Skip to main content
Top
Published in: Archives of Orthopaedic and Trauma Surgery 8/2004

01-10-2004 | Original Article

Computed tomography determined femoral torsion is not accurate

Authors: R. L. Jaarsma, A. W. A. Bruggeman, D. F. M. Pakvis, N. Verdonschot, J. A. M. Lemmens, A. van Kampen

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 8/2004

Login to get access

Abstract

Introduction

Computed tomography (CT) is considered the method of choice for detecting rotational malalignment of the femur. However, it is unclear how reliable the method is, and what the causes are of potential inaccuracies.

Materials and methods

To address these issues three observers measured the CT images of the femur of 76 patients on two separate occasions. The images were made during follow-up of a unilateral femoral shaft fractures. Rotational malalignment was determined by comparing the torsion angle of the injured to the noninjured leg.

Results

The pooled intraobserver variance was 3.9° and interobserver variance 4.1°. Of the two measurements of one observer 95% were up to 10.8° different, and between observers 95% of the measurements were up to 15.6° different.

Conclusions

CT measurements of rotational malalignment of the femur are not accurate. This is due principally to the difficulty in defining a line through the axis of the femoral neck. The accuracy can be improved by taking the average of two measurements.
Literature
1.
2.
go back to reference Bråten M, Terjesen T, Rossvoll I (1992) Femoral anteversion in normal adults: ultrasound measurements in 50 men and 50 women. Acta Orthop Scand 63:29–32PubMed Bråten M, Terjesen T, Rossvoll I (1992) Femoral anteversion in normal adults: ultrasound measurements in 50 men and 50 women. Acta Orthop Scand 63:29–32PubMed
3.
go back to reference Bråten M, Terjesen T, Rossvoll I (1993) Torsional deformity after intramedullary nailing of femoral shaft fractures. J Bone Joint Surg Br 75:799–803PubMed Bråten M, Terjesen T, Rossvoll I (1993) Torsional deformity after intramedullary nailing of femoral shaft fractures. J Bone Joint Surg Br 75:799–803PubMed
4.
go back to reference Dunlap K, Shands AR Jr, Hollister LC Jr, Gaul JS Jr, Streit HA (1953) A new method for determination of torsion of the femur. J Bone Joint Surg Am 35:289–311 Dunlap K, Shands AR Jr, Hollister LC Jr, Gaul JS Jr, Streit HA (1953) A new method for determination of torsion of the femur. J Bone Joint Surg Am 35:289–311
5.
go back to reference Dunn DM (1952) Anteversion of the neck of the femur: a method of measurement. J Bone Joint Surg Br181–186 Dunn DM (1952) Anteversion of the neck of the femur: a method of measurement. J Bone Joint Surg Br181–186
6.
go back to reference Ehrenstein T, Rikli DA, Peine R, Gutberlet M, Mittlmeier T, Banzer D, Mäurer J, Felix R (1999) A new ultrasound-based method for the assessment of torsional differences following closed intramedullary nailing of femoral fractures. Skeletal Radiol 28:336–341CrossRefPubMed Ehrenstein T, Rikli DA, Peine R, Gutberlet M, Mittlmeier T, Banzer D, Mäurer J, Felix R (1999) A new ultrasound-based method for the assessment of torsional differences following closed intramedullary nailing of femoral fractures. Skeletal Radiol 28:336–341CrossRefPubMed
7.
go back to reference Jaarsma RL, Pakvis DFM, Verdonschot N, Biert J, van Kampen A (2004) Rotational malalignment after intramedullary nailing of femoral fractures. J Orthop Trauma (in press) Jaarsma RL, Pakvis DFM, Verdonschot N, Biert J, van Kampen A (2004) Rotational malalignment after intramedullary nailing of femoral fractures. J Orthop Trauma (in press)
8.
go back to reference Jeanmart L, Baert AL, Wackenheim A (1983) Computer tomography of neck, chest, spine and limbs. Atlas of pathologic computer tomography, vol 3. Springer, Berlin Heidelberg New York, pp 171–177 Jeanmart L, Baert AL, Wackenheim A (1983) Computer tomography of neck, chest, spine and limbs. Atlas of pathologic computer tomography, vol 3. Springer, Berlin Heidelberg New York, pp 171–177
9.
go back to reference Kuo TY, Skedros JG, Bloebaum RD (2003) Measurement of femoral anteversion by biplane radiography and computed tomography imaging: comparison with anatomic reference. Invest Radiol 38:221–229CrossRefPubMed Kuo TY, Skedros JG, Bloebaum RD (2003) Measurement of femoral anteversion by biplane radiography and computed tomography imaging: comparison with anatomic reference. Invest Radiol 38:221–229CrossRefPubMed
10.
go back to reference Sennerich T, Sutter P, Ritter G, Zapf S (1992) Computertomographische Kontrolle des Antetorsionwinkels nach Oberschenkelschaftfrakturen des Erwachsenen. Unfallchirurg 95:301–305PubMed Sennerich T, Sutter P, Ritter G, Zapf S (1992) Computertomographische Kontrolle des Antetorsionwinkels nach Oberschenkelschaftfrakturen des Erwachsenen. Unfallchirurg 95:301–305PubMed
11.
go back to reference Starker M, Hanusek S, Rittmeister M, Thoma W (1998) Validation of computerized tomography antetorsion angle measurement of the femur. Z Orthop Ihre Grenzgeb 136:420–427PubMed Starker M, Hanusek S, Rittmeister M, Thoma W (1998) Validation of computerized tomography antetorsion angle measurement of the femur. Z Orthop Ihre Grenzgeb 136:420–427PubMed
12.
go back to reference Strecker W, Franzreb M, Pfeiffer T, Pokar S, Wikström M, Kinzl L (1994) Computerized tomography measurement of torsion angle of the lower extremities. Unfallchirurg 97:609–613 Strecker W, Franzreb M, Pfeiffer T, Pokar S, Wikström M, Kinzl L (1994) Computerized tomography measurement of torsion angle of the lower extremities. Unfallchirurg 97:609–613
13.
go back to reference Svenningsen S, Apalset K, Terjesen T, Anda S (1989) Regression of femoral anteversion: a prospective study of intoeing children. Acta Orthop Scand 60:170–173PubMed Svenningsen S, Apalset K, Terjesen T, Anda S (1989) Regression of femoral anteversion: a prospective study of intoeing children. Acta Orthop Scand 60:170–173PubMed
14.
go back to reference Terjesen T, Anda S, Svenningsen S (1990) Femoral anteversion in adolescents and adults measured by ultrasound. Clin Orthop 256:274–279PubMed Terjesen T, Anda S, Svenningsen S (1990) Femoral anteversion in adolescents and adults measured by ultrasound. Clin Orthop 256:274–279PubMed
15.
go back to reference Wissing H et al. (1986) Determination of rotational defects of the femur by computer tomographic determination of antetorsion angle of the femoral neck. Unfallchirurg 12:1–11 Wissing H et al. (1986) Determination of rotational defects of the femur by computer tomographic determination of antetorsion angle of the femoral neck. Unfallchirurg 12:1–11
16.
go back to reference Wissing H, Buddenbrock B (1993) Determining rotational errors of the femur by axial computerized tomography in comparison with clinical and conventional radiologic determination. Unfallchirurg 19:145–157 Wissing H, Buddenbrock B (1993) Determining rotational errors of the femur by axial computerized tomography in comparison with clinical and conventional radiologic determination. Unfallchirurg 19:145–157
Metadata
Title
Computed tomography determined femoral torsion is not accurate
Authors
R. L. Jaarsma
A. W. A. Bruggeman
D. F. M. Pakvis
N. Verdonschot
J. A. M. Lemmens
A. van Kampen
Publication date
01-10-2004
Publisher
Springer-Verlag
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 8/2004
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-004-0729-7

Other articles of this Issue 8/2004

Archives of Orthopaedic and Trauma Surgery 8/2004 Go to the issue