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Der Orthopäde

, Volume 48, Issue 6, pp 523–530 | Cite as

Torsionen und Torsionsentwicklung der unteren Extremität

  • D. Grisch
  • T. DreherEmail author
Leitthema

Zusammenfassung

Hintergrund

Torsionen sind ein häufiger Konsultationsgrund in der kinderorthopädischen Sprechstunde. Die Torsionen von Femur und Tibia bei Kindern verändern sich im Laufe des Wachstums. Je nach Alter und Kompensationsmöglichkeit können sich diese im Gangbild wiederspiegeln. Verschiedene Ursachen können die normale Entwicklung der Torsionen beeinflussen.

Diagnostik

Im Rahmen der kinderorthopädischen Abklärung ist die Unterscheidung zwischen physiologischen und pathologischen Torsionsverhältnissen essenziell. Neben der Anamnese und Observation des Gangbildes sowie einer ausführlichen klinischen Untersuchung kommen, je nach Befund, zusätzliche bildgebende Verfahren zur Anwendung (Rippstein-Aufnahmen, Torsions-CT/MRT, EOS [Ganzkörperbildgebungssystem]). Bei auffälligen Torsionen wird mittels instrumenteller 3‑D-Ganganalyse die dynamische Auswirkung auf das Gangbild evaluiert.

Pathogenes

Die Evidenz zur langfristigen Bedeutung von Torsionsabweichungen und das Risiko für Folgeschäden sind gering. Prinzipiell ist die isolierte vermehrte femorale Antetorsion ohne begleitende Hüftdysplasie harmlos, bildet sich im Wachstum zurück und muss nur in seltenen Fällen bei störendem Gangbild oder bei Knieproblemen korrigiert werden. Dagegen stellt die Retrotorsion wahrscheinlich eine präarthrotische Fehlstellung dar und sollte großzügiger beobachtet und behandelt werden. Torsionen der Tibia zeigen eine hohe Variabilität und können die Entwicklung der femoralen Torsion beeinflussen. Abzugrenzen sind Torsionsfehlstellungen bei Kindern mit neurologischer oder syndromaler Grundsituation, wo die biomechanischen Einflüsse der Torsionen auf die Gangfunktionen in der Regel relevanter sind und daher auch häufiger eine Behandlung notwendig wird.

Therapie

Durch konservative Maßnahmen kann kein Effekt auf die knöcherne Situation erwartet werden. Eine Korrektur ist nur operativ durch eine Rotationsosteotomie zu erreichen. Die Technik unterliegt einem simplen Prinzip, wohingegen die Indikationsstellung und das Timing eine Herausforderung darstellen.

Schlüsselwörter

Kinder Fehlbildung Femur Rotation Tibia 

Abkürzungen

CT

Computertomographie

EOS

Ganzkörperbildgebungssystem

MRT

Magnetresonanztomographie

TPAT

Trochanterpalpationstest

Torsion and torsional development of the lower extremities

Abstract

Background

Torsion is a frequent reason for consultation in paediatric orthopaedics. Torsion of the femur and the tibia in children change during growth. Depending on the age and possibility for compensation, this can be reflected in the gait pattern. Different causes can affect the normal development of torsion.

Diagnostics

In the context of paediatric orthopaedic assessment, the distinction between physiological and pathological torsion is essential. In addition to the patient history and observation of the gait pattern, as well as a detailed clinical examination, additional imaging techniques are used (Rippstein/Dunn, torsional CT/MRI, EOS). The dynamic effect of abnormal torsion on gait is evaluated by instrumented 3D gait analysis.

Pathogenesis

Evidence for the long-term significance of torsional deviations and the risk of consequential damage are low. Isolated increased femoral anteversion without accompanying hip dysplasia is fundamentally harmless, corrects during growth and only rarely needs correction in the case of ongoing disturbing gait or knee problems. In contrast, retroversion is likely indicate the development of pre-arthritic deformity and should be observed and treated more carefully. Tibial torsion shows great variability and may influence the development of femoral torsion. Torsional deformities in children with neurological or syndromal conditions are differentiated as when the biomechanical effects of torsions on their gait function are generally more marked and therefore treatment is more frequently necessary.

Therapy

Conservative treatments cannot be expected to have an effect on the condition of the bones. Correction can only be achieved surgically with a rotational osteotomy. A simple principle underlies the technique, whereas indication and timing are challenging.

Keywords

Children Deformities Femur Rotation Tibia 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

D. Grisch und T. Dreher geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Universitäts-Kinderspital ZürichZürichSchweiz

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