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Femoral Anteversion in Children with Cerebral Palsy

  • Freeman Miller
Living reference work entry

Abstract

Children with cerebral palsy often develop internal rotation of the hip in early childhood. This internal rotation may slowly improve during childhood and then become worse during the adolescent growth period. The functional problems are related to internal rotation of the feet and or knees. Sometimes children or families complain of the knees knocking together and causing tripping during walking. It may also make sitting more difficult, but there is no evidence that specific sitting postures make this worse. The most common etiology of the internal rotation is failure of physiologic correction of normal infantile femoral torsion. Abnormal muscle forces are the most likely cause of this lack of bone remodeling. Other causes may include muscle contractures, abnormal motor control, and poor balance. When increased femoral anteversion is documented and is functionally causing problems, the correction is recommended by preforming a femoral derotation. The outcome is not dependent on where in the femoral osteotomy is made, so the surgeon may choose the location they find easiest to provide rigid fixation. Surgical correction is recommended between 7 and 12 years of age; however, waiting till completion of growth will not alter the outcome negatively.

Keywords

Femoral anteversion Femoral torsion Coxa valga Hip subluxation Hip rotation CT scan Ultrasound 

References

  1. Arnold AS, Delp SL (2001) Rotational moment arms of the medial hamstrings and adductors vary with femoral geometry and limb position: implications for the treatment of internally rotated gait. J Biomech 34:437–447CrossRefPubMedGoogle Scholar
  2. Bobroff ED, Chambers HG, Sartoris DJ, Wyatt MP, Sutherland DH (1999) Femoral anteversion and neck-shaft angle in children with cerebral palsy. Clin Orthop Relat Res (364):194–204CrossRefGoogle Scholar
  3. Brunner R, Baumann JU (1997) Long-term effects of intertrochanteric varus-derotation osteotomy on femur and acetabulum in spastic cerebral palsy: an 11- to 18-year follow-up study. J Pediatr Orthop 17:585–591CrossRefPubMedGoogle Scholar
  4. Chang CH, Wang YC, Ho PC, Hwang AW, Kao HK, Lee WC, Yang WE, Kuo KN (2015) Determinants of hip displacement in children with cerebral palsy. Clin Orthop Relat Res 473:3675–3681CrossRefPubMedPubMedCentralGoogle Scholar
  5. Chung CY, Lee KM, Park MS, Lee SH, Choi IH, Cho TJ (2010) Validity and reliability of measuring femoral anteversion and neck-shaft angle in patients with cerebral palsy. J Bone Joint Surg Am 92:1195–1205CrossRefPubMedGoogle Scholar
  6. Delp SL, Hess WE, Hungerford DS, Jones LC (1999) Variation of rotation moment arms with hip flexion. J Biomech 32:493–501CrossRefPubMedGoogle Scholar
  7. Dreher T, Wolf SI, Heitzmann D, Swartman B, Schuster W, Gantz S, Hagmann S, Doderlein L, Braatz F (2012) Long-term outcome of femoral derotation osteotomy in children with spastic diplegia. Gait Posture 36:467–470CrossRefPubMedGoogle Scholar
  8. Dunlap K, Shands A, Hollister L, Gaul J, Streit H (1953) A new method for determination of torsion of the femur. J Bone Joint Surg Am 53A:289–311CrossRefGoogle Scholar
  9. Eilert RE, MacEwen GD (1977) Varus derotational osteotomy of the femur in cerebral palsy. Clin Orthop Relat Res (125):168–172Google Scholar
  10. Elke R, Ebneter A, Dick W, Fliegel C, Morscher E (1991) Ultrasound measurement of femur neck anteversion. Z Orthop Ihre Grenzgeb 129:156–163CrossRefPubMedGoogle Scholar
  11. Fujiwara M, Basmajian JV, Iwamoto M (1976) Hip abnormalities in cerebral palsy: radiological study. Arch Phys Med Rehabil 57:278–281PubMedGoogle Scholar
  12. Haspl M, Bilic R (1996) Assessment of femoral neck-shaft and antetorsion angles. Int Orthop 20:363–366CrossRefPubMedGoogle Scholar
  13. Hermanson M, Hagglund G, Riad J, Wagner P (2015) Head-shaft angle is a risk factor for hip displacement in children with cerebral palsy. Acta Orthop 86: 229–232CrossRefPubMedPubMedCentralGoogle Scholar
  14. Hoffer MM, Stein GA, Koffman M, Prietto M (1985) Femoral varus-derotation osteotomy in spastic cerebral palsy. J Bone Joint Surg Am 67:1229–1235CrossRefPubMedGoogle Scholar
  15. Joseph B (1998) Treatment of internal rotation gait due to gluteus medius and minimus overactivity in cerebral palsy: anatomical rationale of a new surgical procedure and preliminary results in twelve hips. Clin Anat (New York, NY) 11:22–28CrossRefGoogle Scholar
  16. Kim H, Aiona M, Sussman M (2005) Recurrence after femoral derotational osteotomy in cerebral palsy. J Pediatr Orthop 25:739–743CrossRefPubMedGoogle Scholar
  17. Kolban M (1999) Variability of the femoral head and neck antetorsion angle in ultrasonographic measurements of healthy children and in selected diseases with hip disorders treated surgically. Ann Acad Med Stetin Suppl 51:1–99PubMedGoogle Scholar
  18. LaGasse DJ, Staheli LT (1972) The measurement of femoral anteversion. A comparison of the fluoroscopic and biplane roentgenographic methods of measurement. Clin Orthop Relat Res 86:13–15CrossRefPubMedGoogle Scholar
  19. Laplaza FJ, Root L (1994) Femoral anteversion and neck-shaft angles in hip instability in cerebral palsy. J Pediatr Orthop 14:719–723CrossRefPubMedGoogle Scholar
  20. Laplaza FJ, Root L, Tassanawipas A, Glasser DB (1993) Femoral torsion and neck-shaft angles in cerebral palsy. J Pediatr Orthop 13:192–199PubMedGoogle Scholar
  21. Mahboubi S, Horstmann H (1986) Femoral torsion: CT measurement. Radiology 160:843–844CrossRefPubMedGoogle Scholar
  22. Massaad A, Assi A, Bakouny Z, Sauret C, Khalil N, Skalli W, Ghanem I (2016) Three-dimensional evaluation of skeletal deformities of the pelvis and lower limbs in ambulant children with cerebral palsy. Gait Posture 49:102–107CrossRefPubMedGoogle Scholar
  23. Miller F, Liang Y, Merlo M, Harcke HT (1997) Measuring anteversion and femoral neck-shaft angle in cerebral palsy. Dev Med Child Neurol 39:113–118CrossRefPubMedGoogle Scholar
  24. Miller F, Slomczykowski M, Cope R, Lipton GE (1999) Computer modeling of the pathomechanics of spastic hip dislocation in children. J Pediatr Orthop 19:486–492CrossRefGoogle Scholar
  25. Park N, Lee J, Sung KH, Park MS, Koo S (2014) Design and validation of automated femoral bone morphology measurements in cerebral palsy. J Digit Imaging 27:262–269CrossRefPubMedGoogle Scholar
  26. Perlmutter MN, Synder M, Miller F, Bisbal R (1993) Proximal femoral resection for older children with spastic hip disease. Dev Med Child Neurol 35:525–531CrossRefPubMedGoogle Scholar
  27. Pomerantz ML, Glaser D, Doan J, Kumar S, Edmonds EW (2015) Three-dimensional biplanar radiography as a new means of accessing femoral version: a comparative study of EOS three-dimensional radiography versus computed tomography. Skelet Radiol 44:255–260CrossRefGoogle Scholar
  28. Ribble T, Santare M, Miller F (1998) Response of the femoral epiphysis to force: a finite element modeling study. Newark Delaware University of DelawareGoogle Scholar
  29. Schmidt DJ, Arnold AS, Carroll NC, Delp SL (1999) Length changes of the hamstrings and adductors resulting from derotational osteotomies of the femur. J Orthop Res 17:279–285CrossRefPubMedGoogle Scholar
  30. Staheli LT (1989) Torsion – treatment indications. Clin Orthop Relat Res (247):61–66Google Scholar
  31. Steel HH (1980) Gluteus medius and minimus insertion advancement for correction of internal rotation gait in spastic cerebral palsy. J Bone Joint Surg Am 62:919–927CrossRefPubMedGoogle Scholar
  32. Tomczak RJ, Guenther KP, Rieber A, Mergo P, Ros PR, Brambs HJ (1997) MR imaging measurement of the femoral antetorsional angle as a new technique: comparison with CT in children and adults. AJR Am J Roentgenol 168:791–794CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.AI DuPont Hospital for ChildrenWilmingtonUSA

Section editors and affiliations

  • Freeman Miller
    • 1
  1. 1.AI DuPont Hospital for ChildrenWilmingtonUSA

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