Development of acetabular anteversion in children with normal hips and those with developmental dysplasia of the hip: a cross-sectional study using magnetic resonance imaging.

Background and purpose - Acetabular anteversion (AA) is related to hip function. Most previous studies were based on radiographic investigations that determine osseous acetabular anteversion (OAA). But children's acetabulum is mostly composed of cartilage; the cartilaginous acetabular anteversion (CAA) represents the real anteversion of the acetabulum. We measured OAA and CAA in children of various ages using MRI, and compared the developmental patterns between children with normal hips and those with developmental dysplasia of the hip (DDH).Patients and methods - The OAA and CAA were measured on MRI cross-sections of the hips in 293 children with normal hips (average age 8 years), and in 196 children with DDH (average age 34 months). Developmental patterns of OAA and CAA in children with normal hips were determined through age-based cross-sectional analysis. Differences in OAA and CAA between children with normal hips and those with DDH were compared.Results - Normal OAA increased from mean 8.7° (SD 3.2) to 12° (3.0) during the first 2 years of life and remained unchanged until 9 years of age. From 9 to 16 years, the OAA showed a minimal increase of 2°-3°. The normal CAA increased rapidly from a mean of 12° (3.1) to 15° (2.7) within the first 2 years of life, and remained constant at 15° (SD 3.4) until 16 years of age. The age-matched average OAA in the normal and DDH cases was 11° (3.2) and 15° (3.0), respectively (p < 0.001). The age-matched average CAA in normal and DDH cases was 17° (4.2) and 23° (4.5), respectively (p < 0.001). Similarly, there was a significant difference in OAA and CAA between the uninvolved hips in unilateral DDH and normal cases (p < 0.001).Interpretation - The CAA was fully formed at birth in normal children, and remained unchanged until adulthood, whereas the OAA increased with age. The OAA and CAA were both over-anteverted in DDH children. MRI evaluation is of importance in children during skeletal development when planning hip surgery.

Femoral anteversion: significance and measurement.

Femoral neck anteversion (FNA) is the angle between the femoral neck and femoral shaft, indicating the degree of torsion of the femur. Differences in FNA affect the biomechanics of the hip, through alterations in factors such as moment arm lengths and joint loading. Altered gait associated with differences in FNA may also contribute to the development of a wide range of skeletal disorders including osteoarthritis. FNA varies by up to 30° within apparently healthy adults. FNA increases substantially during gestation and thereafter decreases steadily until maturity. There is some evidence of a further decrease at a much lower rate during adulthood into old age, but the mechanisms behind it have never been studied. Development of FNA appears to be strongly influenced by mechanical forces experienced during everyday movements. This is evidenced by large differences in FNA in groups where movement is impaired, such as children born breech or individuals with neuromuscular conditions such as cerebral palsy. Several methods can be used to assess FNA, which may yield different values by up to 20° in the same participant. While MRI and CT are used clinically, limitations such as their cost, scanning time and exposure to ionising radiation limit their applicability in longitudinal and population studies, particularly in children. More broadly, applicable measures such as ultrasound and functional tests exist, but they are limited by poor reliability and validity. These issues highlight the need for a valid and reliable universally accepted method. Treatment for clinically problematic FNA is usually de-rotational osteotomy; passive, non-operative methods do not have any effect. Despite observational evidence for the effects of physical activity on FNA development, the efficacy of targeted physical activity remains unexplored. The aim of this review is to describe the biomechanical and clinical consequences of FNA, factors influencing FNA and the strengths and weaknesses of different methods used to assess FNA.

Clinical assessment of growth performance, bone morphometry, bone quality, and serum indicators in broilers affected by valgus-varus deformity.

The large economic losses caused by leg disorders have raised concerns in the broiler industry. Several types of leg disorders in broilers have been identified, such as tibial dyschondroplasia (TD), femoral head necrosis (FHN), and valgus-varus deformity (VVD). In this study, phenotypic changes associated with VVD were examined using clinical diagnosis, anatomical examination, measured growth performance, bone traits, and serum indicators. The incidence of VVD among the chicken population at a commercial facility in Tangshan China was 1.75% (n = 52,000), distributed about 1:1 (n = 122), between females and males. A majority of chickens were characterized by a unilaterally abnormality, while appropriately 17.6% by bilateral abnormality. Approximately 97.9% of affected broilers were classified as the "valgus" type. Growth traits, including body weight, shank length, and shank girth, were significantly lower in chickens with VVD, while tibia and metatarsal bone indexes were about 1.3-fold higher in the affected birds than in the normal birds. Bone mineral density, bone breaking strength, and several serum indicators were significantly different between affected and normal broilers. Sparse and disarranged bony trabecular was observed in abnormal broilers by histological analysis. Generally, leg disorders are associated with compromised growth, bone quality, bone structure, and lipid metabolism. This study provides a reference for clinical diagnosis of VVD and lays a foundation for exploring its underlying mechanisms.

Intra-operative digital imaging: assuring the alignment of components when undertaking total hip arthroplasty.

AIMS: The aims of this study were to examine the rate at which the positioning of the acetabular component, leg length discrepancy and femoral offset are outside an acceptable range in total hip arthroplasties (THAs) which either do or do not involve the use of intra-operative digital imaging. PATIENTS AND METHODS: A retrospective case-control study was undertaken with 50 patients before and 50 patients after the integration of an intra-operative digital imaging system in THA. The demographics of the two groups were comparable for body mass index, age, laterality and the indication for surgery. The digital imaging group had more men than the group without. Surgical data and radiographic parameters, including the inclination and anteversion of the acetabular component, leg length discrepancy, and the difference in femoral offset compared with the contralateral hip were collected and compared, as well as the incidence of altering the position of a component based on the intra-operative image. RESULTS: Digital imaging took a mean of five minutes (2.3 to 14.6) to perform. Intra-operative changes with the use of digital imaging were made for 43 patients (86%), most commonly to adjust leg length and femoral offset. There was a decrease in the incidence of outliers when using intra-operative imaging compared with not using it in regard to leg length discrepancy (20% versus 52%, p = 0.001) and femoral offset inequality (18% versus 44%, p = 0.004). There was also a difference in the incidence of outliers in acetabular inclination (0% versus 7%, p = 0.023) and version (0% versus 4%, p = 0.114) compared with historical results of a high-volume surgeon at the same centre. CONCLUSION: The use of intra-operative digital imaging in THA improves the accuracy of the positioning of the components at THA without adding a substantial amount of time to the operation. Cite this article: Bone Joint J 2018;100B(1 Supple A):36-43.

The effects of broiler chicken growth rate on valgus, varus, and tibial dyschondroplasia.

An experiment was conducted to test the hypothesis that the growth rate of broilers influences their susceptibilities to bone abnormalities, causing major leg problems. Leg angulations, described in the twisted legs syndrome as valgus and bilateral or unilateral varus, were investigated in 2 subpopulations of mixed-sex Arkansas randombred broilers. Valgus angulation was classified as mild (tibia-metatarsus angle between 10 and 25°), intermediate (25-45°), or severe (> 45°). Body weight was measured at hatch and weekly until 6 wk of age. There were 8 different settings of approximately 450 eggs each. Two subpopulations, slow growing (bottom quarter, n = 581) and fast growing (top quarter, n = 585), were created from a randombred population based on their growth rate from hatch until 6 wk of age. At 6 wk of age, tibial dyschondroplasia incidences were determined by making a longitudinal cut across the right tibia. The tibial dyschondroplasia bone lesion is characterized by an abnormal white, opaque, unmineralized, and unvascularized mass of cartilage occurring in the proximal end of the tibia. It was scored from 1 (mild) to 3 (severe) depending on the cartilage plug abnormality size. Mean lesion scores of left and right valgus and tibial dyschondroplasia (0.40, 0.38, and 0.06) of fast-growing broilers were higher than those (0.26, 0.28, and 0.02) of slow-growing broilers (P = 0.0002, 0.0037, and 0.0269), respectively. Growth rate was negatively associated with the twisted legs syndrome and a bone abnormality (tibial dyschondroplasia) in this randombred population.

Factors influencing neck anteversion during femoral nailing: a retrospective analysis of 220 torsion-difference CTs.

BACKGROUND: Rotational malalignment is a well-known complication following intramedullary nailing of femoral shaft fractures. The hypothesis of this study is that various modifiable factors, such as position on the surgical table or nailing technique, influence the incidence of torsional abnormalities. METHODS: For this retrospective study, we analysed the data of 220 consecutive patients with femoral shaft fractures and postoperative torsion-difference computed tomographies (CTs), performed from 2001 to 2009 in our institution. Mean age of the patients was 33±15 years. Average delay to surgery was 8±11 days. The average postoperative neck anteversion difference between both sides was 11±8°. A p value <0.05 was considered to be statistically significant. RESULTS: The average postoperative neck anteversion difference between both sides was not significantly affected from the position of the patient on the surgical table (supine or lateral, p=0.698), the delay till surgery (p=0.989), the nailing technique (antegrade or retrograde, p=0.793; reamed or unreamed, p=0.930), the type of the implant (p=0.885) and the experience of the surgeon (p=0.055). Furthermore, the learning curve regarding this complication was long and not predictable. CONCLUSIONS: We could not identify any risk factors that are associated with an increased incidence of torsional deformities, and thus our hypothesis could not be confirmed. The inability to identify such risk factors renders the prevention of this complication particularly problematic. The invention of new techniques for better intra-operative control of the torsion is probably the only solution to further reduce the incidence of postoperative malrotational deformities.