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

다국어 초록 (Multilingual Abstract)

Objective To 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.
Method Twenty-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. Th e correlation coeffi cients between physical examinations and CT measurements were calculated using Pearson correlation. The data was analyzed statistically using SPSS v12.0.
Results The 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.
Conclusion Before 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.

참고문헌 (Reference)

1 송동호, "제주지역 소아의 경골 염전" 대한소아과학회 48 (48): 75-80, 2005

2 King HA, "Torsional problems in cerebral palsy" 4 : 180-184, 1984

3 Jakob RP, "Tibial torsion calculated by computerised tomography and compared to other methods of measurement" 62-B : 238-242, 1980

4 Lee SH, "Tibial Torsion in Cerebral Palsy: Validity and Reliability of Measurement" LIPPINCOTT WILLIAMS WILLKINS Ltd 467 : 2098-2104, 2009

5 LaGasse DJ, "The measurement of femoral anteversion. A comparison of the fluoroscopic and biplane roentgenographic methods of measurement" 86 : 13-15, 1972

6 Inan M, "Th e evaluation and management of rotational deformity in cerebral palsy" 43 : 106-112, 2009

7 Staheli LT, "Rotational problems in children" 43 : 199-209, 1994

8 Billing L, "Roentgen examination of the proximal femur end in children and adolescents; a standardized technique also suitable for determination of the collum-, anteversion-, and epiphyseal angles; a study of slipped epiphysis and coxa plana" 110 : 1-80, 1954

9 Jang SH, "Relationship between femoral anteversion and tibial torsion in intoeing gait" 23 : 390-396, 1999

10 Butler-Manuel PA, "Measurement of tibial torsion--a new technique applicable to ultrasound and computed tomography" 65 : 119-126, 1992

11 Jend HH, "Mea surement of tibial torsion by computer tomo graphy" 22 : 271-276, 1981

12 Sass P, "Lower extremity abnormalities in children" 68 : 461-468, 2003

13 Li YH, "Intoeing gait in children" 5 : 360-366, 1999

14 Mahboubi S, "Femoral torsion: CT measurement" 160 : 843-844, 1986

15 Weiner DS, "Computed tomography in the measurement of femoral anteversion" 1 : 299-306, 1978

16 Rethlefsen SA, "Causes of intoeing gait in children with cerebral palsy" 88 : 2175-2180, 2006

17 Clementz BG, "Assessment of tibial torsion employing fluoroscopy, computed tomography and the cryosectioning technique" 30 : 75-80, 1989