Relationship between Physical Examinations and Two-Dimensional Computed Tomographic Findings in Children with Intoeing Gait

Abstract

ObjectiveTo evaluate the validity of physical examinations by assessment of correlation between physical examinations and CT measurements in children with intoeing gait and the causes of intoeing gait by age using CT measurements.MethodTwenty-six children with intoeing gait participated in this study. The internal and external hip rotation, thigh-foot angle and transmalleolar angle were measured. In addition, femoral anteversion and tibial torsion of the subjects were assessed using a CT scan. The measurements of torsional angles were performed twice by two raters. The correlation coefficients between physical examinations and CT measurements were calculated using Pearson correlation. The data was analyzed statistically using SPSS v12.0.ResultsThe correlation coefficients between physical examinations and CT measurements were not high. Before 5 years of age, intoeing gait was caused by femoral anteversion in 17.86%, tibial torsion in 32.29% and the combination of causes in 35.71% of cases. After 6 years of age, the contributions changed to 29.17%, 8.33% and 45.83%, respectively.ConclusionBefore 5 years of age, the common cause of an intoeing gait was tibial torsion, whereas after 6 years of age it was femoral anteversion. Regardless of age, the most common cause of intoeing gait was a combination of causes. This study shows poor correlation between physical examinations and CT. Therefore, it is limiting to use physical examination only for evaluating the cause of intoeing gait in clinical practice.

CT and MRI lower extremity torsional profile studies: Measurement reproducibility

“…The lack of objective correlation of either modalities with singleobserver-based clinical examination findings with adequate standardization also remains a limitation of this study, although that was not the focus of the paper. Previous literature that has proved the poor correlation between CT and clinical examination findings decreases the need to reexamine the issue though [30]. Our findings support that MRI is reliable (as compared to information obtained on clinical assessment related to the existence of femoral anteversion/abnormal tibial torsion) and can be utilized for obtaining torsional profile values in children.…”

A New Instrument for Measuring Tibial Torsion in Pediatric Patients

“…Since Staheli and his colleagues [ 8 20 ] described rotational profile, the TFA and transmalleolar axis (TMA) have been used predominantly to measure tibial torsion. Even if one study showed the validity and reliability were better the TMA than TFA compare to CT scan [ 21 ], the other study showed almost physical examinations using goniometer may not accurately reflect the tibial axis due to various posture of fibula [ 22 ], and according to Kim et al [ 23 ], there is a low correlation between CPE and CT measurements.…”

Findings related to rotational malalignment in tibial fractures treated with reamed intramedullary nailing

“…The indirect measurement of tibial rotation can be determined in the clinic by measuring the TFA and the thigh-transmalleolar angle [8]. The transmalleolar angle can be measured using a gravity goniometer [32]. Tibial rotation can also be estimated with the patient supine.…”