Development of a method for measuring femoral torsion using real-time ultrasound

Hafiz, Eliza; Hiller, Claire E.; Nicholson, Leslie L.; Nightingale, Elizabeth J.; Clark, Julian; Grimaldi, Alison; Eisenhuth, John; Refshauge, Kathryn M.

doi:10.1088/0967-3334/35/7/1335

Cited by 4 publications

(4 citation statements)

References 35 publications

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“…[16] Ultrasound can be a proper method, but it relies too much on the experience of the operator. [17] Conventional 2D CT method is supposed to provide accurate measurement, but the femoral head and neck cannot be observed at the same time in general single CT section. Thus, the error of measurement exists in locating the femoral neck axis and other marker lines.…”

Section: Discussionmentioning

confidence: 99%

Application of three-dimensional reconstruction to improve the preoperative measurement accuracy and applicability of femoral neck torsion angle

Han

Zhang²,

Wang³

et al. 2019

Medicine

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Conventional methods have limitations in measuring femoral neck torsion angle (FNTA) of patients with femoral deformities. A new method of three-dimensional (3D) reconstruction technology based on computer tomography (CT) was proposed to enhance measurement accuracy and applicability in this study.Bilateral FNTA of 50 developmental dysplasia of the hip (DDH) patients (DDH group) and 81 volunteers (normal group) were measured by Mimics software based on CT data with the marker lines determined by centerline and curvature. Each FNTA was measured by observer A and observer B for twice separately. 50 DDH patients were classified into 3 groups (group I, II, III) according to Hartofilakidis classification. The statistical analysis of the differences was made among the measurements of the FNTA.The FNTA values were 27.56° ± 12.48° in DDH group and 21.22° ± 8.14° in normal group with significant difference (t = 4.516, P < .001). The FNTA values were 24.53° ± 2.40° in group I, 29.78° ± 1.83° in group II and 39.08° ± 3.13° in group III, with significant difference (F = 7.568, P = .001).The accuracy, reliability and applicable scope of FNTA measurement can be improved by 3D reconstruction in clinical practice. The applicable scope of this method included normal people and patients with femoral deformities. The FNTA of DDH patients is significantly larger than normal volunteers with a positive correlation between the severity of classification. This study will also provide references for preoperative design of Chinese population.

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Section: Discussionmentioning

confidence: 99%

Application of three-dimensional reconstruction to improve the preoperative measurement accuracy and applicability of femoral neck torsion angle

Han

Zhang²,

Wang³

et al. 2019

Medicine

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“…In the current study, measurement of femoral torsion was confined to the femoral shaft, using an ultrasound-assisted method previously developed by the investigators. 28 This method was shown to have excellent intra-and inter-rater reliability. 28 Briefly, the dancer lay supine with her hips and knees relaxed in a neutral position.…”

Section: Physical Measures Femoral Shaft Torsionmentioning

confidence: 98%

“…28 This method was shown to have excellent intra-and inter-rater reliability. 28 Briefly, the dancer lay supine with her hips and knees relaxed in a neutral position. A customized jig with an attached digital inclinometer (Accumar TM ) was aligned with the femoral condyles of the test knee.…”

Section: Physical Measures Femoral Shaft Torsionmentioning

confidence: 98%

“…With the assistance of real-time ultrasound (Siemens ACUSON X300), the assessor produced an image of the greater trochanter "peak." 28 The assessor ensured that the transducer was maintained in the coronal plane using the attached spirit level, after which the whole leg was rotated internally (medially) or externally (laterally) until the "peak" appeared uppermost on the screen. The angle of femoral shaft torsion was defined as the angle measured on the inclinometer, representing the relative position of the axis of the condyles to the greater trochanter.…”

Section: Physical Measures Femoral Shaft Torsionmentioning

confidence: 99%

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Femoral Shaft Torsion in Injured and Uninjured Ballet Dancers and Its Association with Other Hip Measures: A Cross-sectional Study

et al. 2016

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Low range femoral torsion, termed "lateral shaft torsion," has been associated with greater range of hip external rotation and turnout in dancers. It is also hypothesized that achieving greater turnout at the hip minimizes torsion at the knee, shank, ankle, and foot, and consequently reduces incidence of lower limb injuries. The primary aims of this study were to investigate: 1. differences in range of femoral shaft torsion between dancers with and without lower limb injuries; and 2. the relationship between femoral shaft torsion, hip external rotation range, and turnout. A secondary aim was to examine the relationship between femoral shaft torsion and other hip measures: hip strength, lower limb joint hypermobility, hip stability, and foot progression angle, as explanatory variables. Demographic, dance, and injury data were collected, along with physical measures of femoral shaft torsion, hip rotation range of motion, and turnout. Hip strength, control, lower limb hypermobility, and foot progression angle were also measured. Eighty female dancers, 50 with lower limb injury (20.7 ± 4.8 years of age) and 30 without lower limb injury (17.8 ± 4.1 years of age), participated in the study. There was no difference in range of femoral shaft torsion between the groups (p = 0.941). Femoral shaft torsion was weakly correlated with range of hip external rotation (r = -0.034, p = 0.384) and turnout (r = -0.066, p = 0.558). Injured dancers had a significantly longer training history than non-injured dancers (p = 0.001). It was concluded that femoral shaft torsion does not appear to be associated with the overall incidence of lower limb injury in dancers or to be a primary factor influencing extent of turnout in this population.

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Validity and reliability of ultrasonographic assessment of femoral and tibial torsion in children and adolescents: a systematic review

Ruiz-Tarrazo,

Escalona-Marfil,

Pla-Campas

et al. 2024

Eur J Pediatr

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Torsional disorders of the lower limb are common in childhood, and they are one of the primary reasons parents seek consultation with healthcare providers. While clinical manoeuvres can assess femoral and tibial torsion, their reliability is medium to low. Various imaging-based techniques, including computed tomography, magnetic resonance imaging, fluoroscopy, biplanar radiology and ultrasonography, have been used to evaluate torsional alterations of the lower extremity. Among these, ultrasound assessment offers certain advantages: it is a low-cost, non-irradiating technique, which allows the follow-up of children’s torsional development. However, to the best of the authors’ knowledge, its validity and reliability have not been summarised in a systematic review. This study aims to analyse the validity and reliability of ultrasonography in determining femoral and tibial torsion in children and adolescents. A search from Medline (via PubMed), Web of Science, Scopus and CINAHL databases were performed from inception to 16 March 2023. No restrictions were placed on the publication year or language. The methodological quality of all eligible studies was independently reviewed by two authors using QUADAS and STARD checklists. Overall, 1546 articles were identified through the searches; 30 were considered eligible for full-text screening; and 8 studies were finally included in this review. The included studies were conducted in Germany, Norway and the UK. Among them, 7 studies analysed the validity of ultrasonography compared with other imaging techniques such as computed tomography, magnetic resonance imaging and biplanar X-ray, and 4 studies assessed intra- and inter-observer reliability. All the studies assessed femoral torsion, but only one of them also included tibial torsion. Conclusion: Ultrasound is a good alternative for routine evaluation and follow-up of femoral torsional alterations in children and adolescents due to its safety, accessibility and immediate results in the clinical examination room. Although ultrasound has good accuracy and reliability for routine evaluations, there is controversy about whether it is sufficient for surgical planning. In cases where greater accuracy is required, magnetic resonance imaging and biplanar radiography are the preferred imaging techniques. What is Known:• Several imaging-based techniques have been described for the assessment of torsional alterations of the lower extremity.• Computed tomography, magnetic resonance imaging, biplanar radiology and ultrasonography are the most used and studied methods. What is New:• Ultrasonography represents a good alternative for the assessment of femoral and tibial torsional alterations in children and adolescents, given its safety, accessibility and immediacy of results in the consultation room.• Its accuracy and reliability are good but not sufficient for surgical planning, in which case MRI and biplanar X-ray will be the preferred choices.

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Development of a method for measuring femoral torsion using real-time ultrasound

Cited by 4 publications

References 35 publications

Application of three-dimensional reconstruction to improve the preoperative measurement accuracy and applicability of femoral neck torsion angle

Application of three-dimensional reconstruction to improve the preoperative measurement accuracy and applicability of femoral neck torsion angle

Femoral Shaft Torsion in Injured and Uninjured Ballet Dancers and Its Association with Other Hip Measures: A Cross-sectional Study

Validity and reliability of ultrasonographic assessment of femoral and tibial torsion in children and adolescents: a systematic review

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