Imaging Studies

Plain radiographs of the hip are obtained to rule out hip dysplasia. Erect-leg full-length radiographs are important for measuring leg lengths, and anteroposterior (AP) and lateral views are important for measuring the distal femoral and proximal and distal tibial angles. (See the image below.)

Lateral radiograph of 1-year-old child with posteromedial tibial bowing.

Computed tomography (CT) is the criterion standard.^[23]Axial sections should be obtained through the hips and femoral necks, the femoral transcondylar axis, and the transmalleolar axis.^[24]Fluoroscopy and biplane radiography (BPR) are alternatives.

Rosskopf et al conducted a study to evaluate the interchangeability and reliability of femoral and tibial torsion measurements in children using three-dimensional (3D) models based on BPR in comparison with CT measurements.^[25]They found that femoral and tibial torsion measurements in children using 3D models based on BPR were comparable with results with CT and that torsion measurements in children on BPR were as reliable as those on CT images, despite skeletal immaturity.

In children and adolescents, some prefer magnetic resonance imaging (MRI) so as to avoid exposing the patient to radiation.^[26]Basaran et al assessed the use of MRI to measure tibial torsion in 34 limbs in 17 children (mean age, 7.3 years; range, 3-12 years) and concluded that the most useful parameters for this purpose were the anterior talus angle and the posterior malleolar angle.^[27]

Rosskopf et al also compared tibial torsion measurements in children obtained by means of MRI with those from 3D models based on low-dose BPR.^[28] They found that tibial torsion measurements differed between the two modalities but that these differences were comparable to measurement variations between CT and BPR.^[25]

Yan et al prospectively compared EOS imaging (a BPR system) and 3D CT reconstruction for measurement of tibial and femoral torsion in 18 adults (36 lower extremities) aged 24 ± 2 years.^[29] They found good agreement between the two techniques in measuring femoral, tibial and femorotibial torsion, and they found EOS to have good reliability and reproducibility for this application.

Treatment & Management

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Media Gallery

Lateral radiograph of 1-year-old child with posteromedial tibial bowing.

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Author

Minoo Patel, MBBS, PhD, MS, FRACS Senior Lecturer, Monash University; Director, Centre for Limb Reconstruction and Deformities, Epworth Centre; Chairman, Cabrini Hospital Orthopaedic Surgery Specialty Group; Orthopaedic Adult/Pediatric Surgeon, Epworth Hospital; Fellowship Director, Epworth Kleos Upper Limb and Limb Reconstruction Fellowship; Consulting Adult/Pediatric Orthopedic Surgeon, Department of Orthopedic Surgery, Monash Medical Center, Australia

Minoo Patel, MBBS, PhD, MS, FRACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Australian Association of Surgeons, Australian Medical Association, Australian Orthopaedic Association, Royal Australasian College of Surgeons, Orthopaedic Research Society, AO Foundation, Orthopaedics Overseas, Indian Orthopedic Association, Bombay Orthopedic Society, Shoulder and Elbow Society of Australia, Australian Paediatric Orthopaedic Society, Australian Limb Lengthening and Reconstruction Society, Victorian Hand Surgery Society, Victorian Shoulder and Elbow Society

Disclosure: Nothing to disclose.

Coauthor(s)

John Herzenberg, MD, FRCSC Head of Pediatric Orthopedics, Director of International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore

John Herzenberg, MD, FRCSC is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, Pediatric Orthopaedic Society of North America, Limb Lengthening and Reconstruction Society, American Academy of Orthopaedic Surgeons

Disclosure: Received educational grant from Smith and Nephew, EBI, Orthofix for none.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Thomas M DeBerardino, MD Orthopedic Surgeon, UT Health San Antonnio; Professor of Orthopedic Surgery, University of Texas Health Science Center at San Antonio, Joe R and Teresa Lozano Long School of Medicine; Professor of Orthopedic Surgery and Faculty of Sports Medicine Fellowship, Baylor College of Medicine; Consulting Surgeon, Sports Medicine, Arthroscopy and Reconstruction of the Knee, Hip and Shoulder

Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Herodicus Society, International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Arthrex, Inc.; MTF; Aesculap; Conmed; JRF<br/>Received research grant from: Arthrex, Inc.; MTF.

Additional Contributors

Dennis P Grogan, MD Clinical Professor (Retired), Department of Orthopedic Surgery, University of South Florida College of Medicine; Orthopedic Surgeon, Department of Orthopedic Surgery, Shriners Hospital for Children of Tampa

Dennis P Grogan, MD is a member of the following medical societies: American Medical Association, American Orthopaedic Association, Scoliosis Research Society, Irish American Orthopaedic Society, Pediatric Orthopaedic Society of North America, American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society, Eastern Orthopaedic Association

Disclosure: Nothing to disclose.

Tibial Torsion Workup

Imaging Studies

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