Problemi correnti
Il bambino che cammina con i piedi in fuori: ovvero la retroversione dei colli femorali
TOEING-OUT GAIT IN CHILDREN: ITS RELATION TO FEMORAL NECK RETROVERSION
ANNA CAROLA SCAPINELLI1, RAFFAELE SCAPINELLI2
1UO di Ginecologia e Ostetricia, ULSS 15 “Alta Padovana”, Regione Veneto
2Clinica Ortopedica, Dipartimento di Specialitŕ Medico - Chirurgiche, Universitŕ di Padova
Aprile 2006 - pagg. 235 -239
Abstract
The Authors report the data from the literature and the results of a study conducted in 47 subjects (of whom the majority were children), showing diminished anteversion of the femoral necks. This is a frequent and usually benign skeletal abnormality, easily recognisable on the basis of the clinical pattern. It is characterised by toeing-out gait and a specific alteration of function of the hips (increased range of external rotation motion and limitation of internal rotation). In childhood the radiological examination should be reserved to those rare cases, where the torsional deformity of the femora is particularly severe and not prone to resolution. Treatment includes simple corrective manoeuvres and only exceptionally it is surgical, at the end of the growth.
Classificazione MeSH
Bibliografia
1. Crane L. Femoral torsion and its relation to
toeing-in and toeing-out. J Bone Joint Surg
Am 1959;41:421-8.
2. Swanson AB, Greene PW, Allis HD. Rotational deformities of the lower extremity in children and their clinical significance. Clin Orthop 1963;27:157-75.
3. Huguenin Ph, Bensahel H. Les rétroversions du col fémoral. Chir Pédiatr 1982;23:277-81
4. Giunti A, Moroni A, Olmi R, Rimondi E, Soldati D, Vicenzi G. The importance of the angle of anteversion in the development of arthritis of the hip. Ital J Orthop Traumatol 1985;11:23-7.
5. Tönnis D, Heinecke A. Diminished femoral antetorsion syndrome: a cause of pain and osteoarthritis. J Pediatr Orthop 1991;11:419-31.
6. Dunlap K, Shands AR Jr, Hollister LC Jr, Gaul GS, Streit HA. A new method for determination of torsion of the femur. J Bone Joint Surg Am 1953;35:289-311.
7. Ryder CT, Crane L. Measuring femoral anteversion: the problem and a method. J Bone Joint Surg Am 1953;35:321-8.
8. Magilligan DJ. Calculation of the angle of anteversion by means of horizontal lateral roentgenography. J Bone Joint Surg Am 1956; 38:1231-46.
9. Rimondi E, Busacca M, Molinari M, et al. Studio dei vizi torsionali degli arti inferiori mediante Tomografia Computerizzata. La Radiologia Medica 1995;89:22-7.
10. Braten M, Terjesen T, Rossvoll I. Femoral anteversion in normal adults: ultrasound measurements in 50 men and 50 women. Acta Orthop Scand 1992;63:29-32.
11. Hinderaker T, Uden A, Reikeras O. Direct ultrasonographic measurement of femoral anteversion in newborns. Skeletal Radiol 1994; 23:133-5.
12. Watanabe RS. Embryology of the human hip. Clin Orthop 1974;94:8-26.
13. Fabry G, MacEwen GD, Shands AR Jr. Torsion of the femur. A follow-up study in normal and abnormal conditions. J Bone Joint Surg Am 1973;55:1726-38.
14. Le Demany, Stork (1912): cit. da Bedouelle J. Rev Chir Orthop 1982;68:5-13.
15. Somerville EW. Persistent foetal anteversion of the hip. J Bone Joint Surg 1957;39:106-13.
16. Dunn PM. Congenital postural deformities: perinatal associations. Proc Roy Soc Med 1972:65:735-8.
17. Wilkinson JA. Femoral anteversion in the rabbit. J Bone Joint Surg Brit 1962;44:386-97.
18. Staheli LT, Corbett M, Wiss C, King H. Lower extremity rotational problems in children: normal values to guide management. J Bone Joint Surg Am 1985;67:39-47.
19. Cibulka MT. Determination and significance of femoral neck anteversion. Pysical Therapy 2004;84:550-8.
20. Engel GM, Staheli LT. The natural history of torsion and other factors influencing gait in childhood. Clin Orthop 1974;99:12.
21. Kijowski R, Plagens D, Shaeh SJ, Teitge R. The effects of rotational deformities of the femur on contact pressure and contact area in the patellofemoral joint and on strain in the medial patellofemoral ligament. Patellofemoral Study Group Meeting, Meadowood, Napa Valley, CA, 29 Sept. 1999.
22. Kling TF, Hensinger RN. Angular and torsional deformities of the lower limbs in children. Clin Orthop 1983;176:136-47.
23. Cyvin KB. A follow-up study of children with instability of the hip joint at birth: clinical and radiological investigation with special reference to the anteversion of the femoral neck. Acta Orthop Scand Suppl 1977;166:1-62.
24. Birrell F, Croft P, Cooper C, et al. Predicting radiographic hip osteoarthritis from range of movement. Rheumatology (Oxford) 2001;40:506-12.
25. Bedouelle J. Antétorsion des cols femoraux. Rev Chir Orthop 1982;68:5-13.
26. Kitaoka HB, Weiner DS, Cook AJ, Joyt WA, Askew MJ. Relationship between femoral anteversion and osteoarthritis of the hip. J Pediatr Orthop 1989;9:396-404.
27. Ito K, Minka MA- II, Leunig M, Werlen S, Ganz R. Femoroacetabular impingement and the cam-effect: a MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br 2001;83:171-6.
28. Gelberman RH, Cohen MS, Shaw BA, et al. The association of femoral retroversion with slipped capital femoral epiphysis. J Bone Joint Surg Am 1986;68:1000-7.
29. Kleiger B. The anteversion syndrome
2. Swanson AB, Greene PW, Allis HD. Rotational deformities of the lower extremity in children and their clinical significance. Clin Orthop 1963;27:157-75.
3. Huguenin Ph, Bensahel H. Les rétroversions du col fémoral. Chir Pédiatr 1982;23:277-81
4. Giunti A, Moroni A, Olmi R, Rimondi E, Soldati D, Vicenzi G. The importance of the angle of anteversion in the development of arthritis of the hip. Ital J Orthop Traumatol 1985;11:23-7.
5. Tönnis D, Heinecke A. Diminished femoral antetorsion syndrome: a cause of pain and osteoarthritis. J Pediatr Orthop 1991;11:419-31.
6. Dunlap K, Shands AR Jr, Hollister LC Jr, Gaul GS, Streit HA. A new method for determination of torsion of the femur. J Bone Joint Surg Am 1953;35:289-311.
7. Ryder CT, Crane L. Measuring femoral anteversion: the problem and a method. J Bone Joint Surg Am 1953;35:321-8.
8. Magilligan DJ. Calculation of the angle of anteversion by means of horizontal lateral roentgenography. J Bone Joint Surg Am 1956; 38:1231-46.
9. Rimondi E, Busacca M, Molinari M, et al. Studio dei vizi torsionali degli arti inferiori mediante Tomografia Computerizzata. La Radiologia Medica 1995;89:22-7.
10. Braten M, Terjesen T, Rossvoll I. Femoral anteversion in normal adults: ultrasound measurements in 50 men and 50 women. Acta Orthop Scand 1992;63:29-32.
11. Hinderaker T, Uden A, Reikeras O. Direct ultrasonographic measurement of femoral anteversion in newborns. Skeletal Radiol 1994; 23:133-5.
12. Watanabe RS. Embryology of the human hip. Clin Orthop 1974;94:8-26.
13. Fabry G, MacEwen GD, Shands AR Jr. Torsion of the femur. A follow-up study in normal and abnormal conditions. J Bone Joint Surg Am 1973;55:1726-38.
14. Le Demany, Stork (1912): cit. da Bedouelle J. Rev Chir Orthop 1982;68:5-13.
15. Somerville EW. Persistent foetal anteversion of the hip. J Bone Joint Surg 1957;39:106-13.
16. Dunn PM. Congenital postural deformities: perinatal associations. Proc Roy Soc Med 1972:65:735-8.
17. Wilkinson JA. Femoral anteversion in the rabbit. J Bone Joint Surg Brit 1962;44:386-97.
18. Staheli LT, Corbett M, Wiss C, King H. Lower extremity rotational problems in children: normal values to guide management. J Bone Joint Surg Am 1985;67:39-47.
19. Cibulka MT. Determination and significance of femoral neck anteversion. Pysical Therapy 2004;84:550-8.
20. Engel GM, Staheli LT. The natural history of torsion and other factors influencing gait in childhood. Clin Orthop 1974;99:12.
21. Kijowski R, Plagens D, Shaeh SJ, Teitge R. The effects of rotational deformities of the femur on contact pressure and contact area in the patellofemoral joint and on strain in the medial patellofemoral ligament. Patellofemoral Study Group Meeting, Meadowood, Napa Valley, CA, 29 Sept. 1999.
22. Kling TF, Hensinger RN. Angular and torsional deformities of the lower limbs in children. Clin Orthop 1983;176:136-47.
23. Cyvin KB. A follow-up study of children with instability of the hip joint at birth: clinical and radiological investigation with special reference to the anteversion of the femoral neck. Acta Orthop Scand Suppl 1977;166:1-62.
24. Birrell F, Croft P, Cooper C, et al. Predicting radiographic hip osteoarthritis from range of movement. Rheumatology (Oxford) 2001;40:506-12.
25. Bedouelle J. Antétorsion des cols femoraux. Rev Chir Orthop 1982;68:5-13.
26. Kitaoka HB, Weiner DS, Cook AJ, Joyt WA, Askew MJ. Relationship between femoral anteversion and osteoarthritis of the hip. J Pediatr Orthop 1989;9:396-404.
27. Ito K, Minka MA- II, Leunig M, Werlen S, Ganz R. Femoroacetabular impingement and the cam-effect: a MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br 2001;83:171-6.
28. Gelberman RH, Cohen MS, Shaw BA, et al. The association of femoral retroversion with slipped capital femoral epiphysis. J Bone Joint Surg Am 1986;68:1000-7.
29. Kleiger B. The anteversion syndrome