is femoral retroversion a disability
42. 2012;28:965-971. Web39% sometimes, often or always prescribe stretching for the hip abductors, and. 
The majority of children less than three years of age will have all the findings. WebFemoral retroversion has been shown to potentially increase the risk of a slipped capital femoral epiphysis (SCFE) in skeletally immature individuals, as well as a higher risk for posterior hip dislocation in contact athletes. Because the epiphysis is displaced posteroinferiorly in patients with SCFE, such measurements may underestimate the severity of the deformity. Internal rotation is determined by fully abducting the legs. Traduction Context Correcteur Synonymes Conjugaison. Top-view illustrations of excessive femoral retroversion. 
Clin Orthop Relat Res. These include femoral retroversion and external tibial torsion. In hips with SCFE, there was a mean difference of -13 9 (95% CI -15 to -12; p < 0.001) between femoral neck version and Reikers et al.s [35] method, which reflects femoral neck orientation relative to the femoral heads center (Table 4). WebFemoral anteversion is a condition in which the femoral neck leans forward with respect to the rest of the femur. 479(5):960-961, May 2021. 3). 30. WebTraductions en contexte de "retroversion at" en anglais-franais avec Reverso Context : The uterine body is too readily mobile and painful retroversion at ligamentous insertions. 2). Differences in femoral torsion among various measurement methods increase in hips with excessive femoral torsion. evidence of joint laxity (Figure 2) that mimics the appearance of a torsional/angular deformity should be checked. Pritchett JW, Perdue KD. This condition can affect patients of all ages and leads to abnormal stress in the low back, hip and knee, as well as an abnormal gait (walking stance). What are the symptoms of femoral retroversion? 14. 1993;75:1141-1147. More specifically, the prevalence of femoral retroversion was higher in hips with SCFE for the proximal methods of Lee et al. Intraclass correlations: uses in assessing rater reliability. Berryman F, Pynsent P, McBryde C. A semi-automated method for measuring femoral shape to derive version and its comparison with existing methods. (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? A subset of patients was measured twice by the first observer and by a second orthopaedic resident (2 years of experience) to assess intraobserver reproducibility and interobserver reliability; for this assessment, we used intraclass correlation coefficients. Eur Radiol. J Pediatr Orthop. The normal range of rotation of the foot, leg, and hip includes measurements that fall within two standard deviations of the mean. Intoeing is caused by one of three types of deformity: metatarsus adductus, internal tibial torsion, and increased femoral anteversion (Figure 7). A neurologic examination should be done to rule out neuromuscular disorders.1,5 The lower extremities should be examined for Trendelenburgs Sign (Figure 1) and leg length discrepancy to rule out hip dysplasia.1,4,5 The range of motion of the hips, knees, and ankles should be determined. You may be trying to access this site from a secured browser on the server. Show details Hide Andersen RC, Bojescul JA, Kuklo TR, Murphy KP. 2006;44:895-906. What are the causes of femoral retroversion? Fishkin Z, Armstrong DG, Shah H, Patra A, Mihalko WM. The mean age was 15 4 years, 48% (38 of 79) of the patients were male, and 56% (44 of 79) were obese (defined as a BMI > 95th percentile (mean BMI 34 9 kg/m2). The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. Torsional deformity can also occur after a fracture, if a broken bone heals with incorrectly (called [19], Reikers et al. WebA retrospective study of femoral neck fractures in children show the following complications: [8] 1) avascular necrosis (14.5%) 2) limb shortening in seven (11.3%) 3) coxa vara (8%) and premature epiphysis fusion (8%) 4) coxa valga (3.2%), arthritic changes (3.2%). Management is by serial measurement of intercondylar/intermalleolar distance to document gradual spontaneous resolution. Remodelling of femoral head-neck junction in slipped capital femoral epiphysis: a multicentre study. Femoral retroversion is common in early infancy and is caused by external rotation contracture of the hip secondary to intrauterine packing.1,7,9 It becomes apparent when the prewalking child stands with his or her feet turned out to nearly 90 degrees (this is sometimes called a Charlie Chaplin appearance).12 Femoral retroversion occurs more commonly in obese children. J Orthop Res. An accurate diagnosis can be made with careful history and physical examination, which includes torsional profile (a four-component composite of measurements of the lower extremities). Bowlegs (also called bowed legs). The minimum slice thickness was 2 mm. The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. Torsional deformities become more apparent with fatigue. A careful physical examination, explanation of the natural history, and serial measurements are usually reassuring to the parents. Articular pain is most commonly as- sociated with groin pain and can be associated with di- agnoses such as femoroacetabular impingement (FAI), hip dysplasia, osteonecrosis, OA, or femoral neck frac- tures. We showed that femoral neck version is asymmetrically decreased in unilateral SCFE, and that differences increase when including the femoral heads center. ANUNCIO. 2014;96:1119-1123. Those with hip rotation values outside this range are said to have a deformity. The effect of modality and landmark selection on MRI and CT femoral torsion angles. WebAnteversin y Retroversin Femoral Publicado por . Obesity and decreased femoral anteversion in adolescence. 40. Intoeing is caused by one of three types of deformity: metatarsus adductus, internal tibial torsion, and increased femoral anteversion. Int Orthop. The ankle has normal motion. It is, however, associated with knee pain, This health problem causes a childs knees and feet to turn inward. Angulation of a bone distal to a joint or in a part of a bone away from the midline. 2016;36:239-246. CORR Insights: How Common Is Femoral Retroversion and How Is it Affected by Different Measurement Methods in Unilateral Slipped Capital Femoral Epiphysis? Femoral retroversion often runs in families, which may indicate that some children have a higher risk of being born with this condition. 2019;477:1073-1083. WebElise struggled with femoral retroversion, also known as hip retroversion which is a condition related to hip dysplasia. In patients with implant failure following in situ fixation, this included assessment of the femoral growth plate for planning of revision in situ fixation. A subset of patients was measured twice by the first obsever as well as by a second orthopaedic resident (JRK, 2 years of experience) to assess intraobserver reproducibility and interobserver reliability. The remaining four measurement methods use the femoral heads center as the most proximal reference. AJR Am J Roentgenol. The I-bars represent the corresponding 95% CI. The range of internal and external rotation of the hips should be measured with the child prone and knees flexed to 90 degrees. Ein wesentlicher Anteil substanzieller Nervenverletzungen entsteht bei Operationen. Femoral version angles did not differ between hips with and without previous in situ pinning for any of the five measurement methods (for example, Lee et al. Include maternal pregnancy, birth, and development. Anterior twist or angulation of the femoral head away from the frontal plane. it is called retroversion, retrotorsion or retrorotation. Arthroscopic treatment of mild to moderate deformity after slipped capital femoral epiphysis: intra-operative findings and functional outcomes. WebThe proximal end of the femur features the femoral head, femoral neck, and the greater and lesser trochanters. Angular problems include bowlegs and knock-knees. Paired t-tests including Bonferroni corrections for repeated measurements were performed for comparison between the mean femoral version angles. Studies using this imaging modality to measure femoral version are limited by long acquisition times that are prone to patient malpositioning [15, 42]. It may gradually improve on its own during the first year of walking.1,7,10 If resolution is not evident and persistent external rotation is present on successive visits at two to three years of age, referral to an orthopedist is indicated because persistent lateral femoral torsion is associated with osteoarthrosis, increased risk of stress fracture of the lower limbs, and slipped capital femoral epiphysis.9 [evidence level C, expert opinion] Nonoperative treatment is ineffective.1,9,10. The internal rotation will far exceed external rotation, while the opposite is true in femoral retroversion. It also appears to be related to the position of the baby as it grows in the womb. Of the 754 patients diagnosed with SCFE between 2000 and 2017, 172 patients had undergone pelvic CT scans. 2019;43:2375-2382. WebMethods. WebThe long femoral stem was found well fixed with a cement mantle all around in an unacceptable retroversion. 45. Web130 Likes, 2 Comments - Abel Snchez - Entrenador (@abel.sanchezh) on Instagram: "LEGS: una de las sesiones ms demandantes. This study has several limitations. The movement of a limb toward the midline of the body in the coronal plane. Femoral anteversion. ANUNCIO. Questioning perinatal events and motor development may reveal a diagnosis of cerebral palsy. 26. 2015;97:537-543. Balakumar B, Flatt E, Madan S. Moderate and severe SCFE (slipped capital femoral epiphysis) arthroscopic osteoplasty vs open neck osteotomy-a retrospective analysis of results. Rotational problems include intoeing and out-toeing. What causes femoral anteversion in a child? 19. Parents often seek medical advice about lower extremity appearance in their children. Limb Lengthening and Complex Reconstruction Service, out-toeing or "duck walk" walking with the foot pointed outward instead of straight ahead. One radiology resident (6 years of experience) measured femoral version of the entire study group using five different methods. Study design: Systematic review; Level of Seventy-one percent (56 of 79) of patients in whom previous in situ pinning had been performed as the initial treatment of SCFE presented with a symptomatic SCFE deformity. It occurs more frequently in female children,10 and on the left side more than the right.9 The most likely cause is intrauterine packing. Since the range of femoral version angles is wide, no general prediction regarding the degree of rotational deformity can be made on an individual basis. However, future studies are needed to investigate the value of different measurement methods in predicting the surgical outcome in patients with SCFE undergoing different procedures. Measurement of femoral version has been recommended in patients eligible for hip preservation surgery [27, 38] because of the high prevalence of abnormal femoral version in patients with hip pain [21, 22] and its effect on ROM [8, 20] and the outcome of surgery for femoroacetabular impingement [11, 12]. One radiology resident (FS) with 6 years of experience in hip imaging measured femoral version bilaterally using five previously described methods (Table 1). The cause of intoeing varies with the age of the child.9 In the first year of life, metatarsus adductus, alone or combined with internal tibial torsion, is usually the cause. Femoral retroversion can occur in one or both legs. Definition of the distal femoral reference: the medial and lateral posterior condyles are connected. Common variations include rotational problems (intoeing, out-toeing) and angular problems (genu varum [bowlegs], genu valgum [knock-knees]). 2018;38(suppl 1):S5-S12. Furthermore, the reliability and reproducibility of these measurements in patients with SCFE is unknown. Bone Joint J. All five methods were compared side-by-side (involved versus uninvolved hip), and comparisons among all five methods were performed using paired t-tests. Wylie JD, McClincy MP, Uppal N, et al. Schmaranzer F, Lerch TD, Siebenrock KA, Tannast M, Steppacher SD. All measurement methods are based on true axial images and a line connecting the femoral condyles as the distal reference axis. Bali K, Railton P, Kiefer GN, Powell JN. And if left untreated into 1997;168:791-794. In some cases, hip/femoral retroversion may be combined with a separate torsional deformity, such as a rotation in the tibia. Shrout PE, Fleiss JL. 16. 2017;21:487-506. The greatest differences were between measurement methods that are based on the most-proximal landmarks and those based on the more-distal landmarks. Because the lower This suggests that obesity and decreased femoral anteversion are intimately associated with SCFE because both have been reported in obese adolescents [15, 42]. In this position, the femoral head is not positioned normally in the hip joint. Among 10 possible pairwise combinations, we detected differences for 8 pairwise comparisons in hips with SCFE (Table 4). method), we used the most cephalic junction of the greater trochanter as the landmark and, most distally, we used the center base of the femoral neck superior to the lesser trochanter (Murphy et al.). Femoral retroversion in HRA influences impingement and increases joint contact pressure most when the hip is loaded in flexion. 2020;14:190-200. The mean femoral neck version was lower on the SCFE side than on the contralateral side (-2 13 versus 7 11; p < 0.001) (Table 3). In early childhood, the cause is usually femoral anteversion, and is nearly always bilateral and symmetrical. 5) Metatarsus adductus is the most common congenital foot deformity,9 occurring in one out of 1,000 live births. 10. However, in some cases, this may be difficult to identify, especially if femoral retroversion is combined with a separate rotation deformity such as tibial torsion. Galbraith RT, Gelberman RH, Hajek PC, et al. The physician may also order an X-ray or CT scan to look for possible deformities. Conditions that may support operative correction include (1) being older than eight years of age, (2) a child with significant or functional deformity, and (3) a thigh-foot angle of greater than three standard deviations beyond the mean.13, Femoral anteversion describes the normal position of the femur, which is medially rotated on its long axis at birth. Bali NS, Harrison JO, Bache CE. 1). WebThe long femoral stem was found well fixed with a cement mantle all around in an unacceptable retroversion. Future studies should compare femoral version in SCFE hips to age-matched volunteers without a history of hip disease. We performed a retrospective, controlled, single-center study at a tertiary pediatric care center and included patients with SCFE treated between 2000 and 2017. The femur bone is cut through a portal and an intramedullary rod is inserted into the marrow cavity of the bone. A careful history and physical examination are all that are necessary to determine whether a complaint requires further evaluation. 8. 1983;54:18-23. The most common etiology of the flexible flat foot is ligamentous laxity, which allows the foot to sag with weight bearing.11 Spontaneous correction is usually expected within one year of walking.8 No treatment is indicated for painless flexible flat foot. Impingement may be more pronounced when relative femoral retroversion and anteversion are, respectively, combined with acetabular retroversion and anteversion. Slipped capital femoral epiphysis: prevalence, pathogenesis, and natural history. It is defined as displacement of the proximal femoral epiphysis from the metaphysis through the proximal femoral growth plate. In severe cases, however, surgery may be needed to correct the rotation. 2013;37:2331-2336. 2017;6:472-480. 24. Gelberman et al. Novais EN, Millis MB. In hips with SCFE, we found excellent agreement (intraclass correlation coefficient [ICC] > 0.80) for intraobserver reproducibility (reader 1, ICC 0.93 to 0.96) and interobserver reliability (ICC 0.95 to 0.98) for all five measurement methods. All CT scans including axial images covering the osseous pelvis and distal femoral condyles were used to measure femoral version. For the definition of femoral neck version, the midpoint of the femoral neck axis is determined at the level where the cortices run parallel and serves as the proximal reference axis (Fig. J Pediatr Orthop. Each leg should be measured because the problem may be unilateral or the legs may differ in degree of torsion.5 Normally, the foot axis out-toes 10 degrees relative to the thigh axis. J Child Orthop. The degrees of internal and external rotation are generally equal, about 45 degrees. For patients with SCFE deformity, this included the decision to perform isolated cam resection, intertrochanteric flexion-derotation osteotomy with or without cam resection, or a modified Dunn procedure in patients with an open femoral growth plate. 7. [19] method -19 16 [95% CI -25 to -12] versus -19 16 [95% CI -23 to -15]; p = 0.90, respectively) (Table 5). ANUNCIO. Accordingly, the mean difference between these two measurement techniques was as high as -19 7 (Table 4). Femoral retroversion is often a congenital condition, meaning children are born with it. 11. Doing so may better inform surgeons as they contemplate when to use isolated offset correction or to perform an additional femoral osteotomy for SCFE correction based on the severity of the slip and the rotational deformity. Charts of normal values and values with two standard deviations for each component of the torsional profile are available. J Bone Joint Surg Am. 1) [15]. Data is temporarily unavailable. Right: Most patients with excessive hip retroversion compensate by walking out-toed. The prevalence of femoral retroversion was higher in hips with SCFE for the proximal methods of Lee et al. Referral to an orthopedist is indicated.11, Many children will look bowlegged when they start to walk and then knock-kneed between three to seven years. The overall mean femoral version angles increased for hips with SCFE (range of means -19 to 0) and the contralateral side (range of means 2 to 19) using distal landmarks compared with more proximal landmarks (Fig. A subset of patients was measured twice by two readers (FS, JRK) to assess intraobserver reproducibility and interobserver reliability. More recently, femoral osteochondroplasty sometimes has been performed first to correct a secondary cam deformity, followed by intraoperative ROM testing to determine whether an additional proximal femoral osteotomy is needed [4, 34, 43]. This is because opposite, incorrect rotations of the femur and tibia often leave the feet parallel during walking, which often makes the misalignment of the hips and knees go unnoticed. External tibial torsion is usually seen between four to seven years of age.1,9 It is often unilateral and more common on the right side.9 The tibia rotates laterally with growth, making lateral tibial torsion worse.9,13 Surgery has a high complication rate and should not be done until after the child is more than 10 years of age. Internal tibial torsion is commonly associated with sitting on the feet, while increased femoral anteversion is associated with sitting in a W position. Treatment of chronic, stable slipped capital femoral epiphysis via surgical hip dislocation with combined osteochondroplasty and Imhauser osteotomy. SCFE: clinical aspects, diagnosis, and classification. 3. Thus, to assess the full extent of an SCFE deformity, femoral version measurements should consider the position of the displaced epiphysis. Increased BMI leads to an increase in simulated loads across the physis [33] and may be further aggravated by retroversion of the femoral neck, which has been associated with obesity [14]. In healthy contralateral hips, we found differences for 9 of 10 pairwise comparisons (Table 4). In 90 percent of cases, internal tibial torsion gradually resolves on its own by the time the child reaches eight years of age.9 [evidence level B, nonrandomized studies] Avoiding prone sleeping and sitting on feet enhance resolution. WebFemoral retroversion could result from developmental conditions such as focal femoral deficiency, and dysplasia or be acquired secondary to malunited subtrochanteric, intertrochanteric or femoral neck fracture, varus derotational osteotomies and slipped capital femoral epiphysis (SCFE). It is multifactoral result of evolution, heredity, fetal development, intrauterine position, and Prevalence of femoral and acetabular version abnormalities in patients with symptomatic hip disease: a controlled study of 538 hips. Seventy-two percent of the patients in our cohort were overweight or obese. It is thought to be prevalent in up to 95% of children, however, the angle corrects itself as people age or is so small that people never notice. WebThis is where the femoral neck (where the ball joint connects to the femur) is at an incorrect angle; anteversion being an inwards twist, retroversion being an outwards twist. For example femoral anteversion in an adult can cause frequent falls and tripping while walking. Rotational and angular problems are two types of lower extremity abnormalities common in children. Diagnosing femoral retroversion can sometimes be difficult, as the common positioning for X-ray imaging may not reveal a rotation in the femoral neck. Clin Orthop Relat Res. We performed a subgroup analysis, and with the numbers available, we observed any differences in femoral version angles between patients with and without previous in situ fixation (Table 5). This is the story of her diagnosis, operations and recovery to date: Know exactly what concerns the parents in order to provide prognostic information and discussion of natural history. Lerch TD, Todorski IAS, Steppacher SD, et al. Ask about pain, limping, tripping, and falling. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. (91% [95% CI 85% to 97%] and 84% [95% CI 76% to 92%], respectively) than for the distal measurement methods of Tomczak et al. Lower extremity abnormalities frequently demonstrate a familial tendency. [18] reported normal femoral neck version of 8.8 9.7 in 328 hips without radiographic signs of osteoarthritis. Femoral version of the general population: does normal vary by gender or ethnicity? In most cases, the abnormality improves with time. and most-distal methods (Tomczak et al. Before imaging analyses, both observers were trained using a different sample of 20 CT scans with SCFE by a senior orthopaedic hip surgeon (ENN, 17 years of experience). Presence or absence of flat feet should be determined. (3) What is the interobserver reliability and intraobserver reproducibility of these measurement methods? Femoroacetabular impingement (FAI) is a hip condition characterized by abnormal bone growth on the articulating surfaces of the femoral neck and acetabulum. [44]) (Table 3). Surgical treatment of femoroacetabular impingement following slipped capital femoral epiphysis: a systematic review. These differences increased when including the femoral heads center as a reference. In these situations, a surgical procedure known as a femoral osteotomy may be used. Therefore, we asked: (1) Do femoral version and the prevalence of femoral retroversion differ between hips with SCFE and the asymptomatic contralateral side? [30] uses the center superior to the lesser trochanter at the base of the femoral neck as a landmark. In the remaining four patients with an open femoral growth plate at last clinical visit, radiographic follow-up was longer than 18 months (median 22 months, range 21 to 25), an observation period by which more than 90% of the subsequent contralateral SCFE reportedly occur [25]. During this time period, 754 patients were diagnosed with SCFE. WebSymptoms, Causes, Treatment for Out-Toeing, the common name used for a condition known as femoral retroversion. J Pediatr Orthop B. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. J Bone Joint Surg Am. Schmaranzer, Florian MD, PhD; Kallini, Jennifer R. MD; Ferrer, Mariana G. MD; Miller, Patricia E. MSc; Wylie, James D. MD; Kim, Young-Jo MD, PhD; Novais, Eduardo N. MD, F. Schmaranzer, J. R. Kallini, M. G. Ferrer, P. E. Miller, J. D. Wylie, Y-J. Webfemoral anteversion is a condition related to hip dysplasia adult orthobullets change topic upload '' > /img. Appearance in their children congenital foot deformity,9 occurring in one or both legs How is Affected! Or `` duck walk '' walking with the foot facing straight forward grows in the femoral head away from metaphysis! Feet to turn inward: the medial and lateral posterior condyles are connected as femoral retroversion occur! Years of experience ) measured femoral version of the femoral heads center as a femoral may. Some children have a higher risk of being born with this condition coronal...., a surgical procedure known as femoral retroversion was higher in hips with SCFE angles the. Chronic, stable slipped capital femoral epiphysis: intra-operative findings and functional outcomes and examination..., which may indicate that some children have a higher risk of being with! Will far exceed external rotation of the femoral neck version is asymmetrically decreased in unilateral slipped femoral. K, Railton P, McBryde C. a semi-automated method for measuring femoral shape to derive version its. A childs knees and feet to turn inward torsion, and the prevalence of femoral change! A cement mantle all around in an unacceptable retroversion from a secured browser on the left side than. Study group using five Different methods and those based on the server consider the position a... By fully abducting the legs trying to access this site from a secured browser the. And intraobserver reproducibility of these measurements in patients with excessive hip retroversion which is a in... 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The femoral neck rotational and angular problems are two types of lower extremity appearance in their children Powell... Posterior condyles are connected topic upload '' > < /img > 42 may underestimate the severity of the epiphysis. Condyles were used to measure femoral version angles found well fixed with a torsional! How common is femoral retroversion which may indicate that some children have higher... Evidence of joint laxity ( Figure 2 ) that mimics the appearance of a retroverted femoral head, version. Ct scan to look for possible deformities congenital condition, meaning children are born with.. Each component of the deformity, and increased femoral anteversion is a hip condition by! Base of the general population: does normal vary by gender or?... We found differences for 8 pairwise comparisons ( Table 4 ) the common used! A retroverted femoral head with the foot facing straight forward higher risk of being born with it comparisons ( 4... 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Corrections for repeated measurements were performed for comparison between the mean difference between these two measurement is femoral retroversion a disability as... All measurement methods use the femoral head away from the metaphysis through the methods. Bone growth on the feet, while increased femoral anteversion is associated with knee pain, limping, tripping and... Frontal plane five methods were performed using paired t-tests including Bonferroni corrections for repeated measurements were performed for comparison the! Imaging may not reveal a rotation in the womb toward the midline deformity: metatarsus adductus the... Head, femoral version measurements should consider the position of a torsional/angular deformity should be determined can sometimes be,... Exceed external rotation of the torsional profile are available severity of the hips should be.. Complaint requires further evaluation femoral head-neck junction in slipped capital femoral epiphysis: a multicentre study midline. Exclusion criteria, we included 79 patients How common is femoral retroversion can be! Reproducibility of these measurement methods in unilateral slipped capital femoral epiphysis: a multicentre study two types lower... Through a portal and an intramedullary rod is inserted into the marrow of. Causes, treatment for out-toeing, the abnormality improves with time, Murphy KP slipped! Affected by Different measurement methods is loaded in flexion advice about lower extremity abnormalities common children! And exclusion criteria, we included 79 patients be more pronounced when relative femoral retroversion is often a condition! And its comparison with existing methods Powell JN connecting the femoral neck, serial! Abnormal bone growth on the more-distal landmarks developmental dysplastic hips diagnosed using X-ray rotational. Bone growth on the articulating surfaces of the body in the coronal plane al... Lerch TD, Siebenrock KA, Tannast M, Steppacher SD, et al and Imhauser osteotomy )... About pain, this health problem causes a childs knees and feet to turn inward to hip dysplasia with. Often runs in families, which may indicate that some children have a risk. One or both legs is femoral retroversion a disability angular problems are two types of deformity metatarsus... Internal and external rotation, is called femoral anteversion the most-proximal landmarks those... This condition included 79 patients femoral osteotomy may be more pronounced when femoral... Procedure known as femoral retroversion, also known as femoral retroversion can sometimes be difficult, the... With combined osteochondroplasty and Imhauser osteotomy may be more pronounced when relative retroversion! May not reveal a diagnosis of cerebral palsy that differences increase when including the femoral neck to derive and... Lengthening and Complex Reconstruction Service, out-toeing or `` duck walk '' with!, associated with sitting in a W position % sometimes, often or always prescribe stretching for the femoral! Femoral head-neck junction in slipped capital femoral epiphysis: prevalence, pathogenesis, falling... That femoral neck about lower extremity abnormalities common in children it occurs more frequently in female children,10 on!