Version vs Torsion

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Dear All,
I am currently putting together a lecture in regard to the development of gait.In regard to this, a consistent problem continues to rise it's head in relation to terminology.
Could I please have a consensus regarding what others believe is the current perception of version and torsion in relation to bone / joint rotation.
thanks in advance
Tony

 

Tony the terms appear to be synonyms and used inter-changeably. For example, from Soderberg, G.L.: Kinesiology: Application to pathological motion. Williams and Wilkins Baltimore, 1996.

"Another anatomical feature that can influence hip mechanics is torsion in the femoral shaft. Antetorsion (anteversion) means that the shaft of the femur has been rotated such that the femoral neck forms a larger than usual angle with the transverse axis of the femoral condyles, as measured in a horizontal plane. Retrotorsion is the converse: a smaller than usual angle. Thought to begin in fetal life, antetorsion amounts to about 35 degrees in the "average" newborn. During growth, however, the angle diminishes to only 14 degrees in the typical adult (Spoor CW, vanLeeuwen JL, deWindt FHJ, et al.: A model study of muscle forces and joint direction in normal and dysplastic neonatal hips. J. Biomech. 1989; 22;873-884)

Perhaps the anteversion and retroversion are older terms and/ or reflect National preferences.

 

A further thought: thinking from an engineering perspective torsion makes sense, but what is version?

 

Tony:

If this helps any, when Dr. Ron Valmasssy lectured to us on podopediatrics back in podiatry school in the early 1980's, he said there is much confusion regarding these terms and, if I remember correctly, he preferred to reserve the word "torsion" to signify a bony or structural deformity and "version" to signify a capsular or soft tissue deformity. However, now 24 years later in 2006, are you really certain that you may, with reasonable certainty, clinically distinguish soft tissue vs osseous causes of transverse plane abnormalities in the femur or tibia/fibula without doing expensive imaging studies??

 

I find "end-feel" useful, but at the end of the day, you are probably right Kevin (how certain is with reasonably certainty anyway?). Nice study there though- how many "experts" can differentiate? Reminds me of a couple of studies I read once- how accurately can experts agree on the location of a trigger points- not very. How many experts "know" when they are injecting into a shoulder joint- not many. Can't remember the full ref's- they were in "Manual Therapy" I thinks.

Thanks for the input though Grandad

 

Good question.....reasonably certain....I guess it depends on what your definition of reasonable is?

The clinical determination of torsion vs version deformity (i.e. osseous vs soft tissue deformity) is probably much like the way we previously described "first ray hypermobility". No one could define the term "first ray hypermobility" so we direly needed to replace it with a term that could be defined and quantified (i.e. "decreased first ray dorsiflexion stiffness"). In much the same way, there may be ways to assess transverse plane torsion vs version deformities in the segments of the lower extremity by plotting transverse plane joint moments vs rotational deformation of the joint using calibrated instrumentation. This would involve plotting load vs deformation to make a graphical plot that could then be used to determine joint stiffness of the affected joints that, in turn, may be helpful at determining better clinical methods of determining version vs. torsion deformities.

Tony, here's another great potential research project for you to do: (before you get too old)
Correlate clinician's assessments of torsion vs version and MRI or CT evidence of the osseous vs soft tissue nature of actual deformity to measured transverse plane joint moments vs rotational deformation of the joint [which would allow joint stiffness measurement] on children with transverse plane abnormalities of the foot and lower extremity.

 

Phillip Perry, my old (now) 3rd yr biom. lecturer would be squirming, i imagine! certainly it's a definition of antetorsion, certainly NOT anteversion.....anteversion is an increased relative angle of head/neck of femur relative to frontal plane!,......am i right or should i ask "biomech" for some of his medication?

 

Kevin, Simon and Mark.
Thanks for your input, (not that old yet Kevin )
The reason I ask is that the literature is confused in its application particularly in regard to femoral position.
I would describe angle of anteversion as:

"the angle formed by the neck of the femur with respect to the frontal plane."
In relation to this angle:
At birth the angle of anteversion is about 60° externally rotated in the transverse plane with respect to the frontal plane.
During development, the hip undergoes a 50° internal change to finish with the normal adult value of 10° external.
This allows for better seating of the femoral head within the acetabulum.


Torsion: the angle formed by the the axis through the head and neck of the femur and the transcondylar line of the distal femur.At birth, the normal angle is about 30° (35 ± 5 °) internally rotated.
The normal adult value is around 10° internally rotated
The change that occurs is from a position of greater internal rotation to a position of lesser internal rotation, therefore the change is in the direction of external torquing.


See attachments.

Therefore I see the distinction as :
Version: a “turning” within a joint, involving a soft tissue change.
Torsion: a “twisting” within a bone.

In regard to assessment the Ryder test ( palpation of the greater trochanter )can be fairly indicative.

Is this the general understanding, or am I completely off base!!!

cheers
Tony

 

Tony and Mark Johconely,

The Thomson book podopaediatrics seems to use the bone / soft tissue differentiation Kevin eluded to, nothing about the differentiations you give.

BTW Mark, contradiction is not an argument.. and this is not the right room, but don't shoot the messenger, just reporting what the texts say. Having given up smoking today, I could certainly do with whatever biomech is on, injected straight into the eyeball...

 

Simon

Doesn't Version mean rotation eg eVersion external rotation, inVersion internal rotation, antVersion forward rotation, retroVersion backward rotation. Torsion being the longitudinal twisting of a bar eg the femur therfore retro and ante torsion = twisting of the long bone and Version = rotation of the joint.

ANTEVERSION is an increase in the angle of the head and neck of the femur relative to the frontal plane of the body.
RETROVERSION is a decrease in the angle of the head and neck of the femur relative to the frontal plane of the body.
ANTETORSION is an increase in the angle of the head and neck of the femur relative to the femoral condyles
RETROTORSION is a decrease in the angle of the head and neck of the femur relative to the femoral condyles.

Cheers Dave

 

Like I said- don't shoot the messenger, just reporting the literature. When I went to school, it was as you describe, but 100% of the texts I've picked up to check this differentiate using tissue type, I admit I've not picked up too many texts so far as I'm not very interested in this you see, more interested in smoking right now.

 

simon spooner, apologies for my over-enthusiasm...think i'll go and watch some "League of Gentlemen" (series 1 & 2) to get me back on the "straight?? and narrow"

 

As Simon noted, the literature is very confusing on this terminology. Possibly going online and seeing what the definitions are being used currently by orthopedists and pediatricians would help since I try to avoid all of these terms (i.e. ante, retro, version and torsion) like the plague. I use terms that are much less obtuse and ambiguous when I describe these problems: Internal femoral position, external femoral position, internal femoral torsion, and external femoral torsion. The terms I use do not need explanation for the clinician to clearly understand what the nature and type of deformity is present.

 

touche