The condition is usually congenital, meaning children are born with it. 4. Finite-element studies have demonstrated that shear forces across the capital femoral physis increase with reduced femoral anteversion and increased BMI [13, 33]. Torsional deformity can also occur after a fracture, if a broken bone heals with incorrectly (called malunion). A subset of patients was measured twice by two readers (FS, JRK) to assess intraobserver reproducibility and interobserver reliability. 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. Ethical approval for this study was obtained from the institutional review board of Boston Childrens Hospital (protocol number IRB-P00018761). Rebello G, Spencer S, Millis MB, Kim Y-J. In hips with SCFE, there was a mean difference of -13 9 (95% CI -15 to -12; p < 0.001) between femoral neck version and Reikers et al.s [35] method, which reflects femoral neck orientation relative to the femoral heads center (Table 4). This procedure may be done for children over age 10 and adults and has a quick and reliable recovery. All five methods were compared side-by-side (involved versus uninvolved hip), and comparisons among all five methods were performed using paired t-tests. Retrotorsion is a pathologic decrease in the torsion angle; ie it is less than 8 degrees. The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. The present study evaluated, using an integrated vascular approach, changes in structure and function of the common carotid and femoral arteries (CCA and CFA) after prolonged head-down tilt bed rest (HDTBR). This graph shows a comparison of the different methods to measure femoral version for hips with SCFE and contralateral hips. 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. 1997;168:791-794. External Tibial Torsion Much like internal tibial torsion, this condition improves in most children before or around the age of 10. [19] and Reikers et al. Doing so may better inform surgeons as they contemplate when to use isolated offset correction or perform an addional femoral osteotomy for SCFE correction based on the severity of the slip and the rotational deformity. Retroversion refers to an abnormal backward rotation of the hip relative to the knee. 22. Bone Joint J. The patient is a 19-year-old female who was born with a dislocated right hip. Shrout PE, Fleiss JL. The greatest differences were between measurement methods that are based on the most-proximal landmarks and those based on the more-distal landmarks. 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. [30]), and the corresponding prevalence of femoral retroversion were compared between hips with SCFE and the unaffected contralateral side. 1999;81:1747-1770. Elise struggled with femoral retroversion, also known as hip retroversion which is a condition related to hip dysplasia. Clin Orthop Relat Res. In some cases, hip/femoral retroversion may be combined with a separate torsional deformity, such as a rotation in the tibia. 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. Southwick WO. 11. [30], a recent study reported a prevalence of femoral retroversion (< 0) of 5% and a mean femoral version of 19 14 in a cohort of 538 hips with femoroacetabular impingement, developmental dysplasia of the hip, and Perthes disease [22]. Pain in the hip has been present for over 1 year, limiting activities. . Abstract Slipped capital femoral epiphysiolysis (SCFE) may result in femoroacetabular. 1996;5:74-76. In this position, the femoral head is not positioned normally in the hip joint. A 10-year minimum followup study. 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. We found that femoral neck version is asymmetrically decreased by -8 in unilateral hips with SCFE compared with contralateral hips. [30]; range, -39 to 61) using different measurement methods (Table 3). The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. Tnnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. Subcapital osteotomy of the femoral neck for patients with healed slipped capital femoral epiphysis. 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). Among 10 possible pairwise combinations, we detected differences for 8 pairwise comparisons in hips with SCFE (Table 4). How Common Is Femoral Retroversion and How Is it Affected by Different Measurement Methods in Unilateral Slipped Capital Femoral Epiphysis? The hip joint is where the femoral head (the top of the femur) meets the pelvis. Historically, severe and moderate SCFE deformities leading to symptomatic femoroacetabular impingement have been treated with an extraarticular approach by means of an intertrochanteric osteotomy [16, 41]. The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. My doctors would not treat me unless I had surgery to fix the retroversion. In our study, the prevalence of femoral retroversion was higher (60%) in hips with SCFE and the mean femoral version was decreased (-4 16) using the same method described by Murphy et al. Femoral retroversion is a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee. , and. Bookshelf J Pediatr Orthop. This is also called in-toeing. Bali K, Railton P, Kiefer GN, Powell JN. The ICC was graded as slight agreement for 0.20, 0.21 to 0.40 was graded as fair, 0.41 to 0.60 was graded as moderate, and more than 0.80 was graded as almost-perfect agreement [29]. Schmaranzer F, Meier MK, Lerch TD, Hecker A, Steppacher SD, Novais EN, Kiapour AM. In these situations, a surgical procedure known as a. may be used. Tightness of the muscles of the hip that cause the hip to rotate excessively to the outside. These side-by-side differences increased up to -22 (according to the method of Murphy et al. Tomczak et al.s [44] method uses the center of the base of the greater trochanter as a landmark. to call, please leave a message and we will return your call. 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. and Reikers et al. J Pediatr Orthop. A comprehensive analysis of femoral version may provide valuable baseline information to optimize surgical planning in hips with sequalae of SCFE and to allow standardization of studies investigating surgical correction of SCFE deformities. An official website of the United States government. In some cases, the doctor may perform a less invasive version of a femoral osteotomy. SCFE: clinical aspects, diagnosis, and classification. Time from SCFE diagnosis to CT was 1.8 2.5 years (Table 1). To facilitate communication among physicians and for the design of future studies, we recommend consistently reporting the applied measurement technique. 212-606-1415| 212-606-1550| 212-606-1637 | 212-606-1097. 2016;98:127-134. Your message has been successfully sent to your colleague. Please try again soon. 2021 May 1;479(5):935-944. doi: 10.1097/CORR.0000000000001590. and Reikers et al.) Future studies should compare femoral version in SCFE hips to age-matched volunteers without a history of hip disease. Schmaranzer F, Lerch TD, Siebenrock KA, Tannast M, Steppacher SD. However, severe cases require surgical correction. What Is the Association Among Epiphyseal Rotation, Translation, and the Morphology of the Epiphysis and Metaphysis in Slipped Capital Femoral Epiphysis? 21. Femoral Retroversion This condition rarely causes long-term problems, however, in some, it may predispose to slipped capital femoral epiphysis (SCFE). Bone Joint Res. 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. The I-bars represent the corresponding 95% CI. [30] (Table 3). 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 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). J Bone Joint Surg Am. sharing sensitive information, make sure youre on a federal 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. This surgery includes cutting and realigning the femur. Obesity and decreased femoral anteversion in adolescence. Left: Position of a retroverted femoral head with the foot facing straight forward. Montgomery AA, Graham A, Evans PH, Fahey T. Inter-rater agreement in the scoring of abstracts submitted to a primary care research conference. By continuing to use this website you are giving consent to cookies being used. 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. [19] method -19 16 [95% CI -25 to -12] versus -19 16 [95% CI -23 to -15]; p = 0.90, respectively) (Table 5). Bob & Brad 3.9M views 5 years ago. During this time period, 754 patients were diagnosed with SCFE. The physician may also order an X-ray or CT scan to look for possible deformities. In the axial HASTE images over the proximal and distal femur a femoral retroversion can be seen, i.e. Femoral Retroversion. 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. 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. Therefore, quantifying femoral version in patients with SCFE should be based on a measurement technique that includes the femoral rotations center.
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