ABSTRACT
Las deformidades torsionales de las extremidades inferiores corresponden a una de las causas de visita más frecuente al ortopedista infantil. En la mayoría de los casos, estas consultas son innecesarias, pues se trata de condiciones normales del esqueleto en desarrollo, que suelen corregir espontáneamente. El médico no especialista debe estar familiarizado con los cambios fisiológicos que ocurren en las extremidades inferiores del niño, de manera de identificar aquellos casos severos o aquellos que producen alteraciones funcionales.Estas deformidades, pueden ocurrir en cualquier nivel, desde la pelvis a los pies, por lo que un examen físico sistemático permitirá identificar la causa y proponer un tratamiento de acuerdo a los hallazgos. El único tratamiento eficaz, cuando la situación lo requiere, es la cirugía ortopédica. El uso de plantillas, calzado ortopédico y órtesis no cumplen ninguna función en el manejo de estas alteraciones
Torsional deformities of lower limbs are one of the most frequent causes to visit a pediatric orthopedic surgeon. In most cases, these are unnecessary, as they represent a normal stage of the developing skeleton, which usually correct spontaneously. The nonspecialist physician must be familiar with the physiological changes that occur in children's lower limb, in order to identify those cases that are severe, or cause functional disabilities.These deformities can occur at any level, from the pelvis to the feet, so a systematic physical examination will allow the cause to be identified and treated to be proposed according on to the findings. The only effective treatment, when the situation requires it, is orthopedic surgery. The use of insoles, orthopedic footwear, and orthoses have no role in the management of these alterations
Subject(s)
Humans , Child , Adolescent , Lower Extremity/physiopathology , Lower Extremity Deformities, Congenital/physiopathology , Rotation , Tibia/physiopathology , Femur/physiopathologyABSTRACT
OBJECTIVE: The purpose of this study is to evaluate that knee deformity (varus or valgus) due to osteoarthritis of the knee and tibial torsion could be aetiologies of hallux valgus. METHODS: Forty-nine patients (43 females, six males; mean patient age, 69.88±6.12 years) before total knee arthroplasty for advanced primary osteoarthritis were recruited. All deformities were of the left knee. Preoperative torsional computed tomography, anteroposterior (AP) and lateral weight-bearing foot radiographs, AP and lateral weight-bearing knee radiographs, and long-leg standing AP views were obtained for each patient. The correlations between foot angle and knee varus angle or tibial torsion angle were examined. RESULTS: There was no significant correlation between knee varus angle and foot angle. Similarly, there was no significant relationship between tibial torsional angle and foot angle, except talocalcaneal angle (TCA)-lateral (r=0.28). No significant relationships were found between TCA-AP and (1–2 intermetatarsal angle [IMA] and hallux valgus angle [HVA]), or between TCA-lateral and (1–2 IMA and HVA). CONCLUSION: No significant correlations were found between the knee anatomical axis (knee varus angle) and foot angle or between the tibial torsional angle and foot angle. Tibial torsion and knee varus angle were not aetiologies for hallux valgus.
Subject(s)
Female , Humans , Male , Arthroplasty, Replacement, Knee , Congenital Abnormalities , Foot , Hallux Valgus , Hallux , Knee , Osteoarthritis , Weight-BearingABSTRACT
OBJECTIVE: To develop and test the validity and reliability of a new instrument for measuring the thigh-foot angle (TFA) for the patients with in-toeing and out-toeing gait. METHODS: The new instrument (Thigh-Foot Supporter [TFS]) was developed by measuring the TFA during regular examination of the tibial torsional status. The study included 40 children who presented with in-toeing and out-toeing gaits. We took a picture of each case to measure photographic-TFA (P-TFA) in the proper position and to establish a criterion. Study participants were examined by three independent physicians (A, B, and C) who had one, three and ten years of experience in the field, respectively. Each examiner conducted a separate classical physical examination (CPE) of every participant using a gait goniometer followed by a TFA assessment of each pediatric patient with or without the TFS. Thirty minutes later, repeated in the same way was measured. RESULTS: Less experienced examiner A showed significant differences between the TFA values depending on whether TFS used (left p=0.003 and right p=0.008). However, experienced examiners B and C did not show significant differences. Using TFS, less experienced examiner A showed a high validity and all examiner's inter-test and the inter-personal reliabilities increased. CONCLUSION: TFS may increase validity and reliability in measuring tibial torsion in patients who has a rotational problem in lower extremities. It would be more useful in less experienced examiners.
Subject(s)
Child , Humans , Bone Anteversion , Gait , Lower Extremity , Physical Examination , Reproducibility of Results , Torsion AbnormalityABSTRACT
La torsión tibial, es una patología en la cual la tibia presenta una rotación a lo largo de su eje. Para calcular la magnitud de la rotación es necesario realizar una serie de estudios y evaluaciones para determinar el ángulo, el problema radica que al realizar estos exámenes todo depende del juicio y experticia de la persona que lo realice, dado que los puntos clave como los ejes de rotación, pueden ser apreciados y determinados por métodos diferentes, y esto puede causar un impacto negativo en el resultado de la evaluación. El presente trabajo, propone diseñar un dispositivo que permita obtener, de una forma transparente y entendible, la diferencia de ángulos en el plano transverso entre los ejes de la rodilla y el tobillo, el cual indica la magnitud de la rotación. Para lograrlo se trabajó con una metodología de investigación de campo aplicada. Se analizaron diferentes propuestas de prototipos, para así elegir aquella que se adaptara mejor a las necesidades que se desean cubrir. El prototipo constó de sensores ultrasónicos, colocados en los extremos de los ejes de rotación y proporcionaran datos de distancia que mediante un algoritmo desarrollado, permitirá conocer el ángulo de torsión. Para validar el prototipo, se trabajó con pacientes del Centro de Salud Santa Inés y esto permitió comparar los resultados clínicos actuales, con los resultados del prototipo, demostrando que el dispositivo arrojaba los resultados esperados y funcionaba de acuerdo a las especificaciones(AU)
Tibial torsion is a condition in which the tibia has a rotation along its axis. To calculate the amount of rotation is necessary to conduct a series of studies and evaluations to determine the angle, the problem is that doing these tests all depends on the judgment and expertise of the person making the payment, as the key points as the axes rotation can be assessed and determined by different methods, and this can cause a negative impact on the outcome of the evaluation. This paper aims to design a device that provides, in a transparent and understandable way, the difference in the transverse plane angles between the axes of the knee and ankle, which indicates the amount of rotation. To achieve this we worked with a research methodology applied field. Different proposals for prototypes were analyzed and they choose the one that is best adapted to the needs that you want to cover. The prototype consisted of ultrasonic sensors located at the ends of the rotational axes and provide distance data using an algorithm developed which allow to know the angle of twist. To validate the prototype worked with patients of the Health Center Santa Inés and this allowed us to compare current clinical results with the results of the prototype, demonstrating that the device threw the expected results and work according to specifications
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Tibia/anatomy & histology , Torsion Abnormality , Diagnostic Imaging , Proof of Concept Study , Physical Examination , Lower Extremity , AnkleABSTRACT
Tibial torsion, the twisting of the tibia about its long axis, can affect rotational positioning in total knee replacement. This angle varies depending on the ethnicity of the subject. There are no published studies to date to determine the tibial torsion among Filipinos. In this study, 28 cadaveric limbs were examined. Our results show that the average tibial torsion among adult Filipinos is 28.9°.
ABSTRACT
OBJECTIVE: To evaluate the validity of physical examinations by assessment of correlation between physical examinations and CT measurements in children with intoeing gait and the causes of intoeing gait by age using CT measurements. METHOD: Twenty-six children with intoeing gait participated in this study. The internal and external hip rotation, thigh-foot angle and transmalleolar angle were measured. In addition, femoral anteversion and tibial torsion of the subjects were assessed using a CT scan. The measurements of torsional angles were performed twice by two raters. The correlation coefficients between physical examinations and CT measurements were calculated using Pearson correlation. The data was analyzed statistically using SPSS v12.0. RESULTS: The correlation coefficients between physical examinations and CT measurements were not high. Before 5 years of age, intoeing gait was caused by femoral anteversion in 17.86%, tibial torsion in 32.29% and the combination of causes in 35.71% of cases. After 6 years of age, the contributions changed to 29.17%, 8.33% and 45.83%, respectively. CONCLUSION: Before 5 years of age, the common cause of an intoeing gait was tibial torsion, whereas after 6 years of age it was femoral anteversion. Regardless of age, the most common cause of intoeing gait was a combination of causes. This study shows poor correlation between physical examinations and CT. Therefore, it is limiting to use physical examination only for evaluating the cause of intoeing gait in clinical practice.
Subject(s)
Child , Humans , Gait , Hip , Physical ExaminationABSTRACT
0OBJECTIVE: To investigate the mean values and correlations between the rotational profiles of bilateral lower extremities in Korean elderly men. METHOD: 100 lower extremities were examined for the rotational profiles of bilateral lower extremities with radiographic examination. RESULTS: The mean values of femoral anteversion, axial rotation of the knee joint, proximal and distal tibial torsion, bimalleolar axis (BMA), and Q angle were 8.72degrees, 0.19degrees, 34.53degrees, 26.25degrees, 20.97degrees, 5.65degrees. In Korean elderly men, the result of tibial torsion and Q angle was smaller than the results of other studies, and the bilateral differences were detected in the measured profiles of lower extremities, except axial rotation of the knee joint. However, all profiles represented a positive correlation between right and left lower extremities. The correlation between proximal tibial torsion and BMA had a positive correlation, But the femoral anteversion and tibial torsion had no correlations among the profiles in Korean elderly men. CONCLUSION: We suspected that Korean elderly healthy men have reduced tibial torsion and more genu varus alignment, and the rotational profiles of lower extremities showed side to side difference, but there were symmetrical tendency. It will be helpful in assessing the evaluation, treating, researching of the musculoskeletal problem in Korean elderly people.
Subject(s)
Aged , Humans , Male , Axis, Cervical Vertebra , Genu Varum , Knee Joint , Lower ExtremityABSTRACT
Purpose: Tibial torsion is the external rotation of the distal tibia in comparison with the proximal tibia. Rotational deformity of the tibia as a complication of tibial shaft fracture means the loss of tibial torsion. Therefore, evaluating the torsion or the rotation of the distal tibia is the first step in reducing the rotational deformity of the tibia. There are two methods for evaluating the tibial torsion, a method with CT and a method with C-arm. In both methods, the anatomical landmark for evaluation is most important. The ratio of the tibiofibular overlap and fibula width (Tibiofibular Overlap Ratio) is a landmark commonly used to evaluate the tibial torsion. Materials and Methods: The tibial torsion angle and Tibiofibular Overlap Ratio of both legs in 79 cases (48 males and 31 females; mean age 46.2 years) were measured and compared. These 79 cases received 2-D CT of the knee and ankle of both legs. To evaluate the prediction for neutral rotation of the tibia using the contralateral tibia-fibula image, 20 orthopedic residents and nurses were asked to select the same rotational tibia image among the 31 rotational 3-D CT images from 15o external rotation to 15degrees internal rotation in comparison with the mirror image. Results: There was no significant between the comparisons of the tibia torsion angle and Tibiofibular Overlap Ratio in both legs in the 79 cases. Ten orthopedic residents were able to predict the tibia rotational angle within an external rotation of 3degrees and internal rotation of 3degrees. Ten nurses were able to predict the tibia rotational angle within an external rotation of 5degrees and internal rotation of 5degrees. Conclusion: The Tibiofibular Overlap Ratio may be the simple and useful method for predicting the neutral rotation of the tibia.
Subject(s)
Female , Humans , Male , Ankle , Congenital Abnormalities , Fibula , Knee , Leg , Orthopedics , TibiaABSTRACT
The angle of tibial torsion is an inherent angle in human bodies.The angle has been to knew of clinical workers.But the research of mechanism for angle of tibial torsion and relationship with some disease still in initial stage.Recent years,the angle of tibial torsion has been noticed with the concept of torsionaldeform appearance.This paper summarizes measurement of the angle of tibial torsion andits advancement of correlated research.