Problemas rotacionales de las extremidades inferiores en niños y adolescentes / Rotational problems of lower limbs in children and adolescents

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

Femoral Neck Anteversion and Neck Shaft Angles: Determination and their Clinical Implications in Fetuses of Different Gestational Ages

Precise anatomical assessment of femoral neck anteversion (FNA) and the neck shaft angles (NSA) would be essential in diagnosing the pathological conditions involving hip joint and its ligaments. The present study was undertaken on 48 fetal femurs to calculate the NSA and FNA in fetuses digitally. End on images of upper end of the femurs were taken for the estimation of FNA and a photograph in a perpendicular plane was taken to calculate the NSA. Microsoft Paint software was used to mark the points and Image J software was used to calculate the angles digitally. The FNA ranged from 17.08º to 33.97 º on right and 17.32 º to 45.08 º on left. The NSA ranged from 139.33 º to 124.91 º on right and 143.98 º to 123.8 º on left. Unpaired t test showed the FNA and NSA of femur did not vary significantly during the third trimester.

Femoral offset and its relationship to femoral neck-shaft angle and torsion angle / Desplazamiento femoral y su relación con el ángulo cuello-diáfisis femoral y el ángulo de torsión

The aims to study the femoral offset and its relationship to femoral neck-shaft angle and torsion angle. One hundred paired (50 males and 50 females) Chinese femurs were used to measure the femoral offset, femoral neck-shaft angle and torsion angle. The data were analyzed by SPSS software. Femoral offsets were male right 44.40±4.56 mm, left 42.70±4.95 mm; female right 39.90±6.00 mm, left 38.90±6.18 mm. Femoral torsion angles were male right 6.02±10.85°, left 7.08±9.30°; female right 10.02±11.69, ° left 6.02±10.85°. Neck-shaft angles were male right 131.80±4.36°, left 134.00±4.78°; female right 132.10±5.94°, left 132.80±4.93°. There were no sexual differences in the two femoral angles (P>0.05) while there was a significant sexual difference in the femoral offset (P<0.01). The differences between left and right femoral offset and neck-shaft angle were significant (P<0.01). Clinically, our results indicate that FO could be obtained using the regression equation when the torsion angle and/or neck-shaft angle is measured.

El objetivo fue estudiar el desplazamiento femoral y su relación con el ángulo cuello-diáfisis femoral y el ángulo de torsión. Se utilizaron 100 pares de fémures (50 hombres y 50 mujeres) y se tomaron las medidas del desplazamiento femoral, ángulo cuello-diáfisis femoral y ángulo de torsión. Los datos fueron analizados con el software SPSS. El desplazamiento femoral en los hombres fue 44,40±4,56 mm en el lado derecho y 42,70±4,95 mm en el lado izquierdo, y en las mujeres, fue de 39,90±6,00 mm y 38,90±6,18 mm para el lado derecho e izquierdo, respectivamente. El ángulo de torsión femoral del lado derecho en los hombres fue 6,02±10,85° y 7,08±9,30° del izquierdo; mientras que en las mujeres, fue de 10,02±11,69° y 6,02±10,85° para el lado derecho e izquierdo, respectivamente. Los ángulos cuello-diáfisis fueron 131,80±4,36° en el lado derecho, y 134,00±4,78° en el izquierdo, para los hombres, mientras que en las mujeres fueron de 132,10±5,94° en el lado derecho y 132,80±4,93° en el izquierdo. No hubo diferencias según sexo en los dos ángulos femorales (P>0,05), mientras que si hubo una diferencia significativa en el desplazamiento femoral (P<0,01). Las diferencias entre el desplazamiento femoral izquierdo y derecho, y el ángulo cuello-diáfisis fueron significativas (P<0,01). Clínicamente, nuestros resultados indican que el desplazamiento femoral podría obtenerse utilizando la ecuación de regresión cuando se mide el ángulo de torsión o el ángulo cuello-diáfisis.

Study of angle of femoral torsion in western region of India.

Background: The femur is thighbone. The angle of femoral torsion is the angle obtaining between the transverse axes of the neck and head that of the lower end of the bone. In the adult, the angle measures about 12 to 15 degrees, but it is considerably greater in the fetus and at birth averages 40 degrees. In postnatal development a reduction of the FNA angle usually occurs during growth. Aim: to evaluate femoral torsion value on dried femora and to find the difference between Japanese, Caucasian and Indian femoral torsion. Method: The present study was carried out on 200 dry normal adult human femora. The bones studied were free of any pathological condition. The male bones were 117 and 83 were female femora out of 200 dried femora. Out of 111 were left and 89 were right femora. The gender of each specimen was determined by the recognized established practice. The angle of anteversion as measured by placing the femur on the osteometric board, the horizontal surface represents the retrocondylar axis and the plane of reference against which the anteversion is measured with the help of the axis of head and neck of the femur. Results: The average anteversion is 16.1 and 15.65 on the right and left sides respectively in male, 18.17 and 17.95 on the right and left sides respectively in female. Statistical analysis using ‘z’ test revealed significant (p<0.05), greater average anteversion in female bones and right-left variations, being greater on the right side. Conclusion: The objective measurement of this angle is of paramount importance in orthopedic surgery for total replacement to attain a normal activity of the replaced joint.