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Aberrant Femoral Torsion Presenting with Frog-leg Squatting Mimicking Gluteal Muscle Contracture

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Patients with frog-leg squatting have restricted internal rotation and adduction of the affected hips during sitting or squatting. In the surgical literature, the cause generally has been presumed to arise from and be pathognomonic for gluteal muscle contracture. However, we have encountered patients with frog-leg squatting but without gluteal muscle contracture.

Questions/purposes

We therefore raised the following questions: What are the imaging features of patients with frog-leg squatting? Do conditions other than gluteal muscle contracture manifest frog-leg squatting?

Patients and Methods

We retrospectively reviewed the MR images of 67 patients presenting with frog-leg squatting from April 1998 to July 2010. There were four females and 63 males; their mean age was 22.2 years (range, 4–50 years). During MRI readout, we observed aberrant axes of some femoral necks and obtained additional CT to measure femoral torsion angles in 59 of the 67 patients.

Results

MR images of 27 (40%) patients had signs of gluteal muscle contracture. Twenty-two (33%) patients (40 femora) had aberrant femoral torsion, including diminished anteversion (range, 6°–0°; average, 3.9°) in 11 femora of eight patients and femoral retroversion (range, < 0° to −31°, average, −7.5°) in 29 femora of 17 patients. The remaining 18 (27%) patients did not have gluteal muscle contracture or aberrant femoral torsion. The observation of aberrant femoral torsion was not anticipated before imaging studies.

Conclusions

In addition to gluteal muscle contracture, aberrant femoral torsion can be a cause of frog-leg squatting.

Level of Evidence

Level II, diagnostic study. See the guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank the CT and MRI radiographers for assistance in performing these imaging studies.

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Authors and Affiliations

  1. Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Chia-Ling Chiang MD, Meng-Yuan Tsai MD & Clement Kuen-Huang Chen MD

  2. Department of Orthopaedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Wei-Ning Chang MD

  3. Department of Medical Imaging, Chi Mei Medical Center, Number 901, Zhonghua Road, Yongkang District, Tainan City, 71004, Taiwan

    Clement Kuen-Huang Chen MD

  4. National Yang-Ming University School of Medicine, Taipei, Taiwan

    Clement Kuen-Huang Chen MD

Authors
  1. Chia-Ling Chiang MD
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  2. Meng-Yuan Tsai MD
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  3. Wei-Ning Chang MD
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  4. Clement Kuen-Huang Chen MD
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Corresponding author

Correspondence to Clement Kuen-Huang Chen MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that Kaohsiung Veterans General Hospital approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Kaohsiung Veterans General Hospital.

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Chiang, CL., Tsai, MY., Chang, WN. et al. Aberrant Femoral Torsion Presenting with Frog-leg Squatting Mimicking Gluteal Muscle Contracture. Clin Orthop Relat Res 470, 1165–1170 (2012). https://doi.org/10.1007/s11999-011-2084-7

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  • DOI: https://doi.org/10.1007/s11999-011-2084-7

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