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Femoral anteversion in infants: a method using ultrasound
Sirikonda Siva Prasad1, Colin Bruce, Sharon Crawford
1Royal Liverpool Children's Hospital, Eaton Road, Liverpool, L12 2AP, UK. sivaprasad77@hotmail.com
Insights
A new ultrasound method for measuring anterior femoral anteversion in infants demonstrated good reproducibility. However, the method for true femoral anteversion showed significant inter-observer variability, making it less reliable for clinical use.
Area of Science:
- Pediatric Orthopedics
- Medical Imaging
- Biomechanical Measurement
Background:
- Femoral anteversion is a critical parameter in pediatric hip development.
- Accurate measurement is essential for diagnosing and managing conditions like developmental dysplasia of the hip.
- Existing methods for measuring femoral anteversion in infants have limitations in reproducibility.
Purpose of the Study:
- To develop and validate a reproducible sonographic method for measuring femoral anteversion in infants under one year of age.
- To assess the intra- and inter-observer reliability of two distinct sonographic measurement techniques: anterior femoral anteversion and true femoral anteversion.
Main Methods:
- A prospective, observational study involving 74 hips (37 infants) was conducted.
- Infants underwent ultrasound screening for developmental dysplasia of the hip.
- Femoral anteversion was measured using a sonographic technique with the infant in a lateral position, employing two distinct measurement lines.
Main Results:
- The sonographic method for anterior femoral anteversion showed acceptable intra-observer repeatability (+/-6.2 degrees) and inter-observer repeatability (+/-7.8 degrees).
- The method for true femoral anteversion demonstrated acceptable intra-observer repeatability (+/-9.5 degrees) but unacceptable inter-observer repeatability (+/-23.5 degrees).
Conclusions:
- The developed sonographic method for measuring anterior femoral anteversion offers reliable intra- and inter-observer agreement in infants.
- The sonographic method for true femoral anteversion exhibited significant inter-observer variability, limiting its clinical applicability.
Objective:
To design a reproducible method to measure femoral anteversion in children under 1 year old.
Design And Patients:
We conducted a prospective, observational study to determine intra- and inter-observer reproducibility of the sonographic measurement of femoral anteversion in infants. The method involves imaging of the proximal femur using a vertical transducer with the infant in the lateral position. Anterior femoral anteversion is measured using a vertical baseline and a line tangential to the anterior femoral head and the trochanter (anterior anteversion). We similarly measured true femoral anteversion using a line passing through the centre of the femoral head and the femoral neck (true anteversion). Anteversion measurements were taken at the time of routine ultrasound screening for developmental dysplasia of the hip when infants were an average of 10.4 weeks old. Anteversion measurements were made in 74 hips (37 infants).
Results:
Our results showed that for the anterior anteversion measurements intra-observer repeatability was +/-6.2 degrees and inter-observer repeatability was +/-7.8 degrees. For true anteversion measurements intra-observer repeatability was +/-9.5 degrees, but inter-observer repeatability was +/-23.5 degrees.
Conclusions:
Our results have shown that our method for measuring "anterior femoral anteversion" has an acceptable level of inter- and intra-observer agreement. The method used to determine "true anteversion", however, proved to have an unacceptable level of inter-observer variability.