The impact of symptomatic femoral neck anteversion and tibial torsion on gait, function and participation in children and adolescents.

BACKGROUND: Torsional deformities of the lower limbs in children and adolescents are a common cause of in-toeing gait and cause gait deviations. The purpose of this study was to examine the relationship of children and adolescents with suspected Idiopathic Torsional Deformities (ITD) and pain, gait function, activity and participation. METHODS: A retrospective review of all children and adolescents who attended our Centre over a 5-year period for evaluation of the effect of ITD. All children completed three-dimensional gait analysis (3DGA), standardized physical examination, medical imaging and the Pediatric Outcomes Data Collection Instrument (PODCI). Statistical analysis was completed using two sample t-tests, Pearson's Correlation and linear regression. RESULTS: Fifty children and adolescents, 40 females and 10 males with a mean age of 13.5 years were included. Children reported a high prevalence of pain(86%), had increased internal hip rotation(p = 0.002) and decreased external hip rotation(p < 0.001) on physical examination when compared to published normative data. Medical imaging showed a mean(SD) femoral neck anteversion (FNA) of 38°(13°) and external tibial torsion of 39°(12°). Mean(SD) PODCI score was 32(16), indicating these children are functioning below their typically developing peers. The 3DGA kinematics show deviations from typical data including hip rotation, foot progression, pelvic tilt, hip flexion and knee extension. Observed mild kinetic deviations were within typical limits. The relationship between FNA and gait parameters, FNA and PODCI and gait and PODCI were weak. SIGNIFICANCE: These children and adolescents have altered gait and experience pain leading to impaired function and diminished participation. Therefore, ITD is not purely a cosmetic issue.

All terrain vehicle loss of control events in agriculture: contribution of pitch, roll and velocity.

All terrain vehicle (ATV) (i.e. quad bike) loss of control (LOC) events are a major cause of injury and death on New Zealand and Australian farms. ATV LOC history, work experience, anthropometric data and vehicle pitch, roll and velocity data were recorded from 30 farmers. The terrain induced 95th percentiles were forward pitch 27.8 degrees , backward pitch 28.7 degrees and 20.8 degrees for left and right roll. Nineteen participants (mean 42.4 years) had experienced 53 LOC events and were on average 9.5 years younger than the 11 participants (mean 51.9 years) who had not previously experienced LOC. Peak pitch, roll and velocity were not associated with LOC; however, at peak left roll the non-LOC group had a pitch of 3.1 degrees downhill, while the LOC group had a pitch of 2.1 degrees uphill. Results indicate ATV LOC prevalence is considerably underestimated, while increased risk for LOC may be influenced by a combination of personal, mechanical or terrain factors. The ATV pitch, roll and slope traverse data may help in the better understanding of why LOC events occur, may help in the development of safety equipment such as a tilt warning device and will contribute to national safety guidelines. STATEMENT OF RELEVANCE: Approximately 80,000 ATVs are used in rural New Zealand and ATV accidents are the single most common cause of work-related fatalities, apart from road accidents. This fieldwork research provides pitch, roll and velocity data and considers how these data might contribute to risk of ATV accidents.