesses three degrees of freedom of motion with three correspondingly arranged, mutually . Future studies should compare femoral version in SCFE hips to age-matched volunteers without a history of hip disease. Common complications include secondary arthrosis and. NCI CPTC Antibody Characterization Program. The minimum slice thickness was 2 mm. Bookshelf The hip joint and psoas muscle lie directly deep to the femoral . However, severe cases require surgical correction. Retroversion refers to an abnormal backward rotation of the hip relative to the knee. The doctor will also observe the patients gait (manner of walking) to look for signs of out-toeing or gait compensation. 15. All five methods were compared side-by-side (involved versus uninvolved hip), and comparisons among all five methods were performed using paired t-tests. Clinical outcomes after arthroscopic psoas lengthening: the effect of femoral version. These methods differ regarding the definition of the second reference point to determine the proximal reference line (Table 2). The Hip Disability and Osteoarthritis Outcome Score (HOOS) (Klassbo et al., 2003; Nilsdotter et al., 2003), was administered to determine level of hip-specific functional disability in the CHJP group. A turning or tilting backward. J Bone Joint Surg Am. 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