Lower Extremity Disorders Research Articles

On the use of type I tropocollagen for local injection therapy of spine, upper and lower extremity disorders

A meeting of Interdisciplinary Expert Panel with leading specialists in the field of orthopedics/traumatology, surgery, rheumatology, and neurology was held in Moscow on February 10, 2023. The purpose of the meeting was to discuss the current status of local injection therapy (LIT) in Russia and the rationale behind the use of collagen-based products for various musculoskeletal disorders. The experts considered the following issues: (1) General contraindications to the use of medical products based on tropocollagen as well as an algorithm for actions in case of adverse events; (2) Guidelines regarding LIT in general and LIT using tropocollagen in particular, including in combination with other LIT products; (3) Particular indications and approaches to the treatment of patients with abnormal changes in appendicular joints and spine with damage to both intra-articular structures and periarticular soft tissue.

Potential drug-drug interactions in patients presenting with osteoarthritis to community orthopaedic clinics of Abbottabad, Khyber Pakhtunkhwa: A cross-sectional study

Osteoarthritis (OA) causes long-term pain and disorders of lower extremities. Paracetamol is the drug of choice, however, NSAIDs, opioids and steroids are frequently employed in the symptomatic relief of OA. The prescribing of multiple analgesics leads to potential drug-drug interactions (pDDIs). The primary objective of this study was to identify the prevalence and predictors of pDDIs in OA. A total of three hundred and eighty-six patients, either newly diagnosed or with a history of OA were enrolled for this cross-sectional study. Data regarding patients' demographics, clinical characteristics and prescribed medications were recorded from the prescriptions and examined for the pDDIs using Medscape multi-drug interaction checker. Among 386, most patients were females (53.4%). The most prevalent diagnoses were knee OA (39.7%) and unspecified OA (31.3%). Paracetamol and topical NSAIDs were under-prescribed whereas an oral NSAID, Diclofenac, was the most frequently used drug in OA. Total of 109 pDDIs were found in 386 prescriptions, of which, 63.3% DDIs were categorised as moderate, followed by minor (34.9%) and major (1.8%). This study finds a prevalence of DDIs and polypharmacy among the OA patients. Collaborative efforts among healthcare providers, pharmacists, and patients themselves are essential to optimize medication regimens and minimize the polypharmacy including the associated risks as well as DDIs.

The effectiveness of virtual reality cycling exercise towards the motoric and cardiorespiratory functions of post-stroke patients

IntroductionVirtual reality (VR) cycling exercise was developed as a physical rehabilitation therapy to impair the deficit on motoric function and cardiorespiratory fitness on post-stroke patients with lower extremity disorder. This study aims to figure out the effectiveness of VR cycling exercise towards the impairment of lower extremity motoric function and cardiorespiratory fitness on the post-stroke patients.MethodsThis study engaged 15 people chosen through a purposive sampling method which were divided into 8 intervention groups of post-stroke patients without comorbid (post stroke ≥ 2 years) and 7 healthy people in a control group. Fugl Meyer assessment was used to decide the participation of the patients. To assess the lower extremity motoric functions, timed up-and-go test (TUGT) was carried out. 6-minute walking test (6-MWT) was conducted to assess the function of gaits. VO<sub>2</sub>max was carried out to assess the cardiorespiratory fitness. VR cycling exercise had been conducted for 3 months, twice a week.ResultsBoth groups performed significant difference (<i>p</i> < 0.05) in terms of balance, gait ability, and cardiorespiratory fitness. The decrease of TUGT score and increase of 6-MWT and VO<sub>2</sub>max tests’ scores of the intervention group obtained after having VR cycling exercise was significantly bigger than it was before taking the exercise. The group of post-stroke patients were able to take the exercise in 40–60 minutes/time of exercise.ConclusionsVR cycling exercise is such an effective intervention to increase motoric function and cardiorespiratory fitness on chronic post-stroke patients. Therefore, taking VR cycling exercise is recommended for a stroke rehabilitation and clinical practice purposes.

Risk factors of lower extremity injuries in youth athletes

ObjectiveLower extremity sports injuries frequently occur during an individual’s growth period. The object of the current study was to analyse the risk factors for lower extremity sports injuries for youth...

Lower Extremity Malformations.

Lower Extremity Malformations.

Association of the intrinsic foot muscles and plantar fascia with repetitive rebound jumping and jump landing in adolescent athletes: An ultrasound-based study

BackgroundThe characteristics of foot structure in adolescents and adults are different, affecting sports performance and leading to the progression of foot and lower extremity disorders. Research questionThis study aimed to investigate the relationship between the intrinsic foot muscles (IFM) and plantar fascia morphology and the repetitive rebound jumping and jump landing ability in adolescent athletes. MethodsA total of 60 adolescent athletes (35 boys and 25 girls) participated in this study. B-mode ultrasonography was used to obtain images of the IFM and plantar fascia morphology [thickness and cross-sectional area (CSA) of the abductor hallucis (AbH), flexor hallucis brevis (FHB), flexor digitorum brevis (FDB), and thickness of the plantar fascia]. The repetitive rebound jump performance was evaluated using the Optojump™ system. Participants were instructed to jump five times continuously with one leg, jumping as high as possible with minimal ground contact time. The jump landing was assessed by measuring the dynamic posture stability index (DPSI) using forward one-legged jump landings. ResultsThe thickness and CSA of the AbH and FDB were positively correlated with the jump height and reactive jump index. The DPSI score was significantly correlated with the thickness of the AbH, but not with other IFMs or plantar fascia. In the multiple regression analysis, only the thickness of the FDB was associated with the jump height and reactive jump index, indicating that FDB thickness might facilitate adolescent athletes to jump higher with minimal contact time in repetitive rebounding movements. SignificanceThe IFM (especially FDB) should be focused on when examining sports performance in adolescent athletes.

Pathological Thresholds of Segmental Femoral Torsion in Patients With Patellar Dislocation: Influence on Patellofemoral Malalignment.

Femoral torsion can be evaluated from different femoral segments. The pathological thresholds for femoral torsion of different segments and the influence of segmental femoral torsion on patellofemoral alignment remain unknown. To compare femoral torsion between patients with recurrent patellar dislocation and healthy individuals, to determine the statistical physiological range and pathological thresholds of femoral torsion in different segments, and to investigate the influence of femoral torsion on patellofemoral malalignment. Cross-sectional study; Level of evidence, 3. We retrospectively reviewed the records of patients with patellar dislocation who received surgical treatment in our department between 2019 and 2020. Healthy participants were recruited as the control group. The control patients were asymptomatic and had no history of lower extremity disorders. The differences in femoral torsion between the study and control groups were compared. The diagnostic capacity of femoral torsion in different segments and their correlation with patellar tilt were investigated. The mean value and 95% CI of femoral torsion in different segments were established using data from healthy volunteers. A total of 60 patients with patellar dislocation and 100 healthy volunteers were included in this study. The total, mid, and distal femoral torsion values differed significantly between the study and control groups (P < .01). Total femoral torsion had the highest diagnostic value (area under the receiver operating curve = 0.733). Total torsion (r = 0.432; P < .001), mid torsion (r = 0.242; P = .002), and distal torsion (r = 0.324; P < .001) showed significant correlations with patellar tilt. The pathological thresholds of excessive femoral torsion of the total, proximal, mid, and distal femoral segments were 24.73°, 46.68°, -6.55°, and 14.92°, respectively. Patients with patellar dislocation had greater femoral torsion than healthy individuals in multiple femoral segments. Excessive mid, distal, and total torsion was associated with more significant patellar tilt.

The effectiveness of the comprehensive corrective exercise program on kinematics and strength of lower extremities in males with dynamic knee valgus: a parallel-group randomized wait-list controlled trial

BackgroundDynamic knee valgus (DKV) is a prevalent movement impairment widely regarded as a risk factor for lower extremity disorders such as patellofemoral pain syndrome. The present study aimed to investigate the effectiveness of the comprehensive corrective exercise program (CCEP) on kinematics and strength of lower extremities in males with DKV.MethodsThirty asymptomatic young men with DKV between the ages of 18 and 28 years participated in this study. They were randomly assigned to the intervention (n = 15) and control groups (n = 15). The intervention group performed the CCEP for three sessions per week for eight weeks, while the control group only did activities of daily living. Hip external rotator and abductor muscle strength and three-dimensional lower extremity kinematics consisting of knee varus/valgus, femur adduction/abduction, femur medial/lateral rotation, and tibial medial/lateral rotation were measured at the baseline and post-test. The data were analyzed using the analysis of covariance (ANCOVA).ResultsThere were significant improvements in all kinematics variables in the intervention group after the 8-week CCEP. Moreover, the strength of abductor and external rotator muscle improved in the intervention group (P < 0.05).ConclusionsThe CCEP led to substantial improvements in the selected variables of lower extremity kinematics and muscle strength in participants with DKV during a single-leg squat. These results imply that practitioners should adopt a comprehensive approach to pay simultaneous attention to both proximal and distal segments for improving DKV.Trial registrationThe protocol has been approved in the Registry of Clinical Trials (Registration N: IRCT20180821040843N1) on 2018-12-30.

Pain Catastrophizing Predicts Opioid and Health-Care Utilization After Orthopaedic Surgery: A Secondary Analysis of Trial Participants with Spine and Lower-Extremity Disorders.

Most individuals undergoing elective surgery expect to discontinue opioid use after surgery, but many do not. Modifiable risk factors including psychosocial factors are associated with poor postsurgical outcomes. We wanted to know whether pain catastrophizing is specifically associated with postsurgical opioid and health-care use. This was a longitudinal cohort study of trial participants undergoing elective spine (lumbar or cervical) or lower-extremity (hip or knee osteoarthritis) surgery between 2015 and 2018. Primary and secondary outcomes were 12-month postsurgical days' supply of opioids and surgery-related health-care utilization, respectively. Self-reported and medical record data included presurgical Pain Catastrophizing Scale (PCS) scores, surgical success expectations, opioid use, and pain interference duration. Complete outcomes were analyzed for 240 participants with a median age of 42 years (34% were female, and 56% were active-duty military service members). In the multivariable generalized additive model, greater presurgical days' supply of opioids (F = 17.23, p < 0.001), higher pain catastrophizing (F = 1.89, p = 0.004), spine versus lower-extremity surgery (coefficient estimate = 1.66 [95% confidence interval (CI), 0.50 to 2.82]; p = 0.005), and female relative to male sex (coefficient estimate = -1.25 [95% CI, -2.38 to -0.12]; p = 0.03) were associated with greater 12-month postsurgical days' supply of opioids. Presurgical opioid days' supply (chi-square = 111.95; p < 0.001), pain catastrophizing (chi-square = 96.06; p < 0.001), and lower extremity surgery (coefficient estimate = -0.17 [95% CI, -0.24 to -0.11]; p < 0.001), in addition to age (chi-square = 344.60; p < 0.001), expected recovery after surgery (chi-square = 54.44; p < 0.001), active-duty status (coefficient estimate = 0.58 [95% CI, 0.49 to 0.67]; p < 0.001), and pain interference duration (chi-square = 43.47; p < 0.001) were associated with greater health-care utilization. Greater presurgical days' supply of opioids and pain catastrophizing accounted for greater postsurgical days' supply of opioids and health-care utilization. Consideration of several modifiable factors provides an opportunity to improve postsurgical outcomes. Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

English

BACKGROUND Chronic arterial insufficiency (CAI) results in stenotic-occlusive disease of vascularized arterial disorders of tissues and organs. CAI of the lower extremities represents a significant medical and socio-economic problem due to a high incidence of morbidity, invalidity and mortality. METHODS A cross sectional analytical study was conducted in a group of 100 patients, admitted at the Vascular Department of the Sri Venkateshwara Ramnaraian Ruia Government General Hospital, Tirupati during the period from September 2018 to August 2019, with evident symptoms and signs of different stages of lower extremities CAI verified by ultrasonography. In patients with lower extremity disorder of tissue arterial capillaries, SpO2 was determined by pulse oximetry. CAI of the lower extremity was determined on the basis of clinical findings and colour Doppler duplex scan echo sonography results. Using the conventional method (single-gate) and colour Doppler duplex scan (multi-gate), the presence and localization of stenosis, the segmental predominance (with multisegmental forms) and the degree of progression of stenotic-occlusive lesions were verified. RESULTS Results Using pulse oximetry, depending on the of stage of lower extremities CAI, we revealed a considerable difference in the stages of functional ischemia Mean SpO2: Fontaine I – 95.50 %, Fontaine II – 92.90; in stage critical ischemia SpO2: Fontaine III – 65.00 % and Fontaine IV – 49.87 %. In 29 patients with gangrenous foot and fingers SpO2 was immeasurable and progressive decrease in SpO2 of arterial capillaries (p&lt;0.01 between stages). CONCLUSIONS Due to the reliability and simplicity of pulse oximetry it can be a routinely used diagnostic device for patients with early determined stage of lower extremities CAI. KEYWORDS Chronic Arterial Insufficiency, SPO2, Pulse Oximetry, Ischemia

Longitudinal Validity and Minimal Important Change for the Modified Lower Extremity Functional Scale (LEFS) in Orthopedic Foot and Ankle Patients

The lower extremity functional scale (LEFS) is a patient-reported outcome measure for lower extremity disorders. Aim of this study was to assess the longitudinal validity including responsiveness and test-retest reliability of the revised 15-item version, and to define the minimal important change (MIC) of the modified LEFS in a generic sample of orthopedic foot and ankle patients who underwent surgery. Responsiveness, effect size, and standardized response mean were measured by determining the score change between the baseline and 6 months administration of the LEFS from 156 patients. There was no significant difference between preoperative (median 78, interquartile range [IQR] 64.2-90.3) and postoperative (median 75.0, IQR 61.7-95.0) scores. Both effect size and standardized response mean were low (0.06 and 0.06, respectively). Test-retest reliability of the LEFS was satisfactory. Intraclass correlation coefficient was 0.85 (95% confidence interval 0.81-0.88). MIC value could not be estimated due to the lack of significant score change. The modified LEFS presented with relatively low longitudinal validity in a cohort of generic orthopedic foot and ankle patients. The findings of this study indicate that the modified LEFS might not be the optimal instrument in assessing the clinical change over time for these patients.

Relationship between Nonspecific Low Back Pain and Physical Function among Japanese High School Long-distance Runners

Background: For long-distance runners, low back pain as well as lower extremity disorders are becoming more common. This study analyzed the relationship between regular physical assessment results and nonspecific low back pain among long-distance runners. Methods: Subjects included 105 high school long-distance runners, who were divided into the low back pain group (n = 20; LP) and non-pain group (n = 85; NP). All subjects underwent regular chronic pain and physical assessments every six months. Differences in each measurement between both groups were analyzed using an unpaired t-test for comparison.Results: The LP had a shorter history of athletics (LP=3.2 years, NP=4.6 years, 95% confidence interval (95%CI): -2.55, -0.28, r=0.45), a greater hip extension angle (LP=32.7°, NP=28.4°, 95% CI: 2.85, 5.61, r=0.67), a lower hip extension muscle strength (LP=3.1 kgf/kg, NP=4.0 kgf/kg, 95% CI; 0.19, 0.61, r=0.45), and a greater number of times during the stand-up test (LP=11.1, NP=8.1, 95% CI; 0.40, 5.56, r=0.45) than the NP.Conclusion: An excessive hip extension angle and insufficient hip extension muscle strength were considered as risk factors. It is possible that the excessive movement of the hip joint and the biarticular muscles may have caused the low back pain in the inexperienced runners.

Flatfoot and associated factors among Ethiopian school children aged 11 to 15 years: A school-based study.

The Foot health of a child plays a pivotal role in their participation in play, locomotive activities, healthy lifestyle, somatic development, and weight management. The burden of flatfoot among children in Ethiopia is not known. The objective of this study was to analyze the structure of the medial foot arch using Staheli plantar arch index and investigate its associated factors among larger sample school children, aged 11-15 years in Ethiopia. A school-based cross-sectional study was conducted among children aged 11-15 years from eleven randomly selected primary schools. The sample size was determined proportionally across school strength and governmental and private schools to ensure variety within the sample. Data collection consisted of physical measurements, footprint-based measures whilst full weight-bearing, and a structured questionnaire on foot pain, footwear type, and physical activity. Data were analyzed descriptively and through uni- and multivariate logistic regression model. A total of 823 children participated. The overall prevalence of flatfoot was 17.6% with a significant difference between age, gender, type of school, BMI, and type of footwear. Being younger (OR 3.3, 95% CI 1.6-6.7), male (OR 1.6, 95% CI 1.0-2.4), experiencing foot pain (OR 1.9, 95% CI 1.0-3.5), wearing closed shoe (OR 4.4, 95% CI 1.6-11.9), overweight (OR 3.8, 95% CI 1.2-8.7), obese (OR 4.2, 95% CI 2.5-10.9), and low level of physical activity (OR 2.1, 95% CI 1.0-4.6) were significantly associated with flatfoot. Children who were overweight, obese, and also experiencing foot pain have a 2.8 (95% CI 1.62-5.94) and 4.1 (95% CI 2.85-8.31) times greater chance of having flatfoot respectively. The prevalence of flatfoot among 560 normal weight children was 17.5%. The findings of this study demonstrated that the overall prevalence and the prevalence of flatfoot among normal-weight children are almost the same. There is a definite need to develop a screening algorithm for diagnosis and treatment indication for this children's lower extremity disorder.

Psychometric properties of the global rating of change scales in patients with low back pain, upper and lower extremity disorders. A systematic review with meta-analysis

ObjectiveThe purpose of this systematic review was to critically appraise and synthesize the psychometric properties of the Global Rating of Change (GRoC) scales on the assessment of patients with low back pain (LBP), upper extremity and lower extremity disorders. MethodsA search was performed in 4 databases (MEDLINE, EMBASE, CINAHL, SCOPUS) until February 2019. Eligible articles were appraised using Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist and the Quality Appraisal for Clinical Measurement Research Reports Evaluation Form. ResultsThe 8 eligible studies included participants with orthopedic lumbar spine impairments (n = 52,767), patients with work-related musculoskeletal disorders (n = 1944), patients with low back pain (n = 183) and individuals with upper extremity disorders (n = 151). Risk of bias was ranging from “adequate” to “very good” and quality was found excellent for all studies. Based on pooled data, test-retest reliability of 11-item GRoC for patients with low back pain was found excellent ICC = 0.84, 95% CI: 0.65 to 0.94. Test-retest reliability in patients with shoulder pain was found fair to good ICC of 0.62 in a 15-point GRoC scale. Seven studies (n = 7) examined the convergent validity between GRoC and another outcome measure. Minimum important change on the Portuguese version of Global Perceived Effect (GPE) for patients with LBP was 2.5 points out of 11 points. ConclusionsThe current pool of clinical measurement studies indicates that the GRoC has excellent test-retest reliability for patients with low back pain, shoulder pain and with lumbar spine disorders. However, the validity of it as a reference standard in responsiveness studies or as an accurate overall assessment of change has been questioned. While future studies might provide more insight into its measurement properties, this limitation is unlikely to change. Therefore, we suggest that future responsiveness in the studies that want a global indicator measure need to use an additional measure to mitigate recall bias. Prospero registration numberCRD 42020149122.

Postural stability and functional disorders in patients with loosened hip prosthesis

The number of primary hip arthroplasties is growing every year. One of the most common long complications is the aseptic loosening of the prosthesis leading to serious complications in patients life, pain and following surgeries. In the literature, there is a lack of studies regarding balance impairment in this group of patients, which is why there was a need to conduct the study in order to find possible falling risk factors and simple functional, diagnostic test. The aim of the study was to assess functional state and static balance disorders in patients admitted to orthopaedic department due to loosened hip prosthesis prior to its replacement or removal. The study population were 30 patients (15 women and 15 men) admitted to Orthopaedic Department for diagnosis and treatment of loosened hip prosthesis. Patients' mean age was 71.67 ± 9.21, body height 169.20 ± 8.75 cm, body weight 77.83 ± 12.96 kg. The clinical control group consisted of 30 healthy subjects age-, body height- and weight-matched, without degenerative disorders of lower extremities. Function was assessed with Harris Hip score. The static balance test was conducted in the mornings, in quiet separate room on bi-modular stabilometric platform CQStab2P, registering the movement of centre of foot pressure (COP). Measurements with eyes open and closed showed significant differences in limb loads - the load to the healthy limb was several times greater. Results of tests on the platform with eyes closed showed significantly worse balance in patients group. Their total statokinesiogram path was longer, and their COP sways number was greater. Similarly to the test with eyes open, the load of the healthy limb was much greater. Hip replacement loosening results in significant worsening of balance parameters. Balance assessment could be an additional useful diagnostic tool for hip replacement loosening available for physiotherapists.

Health-related quality of life in patients with diabetic foot ulceration: study protocol for adaptation and validation of patient-reported outcome measurements (PROMs) in Dutch-speaking patients

IntroductionDiabetic foot ulceration (DFU) is a common late-stage complication of diabetes with a large impact on health status and quality of life. Patient-reported outcome measures (PROMs) provide a standardised method...

Percutaneous Zadek osteotomy for the treatment of insertional Achilles tendinopathy

BackgroundInsertional Achilles tendinopathy (IAT) is a challenging common lower extremity disorder, despite several treatment options described in literature. Open dorsal closing wedge calcaneal osteotomy or Zadek Osteotomy (ZO), for the treatment of the IAT has good clinical results but a high rate of postoperative complications. The purpose of this study is to describe percutaneous ZO for the treatment of the IAT and to evaluate its impact on the clinical and functional postoperative outcomes. MethodsTwenty-six consecutive patients presenting with unilateral IAT refractory to nonoperative measures were treated with percutaneous ZO. Visual Analogue Scale (VAS) and Foot Function Index Score (FFI) were recorded preoperatively and at final follow-up visit (12±3) months. Postoperative complications, satisfaction, and relief of the pain were also recorded. ResultsThe percutaneous ZO showed a significant improvement (p<0.0001) in preoperative to postoperative FFI (from 65±9 to 8±12) and VAS (from 9±1 to 1±2). Two postoperative complications (8%) were observed: a case of symptomatic non-union and hardware pain, both in healthy patients. The overall rate of satisfaction after surgery was (92%). The relief from pain was achieved after an average period of 12 weeks. ConclusionsZO is a safe and effective procedure for the treatment of IAT. The use of a minimally invasive surgical approach is associated with excellent pain reduction (VAS score) and improved clinical function (FFI score). When compared to the open surgical approach, the percutaneous ZO may decrease recovery time and postoperative complications.Level of evidence: III, retrospective case series.

The magnitude and factors associated with work-related back and lower extremity musculoskeletal disorders among barbers in Gondar town, northwest Ethiopia, 2017: A cross-sectional study

BackgroundWork-related back and lower extremity disorders often present remarkable health and economic burdens on societies. Occupational barbers are usually neglected in research and policy actions, mainly in developing countries, and are hence more vulnerable to the conditions. So far, information about the factors influencing back and lower extremity disorders among barbers in Ethiopia is unknown. Therefore, the aim of this study was to determine the prevalence and factors affecting back and lower extremity disorders among barbers in Gondar town, Ethiopia.MethodsA cross-sectional study was conducted from April to May 2017. A sample of 434 barbers recruited using the systematic random sampling technique. A pre-tested standardized Nordic Musculoskeletal questionnaire was interviewer-administered for data collection. Data were analyzed using statistical package for social sciences (SPSS) version 20. The significance of associations was evaluated at ≤0.05 p-value with a 95% confidence intervals (CI) and adjusted odds ratios (AOR).ResultsThe response rate was 98.8% (N = 429). The mean age and mean length of employment were 26.38 (standard deviations (SD) ± 4.78) and 4.91 years, respectively. The prevalence of work-related low back pain in the previous 12 months and in the last 7 days was 55.7% (N = 239) [95% CI (51.0, 60.4)] and 32.6% (N = 140), respectively. About 40.6% (n = 97) of the participants with back pains indicated their activities were limited. The prevalence of knee/leg and ankle pain was 39.4% (N = 169) and 25.6% (N = 110), respectively. Out of the participants, 17% (n = 41) sought treatment services. Less than half, 40.6% (n = 97) said they perceived high disability, while 38.1% (n = 91) explained their pain was intense (severe). Age [AOR: 2.001; 95% CI (1.174, 4.346)], alcohol use [AOR: 2.283; 95% CI (1.376, 3.789)], lack of safety training [AOR: 0.110; 95% CI (0.032, 0.271], working posture [AOR: 0.142; 95% CI (0.045, 0.215)], and length of employment [AOR: 1.650.132; 95% CI (1.107, 2.140] were significantly associated factors.ConclusionsBack and lower extremity musculoskeletal pain and disability were found to be prevalent among Ethiopian barbers and to be associated with age, alcohol use, safety training, work postures, and length of employment. We believe that programs for management of musculoskeletal disorders need to address these factors.

Radiography, CT, and MRI of Hip and Lower Limb Disorders in Children and Adolescents.

HomeRadioGraphicsVol. 39, No. 4 Previous ErrataFree AccessRadiography, CT, and MRI of Hip and Lower Limb Disorders in Children and AdolescentsMariana S. Silva, Artur R. C. Fernandes, Fabiano N. Cardoso, Carlos H. Longo, André Y. AiharaMariana S. Silva, Artur R. C. Fernandes, Fabiano N. Cardoso, Carlos H. Longo, André Y. AiharaMariana S. SilvaArtur R. C. FernandesFabiano N. CardosoCarlos H. LongoAndré Y. AiharaPublished Online:Jul 8 2019https://doi.org/10.1148/rg.2019194008MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Originally published in:RadioGraphics 2019: 39(3):779-794 • https://doi.org/10.1148/rg.2019180101Radiography, CT, and MRI of Hip and Lower Limb Disorders in Children and AdolescentsMariana S. Silva, Artur R. C. Fernandes, Fabiano N. Cardoso, Carlos H. Longo, André Y. AiharaErratum in:RadioGraphics 2019: 39(4):1232 • https://doi.org/10.1148/rg.2019194008First full paragraph, page 786: The first sentence should read as follows: “The posterior wall sign is present when the ossified posterior wall projects medial [not lateral] to the femoral head center.”Article HistoryPublished online: July 08 2019Published in print: July 2019 FiguresReferencesRelatedDetailsCited ByErworbene Hüftgelenkpathologien im KindesalterSebastianBerg, Kerstin F.Kuminack2022 | Die Radiologie, Vol. 62, No. 9Ultra-low-dose computed tomography for torsion measurements of the lower extremities in children and adolescentsStephanWaelti, TimFischer, JenniferGriessinger, JohannesCip, Tobias JohannesDietrich, MichaelDitchfield, ThomasAllmendinger, MichaelMesserli, StefanMarkart2022 | Insights into Imaging, Vol. 13, No. 1Diagnostic accuracy of ultra-low-dose CT for torsion measurement of the lower limbGabrielKeller, SaifAfat, Marc-DanielAhrend, FabianSpringer2021 | European Radiology, Vol. 31, No. 6The Pediatric HipAndrew MZbojniewicz, Heather LBorders2021 | Seminars in Roentgenology, Vol. 56, No. 3Accompanying This ArticleRadiography, CT, and MRI of Hip and Lower Limb Disorders in Children and AdolescentsMay 6 2019RadioGraphicsRecommended Articles Radiography, CT, and MRI of Hip and Lower Limb Disorders in Children and AdolescentsRadioGraphics2019Volume: 39Issue: 3pp. 779-794MR Imaging in Postreduction Assessment of Developmental Dysplasia of the Hip: Goals and ObstaclesRadioGraphics2016Volume: 36Issue: 3pp. 840-854Traumatic Hip Dislocation: What the Orthopedic Surgeon Wants to KnowRadioGraphics2017Volume: 37Issue: 7pp. 2181-2201Postoperative Imaging in the Setting of Hip Preservation SurgeryRadioGraphics2016Volume: 36Issue: 6pp. 1746-1758Sports Injuries about the Hip: What the Radiologist Should KnowRadioGraphics2016Volume: 36Issue: 6pp. 1717-1745See More RSNA Education Exhibits Rotational Malalignment of the Lower Limb: An Update for the RadiologistDigital Posters2018Radiographic Findings of Total Hip Arthroplasty ComplicationsDigital Posters2020Hip Impingement Syndromes: What the Surgeon Wants to KnowDigital Posters2018 RSNA Case Collection Developmental hip dysplasia RSNA Case Collection2021Legg-Calve-Perthes DiseaseRSNA Case Collection2021Subcapital Femoral Neck FractureRSNA Case Collection2021 Vol. 39, No. 4 Metrics Altmetric Score PDF download

Radiography, CT, and MRI of Hip and Lower Limb Disorders in Children and Adolescents.

Infants and children are vulnerable to congenital and developmental hip and lower extremity disorders. These disorders have diverse causes in pediatric patients, and owing to potential related complications that can lead to degenerative disease in adulthood, an accurate diagnosis is essential. A common disease is developmental dysplasia of the hip, which affects nearly 1% of newborns. This condition is best evaluated with US and conventional radiography. Slipped capital femoral epiphysis affects approximately 0.01% of young teenagers and is initially evaluated with radiography. Femoroacetabular impingement is a risk factor for early osteoarthritis and can be assessed with radiography, CT, or MRI. Limb length discrepancy is defined as a greater than 2-cm difference in length between paired bilateral lower extremities. There are several methods of measuring this difference, and the use of an accurate imaging modality is essential for treatment. Developmental bowing is a physiologic condition involving varus angulation of the knee and is best evaluated by using conventional radiography. Blount disease is a progressive pathologic genu varum centered at the tibia; the three subtypes are infantile, juvenile, and adolescent. In- and out-toeing disorders are caused by abnormal tibial and femoral torsion that usually self-corrects during lower limb growth. The ability to recognize these conditions is essential for differentiating those that will resolve spontaneously versus those that will require treatment. The imaging features of congenital and developmental hip and lower extremity disorders are reviewed, with emphasis on diagnosis, radiologic assessment, associated findings, and classification. ©RSNA, 2019.