Fabry et al. report a 20-year longitudinal study of femoral anteversion using the Dunlap-Shands radiographic method across 1,990 studies in normal children and those with congenital hip dislocation, Legg-Calvé-Perthes disease, toeing-in gait, and cerebral palsy. The study asks how anteversion differs across these conditions and whether it changes with age or treatment.
A child presents at age 9 with toeing-in gait and internal rotation that exceeds external rotation. The family asks whether bracing will fix it. This paper gives you the answer: conservative treatment produces 2–3° of correction, identical to no treatment at all.
After age 8, femoral anteversion in toeing-in does not spontaneously remodel, and no brace changes that trajectory. What actually determines functional outcome is whether the tibia compensates with external rotation — and 50% of children normalize gait this way regardless of what you do to the femur.
When you see a child with unilateral congenital hip dislocation, measure the contralateral hip too. That 'normal' side averages 44.62°. Even higher than the dislocated hip. And improves only ~1°/year without osteotomy. Factor this bilateral elevation into your surgical planning rather than waiting for remodeling that will not occur.
The Perthes finding reshapes how you interpret imaging: normal anteversion at disease onset means elevated anteversion in an older Perthes patient reflects failed remodeling from the disease itself, not a pre-existing deformity that predisposed the child to AVN.
Fabry et al. report a 20-year longitudinal study of femoral anteversion using the Dunlap-Shands radiographic method across 1,990 studies in normal children and those with congenital hip dislocation, Legg-Calvé-Perthes disease, toeing-in gait, and cerebral palsy. The study asks how anteversion differs across these conditions and whether it changes with age or treatment.
A child presents at age 9 with toeing-in gait and internal rotation that exceeds external rotation. The family asks whether bracing will fix it. This paper gives you the answer: conservative treatment produces 2–3° of correction, identical to no treatment at all.
After age 8, femoral anteversion in toeing-in does not spontaneously remodel, and no brace changes that trajectory. What actually determines functional outcome is whether the tibia compensates with external rotation — and 50% of children normalize gait this way regardless of what you do to the femur.
When you see a child with unilateral congenital hip dislocation, measure the contralateral hip too. That 'normal' side averages 44.62°. Even higher than the dislocated hip. And improves only ~1°/year without osteotomy. Factor this bilateral elevation into your surgical planning rather than waiting for remodeling that will not occur.
The Perthes finding reshapes how you interpret imaging: normal anteversion at disease onset means elevated anteversion in an older Perthes patient reflects failed remodeling from the disease itself, not a pre-existing deformity that predisposed the child to AVN.