Femoral Anteversion in Children with Cerebral Palsy
Children with cerebral palsy often develop internal rotation of the hip in early childhood. This internal rotation may slowly improve during childhood and then become worse during the adolescent growth period. The functional problems are related to internal rotation of the feet and or knees. Sometimes children or families complain of the knees knocking together and causing tripping during walking. It may also make sitting more difficult, but there is no evidence that specific sitting postures make this worse. The most common etiology of the internal rotation is failure of physiologic correction of normal infantile femoral torsion. Abnormal muscle forces are the most likely cause of this lack of bone remodeling. Other causes may include muscle contractures, abnormal motor control, and poor balance. When increased femoral anteversion is documented and is functionally causing problems, the correction is recommended by preforming a femoral derotation. The outcome is not dependent on where in the femoral osteotomy is made, so the surgeon may choose the location they find easiest to provide rigid fixation. Surgical correction is recommended between 7 and 12 years of age; however, waiting till completion of growth will not alter the outcome negatively.
KeywordsFemoral anteversion Femoral torsion Coxa valga Hip subluxation Hip rotation CT scan Ultrasound
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