External tibial torsion
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Synopsis
Causes / typical injury mechanism: During the seventh week of gestation, the lower limb internally rotates while the hip and femur externally rotate, reflecting the newborn posture. Abnormalities result due to extrinsic constraints that are secondary to in utero crowding, which can be due to factors resulting from the mother, fetus, or a combination of both.Classic history and presentation: Typically, a child or adolescent presents with concern with cosmesis, abnormal gait, tripping, falling, issues wearing shoes, or lower limb pain, especially in the patellofemoral region. It is often unilateral and more commonly the right side.
Prevalence:
- Age – Typically presents in patients between 4 and 7 years and worsens during late childhood and adolescence.
- Sex / gender – equal incidence between sexes
- Preterm infancy
- Familial history
- Malunion of tibial fractures
- Neuromuscular conditions (eg, polio, myelodysplasia)
Codes
ICD10CM:M21.869 – Other specified acquired deformities of unspecified lower leg
SNOMEDCT:
299229000 – External tibial torsion
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Cerebral palsy
- Neuromuscular disease
- Hemiparesis
- Slipped capital femoral epiphysis (SCFE)
- Congenital hip dysplasia
- Miserable malalignment syndrome
- Femoral anteversion
- Genu valgum
- Transverse plane deformity
- Osteochondritis dissecans
- Osgood-Schlatter disease
- Unstable patellofemoral joints
- Neoplasm
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References
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Last Reviewed:11/17/2020
Last Updated:11/17/2020
Last Updated:11/17/2020