Femoral Anteversion in Children

 

– Discussion:
    – femoral version is defined as the angular difference between axis of femoral neck and transcondylar axis of the knee;
    – excessive femoral anteversion (medial femoral torsion) is most common cause of in-toeing that first presents in early childhood;
    – it is twice as common in girls as in boys, it is nearly always symmetrical, and it is often familial;
    – tripping as a result of crossing the feet may occur, and child may be teased by peers because of pigeon-toed gait and the awkward running pattern;
    – normal values:
           – on average, femoral anteversion ranges from 30-40 deg at birth and decreases progressively throughout growth to about 15 deg at skeletal maturation;
           – in adults, anteversion averages between 8 and 14 deg, w/ an average of 8 degrees in men and 14 degrees in women;
    – diff dx of intoeing:
           – metatarsus adductus
           – tibial torsion
           – femoral anteversion
    – natural history:
           – parents usually become concerned after the child reaches age 3 years;
           – in-toeing secondary to medial femoral torsion is most pronounced between ages 4 to 6 years, but subsquently improves during later childhood,
                   averaging about 1.5 degrees of correction per year;
                   – this is partially due to fact that medial hip rotation is greatest during early childhood, but then declines w/ increasing age, decreasing  about 2-3 deg/year;
           – if assoc w/ internal tibial torsion, femoral anteversion may lead to patellofemoral subluxation due to an increase in the Q angle;
           – both the decrease in femoral anteversion and decrease in medial rotation, result in near complete resolution of the intoeing in more
                   than 80 % of affected children, usually by age 10 years;
                   – additional concious compsensation may occur during adolescence;


– Exam:
    – increased medial rotation and decreased lateral rotation noted on exam  of child with an intoeing gait with patellae medially rotated;
    – medial rotation of thigh in extension exceeding 70 deg is abnormal;
    – if hip rotation is asymmetric, then consider DDH;
    – gait:
          – child ambulates w/ patella medially rotated, and runs in an awkward pattern;
          – running is characterized by medial rotation of thighs during swing phase, which causes outward rotation of legs;
    – Reider Test:
          – prominence of the greater trochanter indicates axis of the femoral neck;
          – noting the position of the patella, an accurate determination of the femoral anteversion can be determined;


– Operative Inidcations:
    – procedure should be performed only after age of eight to ten years, for persistent, severe deformity;
    – child should have more than 50 degrees of measured anteversion & more than 80 degrees of medial hip rotation;

Supported  by
CLINICAL PEDIATRIC ONLINE 

Yudhasmara Foundation 

JL Taman Bendungan Asahan 5 Jakarta Indonesia

phone : 62(021) 70081995 – 5703646 

email : judarwanto@gmail.com,

http://clinicalpediatric.wordpress.com/

 

 

Clinical and Editor in Chief :

DR WIDODO JUDARWANTO

email : judarwanto@gmail.com,

 

Copyright © 2009, Clinical Pediatric Food Allergy Information Education Network. All rights reserved.

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