Mehmet Albayrak, A' Erdem Bagatur, Gazi Zorer

1
Evaluation of femoral neck anteversion and
femoral neck-shaft angles in cerebral palsy
patients

• Mehmet Albayrak, A. Erdem Bagatur, Gazi Zorer
• Istanbul, Turkey

Evaluation of femoral neck anteversion (FNA) and
femoral neck-shaft angles (FNS) in cerebral palsy
patients and comparison of the data with those of
normal population were carried out.
Patientes and Methods The study included 60
patients (32 girls, 28 boys mean age 11 years 2
months range 4-22 years) with spastic cerebral
palsy. Quadriplegia, diplegia, and hemiplegia
were present in 33, 16, and 11 patients,
respectively and all were able to walk either
dependently or independently. Forty-nine patients
(27 girls, 22 boys mean age 11 years 6 months
range 4-22 years) who did not have a history of
cerebral palsy and were followed-up for other
reasons and had pelvis radiographs and
computerized tomographies (CT) for that reason
made up the control group. Femoral neck
anteversion and FNS angles were measured in the
control group and the values were compared
between two groups. All pelvis radiographs were
taken from 110 cm of distance.
Fig 3. The CT image of the reference points
taken for the left hip measurement. .
Fig 4. The CT image of the reference points
taken for both knees.
FNA angle values in the study group differed
significantly (plt0.05) between both hips of
diplegic patients (mean 37.04 degrees, SD 11.55)
and involved sides of hemiplegic patients (mean
24.72 degrees, SD 13.80). On the other hand, the
differences between quadriplegic (mean 29.53
degrees, SD 15.10) and diplegic (pgt0.05) and
quadriplegic and hemiplegic patients (pgt0.05)
were insignificant in regard of FNA angle values.
When these comparisons were carried out in regard
of FNS angle, the differences were not
significant between any two groups (pgt0.05).
Fig. 1. FNS measurement on AP pelvis radiograph
of a quadriplegic patient. FNS was 132 degrees in
both hips.
Conclusion Femoral neck anteversion and FNS
angles increase in cerebral palsy due to the
spasticity of muscles which leads to imbalance of
muscle power that is acting on hip. Increased FNA
angle values and muscle power imbalances may
cause severe gait abnormalities, hip subluxation
and in advanced stages hip dislocation in
cerebral palsy patients when they coexist with
bony deformities like acetabular dysplasia or
coxa valga. For this reason, to prevent the
progression of hip problems in children with
cerebral palsy, either soft tissue or bony
procedures must not be avoided.
Fig. 2. Slices through the knees and hips on CT
scanogram during FNA measurement.
Results Femoral neck anteversion angle was 30.91
(SD 14.62) degrees in the study group and 20.26
(SD 4.75) degrees in control group, FNS angle was
139.80 (SD 2.76) degrees in the study group and
129.80 (SD 1.43) degrees in the control group.
The differences were significant in both
parameters (plt0.05). When patients in the study
group were compared in regard of cerebral palsy
involvement types,