Ultrasound Measurements of Torsions in the Tibia and Femur

Hudson, David; Royer, Todd D.; Richards, James G.

doi:10.2106/jbjs.d.02924

Cited by 37 publications

(21 citation statements)

References 25 publications

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“…We took care to develop a reliable method that accurately measures the amount of torsion in the femur by using validation with dry femora and masking the examiner to the results of MRI. Our ultrasonographic procedures were based on those developed by Hudson et al, 20 with minor modifications made in participant positioning to improve the visualization of the femur. In the study by Hudson et al, 20 participants were seated and semirecumbent, but the examiner in the present study found it difficult to clearly visualize the appropriate anatomical landmarks and read the tilt angle from the inclinometer when that positioning was used.…”

Section: Discussionmentioning

confidence: 99%

“…Our ultrasonographic procedures were based on those developed by Hudson et al, 20 with minor modifications made in participant positioning to improve the visualization of the femur. In the study by Hudson et al, 20 participants were seated and semirecumbent, but the examiner in the present study found it difficult to clearly visualize the appropriate anatomical landmarks and read the tilt angle from the inclinometer when that positioning was used. Supine positioning of participants allowed better visualization and ease of measurement.…”

Section: Discussionmentioning

confidence: 99%

“…The static femoral positions were documented with a photograph taken perpendicular to the plane of the femoral condyles ( Fig. 1), as well as with a US image obtained with the transducer tilting technique described by Hudson et al 20 In brief, the angle of femoral torsion was the angle formed by a line drawn through the center of the femoral neck and head and a line representing the horizontal plane of the posterior femoral condyles. Using ultrasonography, the transducer was tilted until the image of the femoral head and neck was horizontal on the computer screen.…”

Section: Methodsmentioning

confidence: 99%

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Measurement of Femoral Torsion by Ultrasound and Magnetic Resonance Imaging: Concurrent Validity

et al. 2010

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Measurement of Femoral Torsion by Ultrasound and Magnetic Resonance Imaging: Concurrent Validity

et al. 2010

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“…Its use has been advocated in numerous studies [2,3,7,11,12,25]. Other methods such as MRI [17,18,24] and ultrasound [2,10] also are valid tools for measuring the level of tibial torsion and can be used as reference standards. However, because CT was invented earlier, studies on the validity of MRI and ultrasound have used CT as the reference standard [2,18].…”

Section: Discussionmentioning

confidence: 99%

Tibial Torsion in Cerebral Palsy: Validity and Reliability of Measurement

Lee¹,

Chung²,

Park

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Physical examinations of tibial torsion are used for preoperative planning and to assess outcomes of tibial osteomy in patients with cerebral palsy (CP). The thigh-foot angle (TFA) and transmalleolar axis (TMA) are commonly used, and the second toe test recently was introduced. However, the validity and reliability of the three methods have not been clarified. This study was performed to evaluate the validity and reliability of these physical measures. We recruited 18 patients (36 limbs) with CP. During reliability sessions, three raters with various levels of orthopaedic experience independently measured tibial torsion using the three different methods during one day before surgery. Validity was assessed by performing a correlation study between physical examination and two-dimensional computed tomographic (CT) findings. Interobserver reliability was greatest for the TMA followed by TFA and then by the second toe test with intraclass correlation coefficients of 0.92, 0.74, and 0.57, respectively. In terms of the concurrent validity, the correlation coefficients (r) for the CT measurements were 0.62, 0.52, and 0.55. When depicting tibial torsion by physical examination, all three methods had substantial validity, but test reliability and validity were highest for TMA measurements.

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“…The torsion angle of the tibia, defined as the angle formed between the bicondylar axis of the proximal tibia and the bimalleolar axis, is an indicator of tibial torsion. This angle has been previously investigated by various means: clinical assessment only [1,2,4-6,9,10,20,21], radiographic examination [1,5,10,22,23], ultrasound [3,[24][25][26][27], and CT scan [18,21,24,28,29]. According to those studies, the torsion angle of the tibia varies in normal individuals from neutral at birth to a value from 17.41 to 40.51 of external torsion at maturity.…”

Section: Discussionmentioning

confidence: 99%

Tibiofibular torsion in congenital clubfoot

Farsetti

Dragoni

Ippolito

2012

Journal of Pediatric Orthopaedics B

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Tibiofibular torsion was measured by computed tomography in three series of patients affected by congenital clubfoot who were treated with different protocols. The normal leg of unilateral deformities served as the control. For the bilateral cases, only the right side was included in the study. The angle between the bicondylar axis of the tibia and the bimalleolar axis was the index of tibiofibular torsion. There were 34 clubfeet in the first series, treated with a posteromedial release, and 40 clubfeet in the second series, treated with a modified Ponseti method, whereas the third series included 16 clubfeet, treated with the original Ponseti method. All 90 clubfeet were graded at birth as group 3 according to the Manes classification. No patient had previous treatment. The patients of the first and the second series were followed up to maturity, whereas the patients of the third series were followed up to a maximum of 11 years of age. In the congenital clubfoot, the tibia and the fibula were externally rotated, in comparison with the normal leg; in fact, the average value of the angle of tibiofibular torsion was 32.28 in the first series, 23.98 in the second series, and 21.18 in the third series. In the normal tibiae, the average value of the angle of tibiofibular torsion was 21.48. The difference between the first series and the normal controls was statistically significant, as was the difference between the first one and the other two series. The value of the tibiofibular torsion angle seems to be related to the manipulation technique used to treat clubfoot: when the manipulation does not allow a progressive eversion of the talus underneath the calcaneus, the external tibial torsion increases. At follow-up, an intoeing gait was present in seven treated clubfeet of the first series. In all of them except one, the highest value of the external tibial torsion angle was observed, with a low value of the Kite's angle and/or residual forefoot adduction. In the treated congenital clubfoot, persistent intoeing is not related to the angle of tibial torsion but rather to the amount of correction of calcaneal inversion and residual forefoot adduction.

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Ultrasound Measurements of Torsions in the Tibia and Femur

Abstract: Ultrasound is a viable tool for measuring torsion of the tibia and femur. In order to minimize measurement errors, the ultrasound measurement should be used to calculate the predicted value of torsion with use of the regression equation.

Cited by 37 publications

References 25 publications

Measurement of Femoral Torsion by Ultrasound and Magnetic Resonance Imaging: Concurrent Validity

Measurement of Femoral Torsion by Ultrasound and Magnetic Resonance Imaging: Concurrent Validity

Tibial Torsion in Cerebral Palsy: Validity and Reliability of Measurement

Tibiofibular torsion in congenital clubfoot

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