metodebok.no  Ortopedi
/
 

Rotasjonsproblematikk

Sist oppdatert: 20.10.2021
Mer informasjon
Utgiver: Vestre Viken HF
Versjon: 0.6
Kopier lenke til dette emnet
Foreslå endringer/gi kommentarer

Beskrivelse 

  • Mange barn har inntåing med/uten innkneing uten at de har plager av dette.
  • Vanligvis normaliseres rotasjonsforholdene i underekstremitetene i løpet av vekst og alder.
  • Hos voksne er gjennomsnittlig femuranteversjon 15° og extern tibiatorsjon 10°.
  • På hvilket nivå befinner rotasjonsavviket seg?

Klinikk 

Barn med inn-rotasjonsdeformitet vil gjerne klage over

  • snubletendens
  • knærne går i hverandre ("knock knees")
  • vansker med løing, beina går som "hjulvisper" under løp
  • vansker med å sparke fotball med innsiden av skoen
  • vansker med å gå på ski (gå fiskebein)
  • vansker med å gå på skøyter
  • andre funksjonelle vansker

 

Små barn med økt femuranteversjon har lett for å sitte i W-stilling på gulvet. Dette er ikke skadelig (slik enkelte mener), men er et uttrykk for den økte innrotasjonen i hoftene.

Diagnostikk 

Hvilket nivå befinner rotasjonsavviket seg?

 

Klinisk undersøkelse:

  • Femur (forøket femuranterversjon) med stor asymmetri i rotasjonsutslag, ROM utrotasjon < 20 gr
  • Tibia (økt intern tibiatorsjon) med rettstilte knær og redusert bimalleolær vinkel ROM < 20 gr
  • Foten (vanligvis pes adduktus)

 

Sjekk også for andre akseavvik i UX, for eksempel varus/valgus og anisomeli og hoftedysplasi.

 

Fra Lynn Staheli's bok om barneortopedi: Fundamentals of Pediatric Orthopedics, Seattle 2008.

 

Det vil vanligvis ikke være indikasjon for deroterende osteotomi dersom femuranteversjonen målt på CT er under 40 grader.

 

Utregning av rotasjonsforholdene på CT mål kan gjøres ved hjelp av denne kalkulatoren: http://uwmsk.org/legrotation.html

 

Femuranteversjonen endres i løpet av vekst og alder, se kurve under. Det er derfor fornuftig å avvente operasjon til pasienten nærmer seg utvokst, for eksempel i 12-13 års alder.

 

 

Sjekk også for andre akseavvik i UX, for eksempel varus/valgus og anisomeli og hoftedysplasi.

 

Alle barn som vurderes for operasjon skal ha tatt rtg bekken front og CT rotasjonsmål av UX.

 

Normalgrense for femuranteversjon er < 40°, for tibia >15° utrotasjon.

 

Barn med inntåing kan vurderes for operasjon (deroterende femurosteotomi) dersom de;

  • er over 10 år (helst 11-12 år)
  • har funksjonelle plager eller smerter assosiert med inntåingen
  • Utrotasjon i hoften er < 20 grader

 

Barn med inntåing kan vurderes for operasjon (deroterende distal tibiaosteotomi) dersom de;

  • Bimalleolærvinkel er < 20 grader

 

Dersom rotasjonsdeformiteten sitter på

  • femur-nivå gjøres proksimal deroterende femurosteotomi ca 30 grader.
  • legg-nivå gjøres distal deroterende tibiaosteotomi ca 15-30 grader. Ved behov gjøres skråosteotomi av fibula midt på leggen.
  • Fot-nivå gjøres korrigerende fotkirurgi, eksempelvis dobbeltosteotomi i forfoten.

Behandling 

Barn med inntåing kan som regel vurderes for operasjon (deroterende osteotomi) dersom de;

  • er over 10 år (helst 11-12 år)
  • har redusert funksjon eller smerter assosiert med inntåingen
  • Utrotasjon i hoften er < 20 grader eller
  • Bimalleolærvinkel er < 20 grader

 

Dersom rotasjonsdeformiteten sitter på

  • femur-nivå: proksimal deroterende femurosteotomi 30-40 grader, alternativt distal detorerende femurosteotomi eller midt-diafysært.
  • legg-nivå: distal deroterende tibiaosteotomi 20-30 grader. Ved behov, vanligvis ved derotasjon over 20 grader, gjøres skråosteotomi av fibula midt på leggen.
  • fot-nivå: korrigerende fotkirurgi, eksempelvis dobbeltosteotomi i forfoten.

 

Ved midt-diafysær eller subtrokantær rotasjonsosteotomi benyttes IM trokantær nagle. Fordelen med denne metoden er at den er perkutan og at pasienten som regel kan mobiliseres og belaste inntil smertegrensen umiddelbart etter operasjonen. Ved mer proksimal osteotomi, hvor det for eksempel skal gjøres mer kombinerte korreksjoner (varus/ekstenderende, osv) er det rimelig å benytte låseplate/hofteplate.

 

Dersom det samtidig er indikasjon for varisering i hoften kan man vurdere å benytte en rett IM nagle, for eksempel en humerus-nagle. Vi har så langt gode erfaringer med en slik rett nagle. Metoden har mange av de samme fordelene som ved lang IM nagle og proksimal/midt-diafysær osteotomi, men mobiliseringen og belastningen kan da bli mer begrenset og må vurderes individuelt.

 

I proksimale femur bruker vi primært en IM nagle, evenutelt en Pediatric Hip Plate 120-130 grader (flere tilgjengelige leverandører).

I distale femur benyttes femurkondylplate (flere leverandører).


Implantantene skal matche pasientens vekt, det vil vanligvis bety 3.5 mm plate ved vekt < 35 kg og 5.0 mm plate ved vekt > 35 kg.

Etterbehandling 

Grad av belastning er avhengig av valg av operasjonsmetode.

  • Ved osteotomi med IM nagle kan pasienten fullbelaste inntil smertegrensen umiddelbart etter operasjonen.
  • Ved proksimal eller distal osteotomi med platefiksasjon kan pasienten avlaste benet med krykker under tilhelingen. Det kan tillates touch-belastning, max 5-10 kg.

 

Eventuell oppfølging av lokal fysioterapeut. Rekvisisjon er ikke nødvendig.

Kontroll 

  • Kontroll tilheling 6 uker postoperativt.
  • Klinisk og radiologisk kontroll.
  • Etter tilheling kan pasienten tillates full belastning, men anbefaler gradvis opptrening.
  • Pasienten kan ved behov kontakte lokal fysioterapeut for hjelp med opptreningen med vekt på styrke, stabilitet, balanse.
  • Ved ukomplisert tilheling etter 6 uker er det ikke påkrevet med videre kontroller.

Prognose  

  • God prognose. Ved korrekt utført derotasjonsosteotomi oppnår man endring tilsvarende utført derotasjon. Pasienten blir som regel mindre slitne av aktivitet fordi de nå ikke trenger å bruke aksessorisk muskulatur for å opprettholde kliniske akser under aktiviteten.
  • Pasienten gjøres oppmerksom på å tape (Norgesplaster) såret det første postoperative året for å unngå uheldig/overdreven arrdannelse.
  • Dersom derotasjonen utføres i tidlig barnealder - for eksempel i 6-7 års alderen - er det en risiko for tilbakefall av femuranteversjonen.
  • Det er ikke kjent at man kan ha tilsvarende tilbakefall etter en deroterende distal tibiaosteotomi, muligens på grunn av lavere vekst i distale tibia.
  • Ved fotkorreksjoner vil det være avgjørende å velge riktig operasjon. Det vil vanligvis være tilstrekkelig med korrigerende dobbeltosteotomi gjennom midtfoten ved pes adduktus-deformitet, men som alltid må man også se på foten som helhet på leting etter andre eventuell tilhørende deformiteter, for eksempel cavovarus.

Komplikasjoner 

  • Største risiko ved korreksjon av rotasjonsdeformitet er feil valg av prosedyre.
  • Man ser svært sjelden osteosyntesesvikt, infeksjoner, blødniner eller sårproblemer ved korrekt utført kirurgi.

Litteratur 

Oversikt

  1. Staheli LT. Rotational problems in children. Instr Course Lect. 1994;43:199-209.Abstract external link opens in a new window
  2. Staheli LT, Corbett M, Wyss C, et al. Lower-extremity rotational problems in children: normal values to guide management. J Bone Joint Surg Am. 1985 Jan;67(1):39-47.Abstract external link opens in a new window

 

Litteratur

  1. Staheli LT. Rotational problems in children. Instr Course Lect. 1994;43:199-209.Abstract external link opens in a new window
  1. Staheli LT, Corbett M, Wyss C, et al. Lower-extremity rotational problems in children: normal values to guide management. J Bone Joint Surg Am. 1985 Jan;67(1):39-47.Abstract external link opens in a new window
  1. Engel GM, Staheli LT. The natural history of torsion and other factors influencing gait in childhood: a study of the angle of gait, tibial torsion, knee angle, hip rotation, and development of the arch in normal children. Clin Orthop Relat Res. 1974 Mar-Apr;(99):12-7.Abstract external link opens in a new window
  1. Hensinger RN. Standards in orthopedics: tables, charts, and graphs illustrating growth. New York, NY: Raven Press; 1986.
  1. Jacquemier M, Glard Y, Pomero V, et al. Rotational profile of the lower limb in 1319 healthy children. Gait Posture. 2008 Aug;28(2):187-93.Abstract external link opens in a new window
  1. Reeder BM, Lyne ED, Patel DR, et al. Referral patterns to a pediatric orthopedic clinic: implications for education and practice. Pediatrics. 2004 Mar;113(3 Pt 1):e163-7.Full text external link opens in a new windowAbstract external link opens in a new window
  1. Cheng JC, Chan PS, Chiang SC, et al. Angular and rotational profile of the lower limb in 2,630 Chinese children. J Pediatr Orthop. 1991 Mar-Apr;11(2):154-61.Abstract external link opens in a new window
  1. Craxford AD, Minns RJ, Park C. Plantar pressures and gait parameters: a study of foot shape and limb rotations in children. J Pediatr Orthop. 1984 Aug;4(4):477-81.Abstract external link opens in a new window
  1. Losel S, Burgess-Milliron MJ, Micheli LJ, et al. A simplified technique for determining foot progression angle in children 4 to 16 years of age. J Pediatr Orthop. 1996 Sep-Oct;16(5):570-4.Abstract external link opens in a new window
  1. Dias LS, Jasty MJ, Collins P. Rotational deformities of the lower limb in myelomeningocele: evaluation and treatment. J Bone Joint Surg Am. 1984 Feb;66(2):215-23.Abstract external link opens in a new window
  1. Fraser RK, Menelaus MB. The management of tibial torsion in patients with spina bifida. J Bone Joint Surg Br. 1993 May;75(3):495-7.Full text external link opens in a new windowAbstract external link opens in a new window
  1. Wren TA, Rethlefsen S, Kay RM. Prevalence of specific gait abnormalities in children with cerebral palsy: influence of cerebral palsy subtype, age, and previous surgery. J Pediatr Orthop. 2005 Jan-Feb;25(1):79-83.Abstract external link opens in a new window
  1. Rethlefsen SA, Healy BS, Wren TA, et al. Causes of intoeing gait in children with cerebral palsy. J Bone Joint Surg Am. 2006 Oct;88(10):2175-80.Abstract external link opens in a new window
  1. Laplaza FJ, Root L, Tassanawipas A, et al. Femoral torsion and neck-shaft angles in cerebral palsy. J Pediatr Orthop. 1993 Mar-Apr;13(2):192-9.Abstract external link opens in a new window
  1. Robin J, Graham HK, Selber P, et al. Proximal femoral geometry in cerebral palsy: a population-based cross-sectional study. J Bone Joint Surg Br. 2008 Oct;90(10):1372-9.Abstract external link opens in a new window
  1. Lampert C, Thomann B, Brunner R. Tibial torsion deformities. Orthopade. 2000 Sep;29(9):802-7.Abstract external link opens in a new window
  1. Sutherland DH, Schottstaedt ER, Larsen LJ, et al. Clinical and electromyographic study of seven spastic children with internal rotation gait. J Bone Joint Surg Am. 1969 Sep;51(6):1070-82.Abstract external link opens in a new window
  1. Steel HH. Gluteus medius and minimus insertion advancement for correction of internal rotation gait in spastic cerebral palsy. J Bone Joint Surg Am. 1980 Sep;62(6):919-27.Abstract external link opens in a new window
  1. Chong KC, Vojnic CD, Quanbury AO, et al. The assessment of the internal rotation gait in cerebral palsy: an electromyographic gait analysis. Clin Orthop Relat Res. 1978 May;(132):145-50.Abstract external link opens in a new window
  1. Joseph B. Treatment of internal rotation gait due to gluteus medius and minimus overactivity in cerebral palsy: anatomical rationale of a new surgical procedure and preliminary results in twelve hips. Clin Anat. 1998;11(1):22-8.Abstract external link opens in a new window
  1. Crane L. Femoral torsion and its relation to toeing-in and toeing-out. J Bone Joint Surg Am. 1959 Apr;41-A(3):421-8.Abstract external link opens in a new window
  1. Altinel L, Kose KC, Aksoy Y, et al. Hip rotation degrees, intoeing problem, and sitting habits in nursery school children: an analysis of 1,134 cases. Acta Orthop Traumatol Turc. 2007;41(3):190-4.Abstract external link opens in a new window
  1. Kim HD, Lee DS, Eom MJ, et al. Relationship between physical examinations and two-dimensional computed tomographic findings in children with intoeing gait. Ann Rehabil Med. 2011 Aug;35(4):491-8.Full text external link opens in a new windowAbstract external link opens in a new window
  1. Svenningsen S, Terjesen T, Auflem M, et al. Hip rotation and in-toeing gait: a study of normal subjects from four years until adult age. Clin Orthop Relat Res. 1990 Feb;(251):177-82.Abstract external link opens in a new window
  1. Davids JR, Davis RB. Tibial torsion: significance and measurement. Gait Posture. 2007 Jul;26(2):169-71.Abstract external link opens in a new window
  1. Davids JR, Davis RB, Jameson LC, et al. Surgical management of persistent intoeing gait due to increased internal tibial torsion in children. J Pediatr Orthop. J Pediatr Orthop. 2014 Jun;34(4):467-73Abstract external link opens in a new window
  1. Krackow KA, Mandeville DS, Rachala SR, et al. Torsion deformity and joint loading for medial knee osteoarthritis. Gait Posture. 2011 Apr;33(4):625-9.Abstract external link opens in a new window
  1. MacWilliams BA, McMulkin ML, Baird GO, et al. Distal tibial rotation osteotomies normalize frontal plane knee moments. J Bone Joint Surg Am. 2010 Dec 1;92(17):2835-42.Abstract external link opens in a new window
  1. Turner MS, Smillie IS. The effect of tibial torsion of the pathology of the knee. J Bone Joint Surg Br. 1981;63-B(3):396-8.Abstract external link opens in a new window
  1. Yagi T. Tibial torsion in patients with medial-type osteoarthrotic knees. Clin Orthop Relat Res. 1994 May;(302):52-6.Abstract external link opens in a new window
  1. Eckhoff DG. Effect of limb malrotation on malalignment and osteoarthritis. Orthop Clin North Am. 1994 Jul;25(3):405-14.Abstract external link opens in a new window
  1. Eckhoff DG, Johnston RJ, Stamm ER, et al. Version of the osteoarthritic knee. J Arthroplasty. 1994 Feb;9(1):73-9.Abstract external link opens in a new window
  1. Trost J. Physical assessment and observational gait analysis. In: Gage JR, ed. The treatment of gait problems in cerebral palsy. London, UK: Mac Keith Press; 2004:79-80, 187, 212.
  1. Somerville EW. Persistent foetal alignment of the hip. J Bone Joint Surg Br. 1957 Feb;39-B(1):106-13.Full text external link opens in a new windowAbstract external link opens in a new window
  1. Schwartz M, Lakin G. The effect of tibial torsion on the dynamic function of the soleus during gait. Gait Posture. 2003 Apr;17(2):113-8.Abstract external link opens in a new window
  1. Coon V, Donato G, Houser C, et al. Normal ranges of hip motion in infants six weeks, three months and six months of age. Clin Orthop Relat Res. 1975 Jul-Aug;(110):256-60.Abstract external link opens in a new window
  1. Hoffer MM. Joint motion limitation in newborns. Clin Orthop Relat Res. 1980 May;(148):94-6.Abstract external link opens in a new window
  1. Siegel DB, Kasser JR, Sponseller P, et al. Slipped capital femoral epiphysis: a quantitative analysis of motion, gait, and femoral remodeling after in situ fixation. J Bone Joint Surg Am. 1991 Jun;73(5):659-66.Abstract external link opens in a new window
  1. Song KM, Halliday S, Reilly C, et al. Gait abnormalities following slipped capital femoral epiphysis. J Pediatr Orthop. 2004 Mar-Apr;24(2):148-55.Abstract external link opens in a new window
  1. Post WR, Teitge R, Amis A. Patellofemoral malalignment: looking beyond the viewbox. Clin Sports Med. 2002 Jul;21(3):521-46, x.Abstract external link opens in a new window
  1. Cooke TD, Price N, Fisher B, et al. The inwardly pointing knee: an unrecognized problem of external rotational malalignment. Clin Orthop Relat Res. 1990 Nov;(260):56-60.Abstract external link opens in a new window
  1. Halpern AA, Tanner J, Rinsky L. Does persistent fetal femoral anteversion contribute to osteoarthritis?: a preliminary report. Clin Orthop Relat Res. 1979 Nov-Dec;(145):213-6.Abstract external link opens in a new window
  1. Flandry F, Hughston JC. Complications of extensor mechanism surgery for patellar malalignment. Am J Orthop. 1995 Jul;24(7):534-43.Abstract external link opens in a new window
  1. James SL. Chondromalacia of the patella in the adolescent. In: Kennedy JC, ed. The injured adolescent knee. Baltimore, MD: Williams & Wilkins; 1979:205-251.
  1. Stefko RM, de Swart RJ, Dodgin DA, et al. Kinematic and kinetic analysis of distal derotational osteotomy of the leg in children with cerebral palsy. J Pediatr Orthop. 1998 Jan-Feb;18(1):81-7.Abstract external link opens in a new window
  1. Rerucha CM, Dickison C, Baird DC. Lower extremity abnormalities in children. Am Fam Physician. 2017 Aug 15;96(4):226-33.Full text external link opens in a new windowAbstract external link opens in a new window
  1. The Easter Seal Society. The Easter Seal guide to children's orthopaedics: prevention, screening and problem solving. 2008 (originally published 1982) [internet publication].Full text external link opens in a new window
  1. Delgado ED, Schoenecker PL, Rich MM, et al. Treatment of severe torsional malalignment syndrome. J Pediatr Orthop. 1996 Jul-Aug;16(4):484-8.Abstract external link opens in a new window
  1. Lincoln TL, Suen PW. Common rotational variations in children. J Am Acad Orthop Surg. 2003 Sep-Oct;11(5):312-20.Abstract external link opens in a new window
  1. Lee SH, Chung CY, Park MS, et al. Tibial torsion in cerebral palsy: validity and reliability of measurement. Clin Orthop Relat Res. 2009 Aug;467(8):2098-104.Abstract external link opens in a new window
  1. Hazlewood ME, Simmons AN, Johnson WT, et al. The Footprint method to assess transmalleolar axis. Gait Posture. 2007 Apr;25(4):597-603.Abstract external link opens in a new window
  1. Ruwe PA, Gage JR, Ozonoff MB, et al. Clinical determination of femoral anteversion: a comparison with established techniques. J Bone Joint Surg Am. 1992 Jul;74(6):820-30.Abstract external link opens in a new window
  1. Davids JR, Benfanti P, Blackhurst DW, et al. Assessment of femoral anteversion in children with cerebral palsy: accuracy of the trochanteric prominence angle test. J Pediatr Orthop. 2002 Mar-Apr;22(2):173-8.Abstract external link opens in a new window
  1. Chung CY, Lee KM, Park MS, et al. Validity and reliability of measuring femoral anteversion and neck-shaft angle in patients with cerebral palsy. J Bone Joint Surg Am. 2010 May;92(5):1195-205.Abstract external link opens in a new window
  1. Greene WB. Genu varum and genu valgum in children: differential diagnosis and guidelines for evaluation. Compr Ther. 1996 Jan;22(1):22-9.Abstract external link opens in a new window
  1. Perry J, Hoffer MM, Giovan P, et al. Gait analysis of the triceps surae in cerebral palsy: a preoperative and postoperative clinical and electromyographic study. J Bone Joint Surg Am. 1974 Apr;56(3):511-20.Abstract external link opens in a new window
  1. Shtarker H, Volpin G, Stolero J, et al. Correction of combined angular and rotational deformities by the Ilizarov method. Clin Orthop Relat Res. 2002 Sep;(402):184-95.Abstract external link opens in a new window
  1. Jakob RP, Haertel M, Stussi E. Tibial torsion calculated by computerised tomography and compared to other methods of measurement. J Bone Joint Surg Br. 1980 May;62-B(2):238-42.Abstract external link opens in a new window
  1. Paley D, Tetsworth K. Mechanical axis deviation of the lower limbs: preoperative planning of uniapical angular deformities of the tibia or femur. Clin Orthop Relat Res. 1992 Jul;(280):48-64.Abstract external link opens in a new window
  1. Davids JR, Blackhurst DW, Allen BL Jr. Clinical evaluation of bowed legs in children. J Pediatr Orthop B. 2000 Oct;9(4):278-84.Abstract external link opens in a new window
  1. Langenskiöld A. Tibia vara: a critical review. Clin Orthop Relat Res. 1989 Sep;(246):195-207.Abstract external link opens in a new window
  1. Langenskioeld A, Riska EB. Tibia vara (osteochondrosis deformans tibiae): a survey of seventy-one cases. J Bone Joint Surg Am. 1964 Oct;46:1405-20.Abstract external link opens in a new window
  1. Murphy SB, Simon SR, Kijewski PK, et al. Femoral anteversion. J Bone Joint Surg Am. 1987 Oct;69(8):1169-76.Abstract external link opens in a new window
  1. Hudson D, Royer T, Richards J. Ultrasound measurements of torsions in the tibia and femur. J Bone Joint Surg Am. 2006 Jan;88(1):138-43.Abstract external link opens in a new window
  1. Schneider B, Laubenberger J, Jemlich S, et al. Measurement of femoral antetorsion and tibial torsion by magnetic resonance imaging. Br J Radiol. 1997 Jun;70(834):575-9.Abstract external link opens in a new window
  1. Bruce WD, Stevens PM. Surgical correction of miserable malalignment syndrome. J Pediatr Orthop. 2004 Jul-Aug;24(4):392-6.Abstract external link opens in a new window
  1. Stevens PM, Anderson D. Correction of anteversion in skeletally immature patients: percutaneous osteotomy and transtrochanteric intramedullary rod. J Pediatr Orthop. 2008 Apr-May;28(3):277-83.Abstract external link opens in a new window
  1. Basaran SH, Ercin E, Bayrak A, et al. The measurement of tibial torsion by magnetic resonance imaging in children: the comparison of three different methods. Eur J Orthop Surg Traumatol. 2015 Dec;25(8):1327-32.Abstract external link opens in a new window
  1. Muhamad AR, Freitas JM, Bomar JD, et al. CT and MRI lower extremity torsional profile studies: measurement reproducibility. J Child Orthop. 2012 Oct;6(5):391-6.Full text external link opens in a new windowAbstract external link opens in a new window
  1. Gaumétou E, Quijano S, Ilharreborde B, et al. EOS analysis of lower extremity segmental torsion in children and young adults. Orthop Traumatol Surg Res. 2014 Feb;100(1):147-51.Abstract external link opens in a new window
  1. Meyrignac O, Moreno R, Baunin C, et al. Low-dose biplanar radiography can be used in children and adolescents to accurately assess femoral and tibial torsion and greatly reduce irradiation. Eur Radiol. 2015 Jun;25(6):1752-60.Abstract external link opens in a new window
  1. Szuper K, Schlégl ÁT, Leidecker E, et al. Three-dimensional quantitative analysis of the proximal femur and the pelvis in children and adolescents using an upright biplanar slot-scanning X-ray system. Pediatr Radiol. 2015 Mar;45(3):411-21.Abstract external link opens in a new window
  1. Schoenecker PL, Rich MM. The lower extremity. In: Morrissy RT, Weinstein SL, eds. Lovell and Winter's pediatric orthopaedics. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:1160-1163.
  1. Kling TF Jr, Hensinger RN. Angular and torsional deformities of the lower limbs in children. Clin Orthop Relat Res. 1983 Jun;(176):136-47.Abstract external link opens in a new window
  1. Dodgin DA, De Swart RJ, Stefko RM, et al. Distal tibial/fibular derotation osteotomy for correction of tibial torsion: review of technique and results in 63 cases. J Pediatr Orthop. 1998;18:95-101.Abstract external link opens in a new window
  1. Redmond AC. An evaluation of the use of gait plate inlays in the short-term management of the intoeing child. Foot Ankle Int. 1998 Mar;19(3):144-8.Abstract external link opens in a new window
  1. Redmond AC. The effectiveness of gait plates in controlling in-toeing symptoms in young children. J Am Podiatr Med Assoc. 2000 Feb;90(2):70-6.Abstract external link opens in a new window
  1. Uden H, Kumar S. Non-surgical management of a pediatric "intoed" gait pattern - a systematic review of the current best evidence. J Multidiscip Healthc. 2012;5:27-35.Full text external link opens in a new windowAbstract external link opens in a new window
  1. Staheli LT. Torsion: treatment indications. Clin Orthop Relat Res. 1989 Oct;(247):61-6.Abstract external link opens in a new window
  1. Gage JR, Schwartz M. Pathological gait and lever-arm dysfunction. In: Gage JR, ed. The treatment of gait problems in cerebral palsy. London, UK: Mac Keith Press; 2004:180-204.
  1. Pascual-Pascual SI, Pascual-Castroviejo I, Ruiz PJ. Treating spastic equinus foot from cerebral palsy with botulinum toxin type A: what factors influence the results?: an analysis of 189 consecutive cases. Am J Phys Med Rehabil. 2011 Jul;90(7):554-63.Abstract external link opens in a new window
  1. Kay RM, Rethlefsen SA, Fern-Buneo A, et al. Botulinum toxin as an adjunct to serial casting treatment in children with cerebral palsy. J Bone Joint Surg Am. 2004 Nov;86-A(11):2377-84.Abstract external link opens in a new window
  1. King HA, Staheli LT. Torsional problems in cerebral palsy. Foot Ankle. 1984 Jan-Feb;4(4):180-4.Abstract external link opens in a new window
  1. Rethlefsen SA, Kay RM. Transverse plane gait problems in children with cerebral palsy. J Pediatr Orthop. 2013 Jun;33(4):422-30.Abstract external link opens in a new window
  1. Rushforth GF. The natural history of hooked forefoot. J Bone Joint Surg Br. 1978 Nov;60-B(4):530-2.Abstract external link opens in a new window
  1. Farsetti P, Weinstein SL, Ponseti IV. The long-term functional and radiographic outcomes of untreated and non-operatively treated metatarsus adductus. J Bone Joint Surg Am. 1994 Feb;76(2):257-65.Abstract external link opens in a new window
  1. Canadian Paediatric Society. Footwear for children. Feb 2009 [internet publication].Full text external link opens in a new window
  1. Staheli LT. Torsional deformity. Pediatr Clin North Am. 1977;24:799-811.Abstract external link opens in a new window
  1. Fuchs R, Staheli LT. Sprinting and intoeing. J Pediatr Orthop. 1996;16:489-491.Abstract external link opens in a new window
  1. Staheli LT, Engel GM. Tibial torsion: a method of assessment and a survey of normal children. Clin Orthop Relat Res. 1972;86:183-186.Abstract external link opens in a new window
  1. Watanabe RS. Embryology of the human hip. Clin Orthop Relat Res. 1974;(98):8-26.Abstract external link opens in a new window
  1. Walker JM. Comparison of normal and abnormal human fetal hip joints: a quantitative study with significance to congenital hip disease. J Pediatr Orthop. 1983;3:173-183.Abstract external link opens in a new window
  1. 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;55:1726-1738.Abstract external link opens in a new window
  1. Fabry G, Cheng LX, Molenaers G. Normal and abnormal torsional development in children. Clin Orthop Relat Res. 1994;(302):22-26.Abstract external link opens in a new window
  1. Hubbard DD, Staheli LT, Chew DE, et al. Medial femoral torsion and osteoarthritis. J Pediatr Orthop. 1988;8:540-542.Abstract external link opens in a new window
  1. Tonnis D, Heinecke A. Diminished femoral antetorsion syndrome: a cause of pain and osteoarthritis. J Pediatr Orthop. 1991;11:419-431.Abstract external link opens in a new window
  1. Goutallier D, Van Driessche S, Manicom O, et al. Influence of lower-limb torsion on long-term outcomes of tibial valgus osteotomy for medial compartment knee osteoarthritis. J Bone Joint Surg Am. 2006;88:2439-2447.Abstract external link opens in a new window
  1. Akcali O, Tiner M, Ozaksoy D. Effects of lower extremity rotation on prognosis of flexible flatfoot in children. Foot Ankle Int. 2000;21:772-774.Abstract external link opens in a new window
  1. Inman VT. Hallux valgus: a review of etiologic factors. Orthop Clin North Am. 1974;5:59-66.Abstract external link opens in a new window
  1. Bramer JA, Maas M, Dallinga RJ, et al. Increased external tibial torsion and osteochondritis dissecans of the knee. Clin Orthop Relat Res. 2004;(422):175-179.Abstract external link opens in a new window
  1. Edeen J, Dainer RD, Barrack RL, et al. Results of conservative treatment of recalcitrant anterior knee pain in active young adults. Orthop Rev. 1992;21:593-599.Abstract external link opens in a new window
  1. Beals RK. Developmental changes in the femur and acetabulum in spastic paraplegia and diplegia. Dev Med Child Neurol. 1969;11:303-313.Abstract external link opens in a new window
  1. Lewis FR, Samilson RR, Lucas DB. Femoral torsion and coax valga in cerebral palsy: a preliminary report. Dev Med Child Neurol. 1964;6:591-597.Abstract external link opens in a new window
  1. Bobroff ED, Chambers HG, Sartoris DJ, et al. Femoral anteversion and neck-shaft angle in children with cerebral palsy. Clin Orthop Relat Res. 1999;(364):194-204.Abstract external link opens in a new window
Personvernerklæring Ansvarsfordeling Redaktører og forfattere Om metodebok.no
App Store
Google Play