Zusammenfassung
Hintergrund
Torsionen sind ein häufiger Konsultationsgrund in der kinderorthopädischen Sprechstunde. Die Torsionen von Femur und Tibia bei Kindern verändern sich im Laufe des Wachstums. Je nach Alter und Kompensationsmöglichkeit können sich diese im Gangbild wiederspiegeln. Verschiedene Ursachen können die normale Entwicklung der Torsionen beeinflussen.
Diagnostik
Im Rahmen der kinderorthopädischen Abklärung ist die Unterscheidung zwischen physiologischen und pathologischen Torsionsverhältnissen essenziell. Neben der Anamnese und Observation des Gangbildes sowie einer ausführlichen klinischen Untersuchung kommen, je nach Befund, zusätzliche bildgebende Verfahren zur Anwendung (Rippstein-Aufnahmen, Torsions-CT/MRT, EOS [Ganzkörperbildgebungssystem]). Bei auffälligen Torsionen wird mittels instrumenteller 3‑D-Ganganalyse die dynamische Auswirkung auf das Gangbild evaluiert.
Pathogenes
Die Evidenz zur langfristigen Bedeutung von Torsionsabweichungen und das Risiko für Folgeschäden sind gering. Prinzipiell ist die isolierte vermehrte femorale Antetorsion ohne begleitende Hüftdysplasie harmlos, bildet sich im Wachstum zurück und muss nur in seltenen Fällen bei störendem Gangbild oder bei Knieproblemen korrigiert werden. Dagegen stellt die Retrotorsion wahrscheinlich eine präarthrotische Fehlstellung dar und sollte großzügiger beobachtet und behandelt werden. Torsionen der Tibia zeigen eine hohe Variabilität und können die Entwicklung der femoralen Torsion beeinflussen. Abzugrenzen sind Torsionsfehlstellungen bei Kindern mit neurologischer oder syndromaler Grundsituation, wo die biomechanischen Einflüsse der Torsionen auf die Gangfunktionen in der Regel relevanter sind und daher auch häufiger eine Behandlung notwendig wird.
Therapie
Durch konservative Maßnahmen kann kein Effekt auf die knöcherne Situation erwartet werden. Eine Korrektur ist nur operativ durch eine Rotationsosteotomie zu erreichen. Die Technik unterliegt einem simplen Prinzip, wohingegen die Indikationsstellung und das Timing eine Herausforderung darstellen.
Abstract
Background
Torsion is a frequent reason for consultation in paediatric orthopaedics. Torsion of the femur and the tibia in children change during growth. Depending on the age and possibility for compensation, this can be reflected in the gait pattern. Different causes can affect the normal development of torsion.
Diagnostics
In the context of paediatric orthopaedic assessment, the distinction between physiological and pathological torsion is essential. In addition to the patient history and observation of the gait pattern, as well as a detailed clinical examination, additional imaging techniques are used (Rippstein/Dunn, torsional CT/MRI, EOS). The dynamic effect of abnormal torsion on gait is evaluated by instrumented 3D gait analysis.
Pathogenesis
Evidence for the long-term significance of torsional deviations and the risk of consequential damage are low. Isolated increased femoral anteversion without accompanying hip dysplasia is fundamentally harmless, corrects during growth and only rarely needs correction in the case of ongoing disturbing gait or knee problems. In contrast, retroversion is likely indicate the development of pre-arthritic deformity and should be observed and treated more carefully. Tibial torsion shows great variability and may influence the development of femoral torsion. Torsional deformities in children with neurological or syndromal conditions are differentiated as when the biomechanical effects of torsions on their gait function are generally more marked and therefore treatment is more frequently necessary.
Therapy
Conservative treatments cannot be expected to have an effect on the condition of the bones. Correction can only be achieved surgically with a rotational osteotomy. A simple principle underlies the technique, whereas indication and timing are challenging.
Abbreviations
- CT:
-
Computertomographie
- EOS:
-
Ganzkörperbildgebungssystem
- MRT :
-
Magnetresonanztomographie
- TPAT :
-
Trochanterpalpationstest
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Grisch, D., Dreher, T. Torsionen und Torsionsentwicklung der unteren Extremität. Orthopäde 48, 523–530 (2019). https://doi.org/10.1007/s00132-019-03752-3
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DOI: https://doi.org/10.1007/s00132-019-03752-3