OHSU

Musculoskeletal

Anteversion

Normal Anteversion of the Femoral Neck (radiography)1,2

Age (years) Anteversion 
Birth - 1 30° - 50°
2 30°
3 - 5 25°
6 - 12 20°
12 - 15 17°
16 - 20 11°
20

 

Normal Femoral Neck Torsion Angle (Computed Tomography)3

(see reference for method)

Age Anteversion angle 
Birth +34° to +40°
Adult +10° to +15°

 

Reference:

  1. Billing L:  Acta Radiol 1954; Suppl 110.  Averages adapted from several investigators.
  2. Keats TE  Atlas of Roentgenographic Measurement.  Mosby Year Book: St. Louis. 1990. p. 330.
  3. Mesgarzadeh, M, Revesz G, Bonakdarpour K.  Femoral neck torsion angle measurement by computed tomography.  Journal of Computed Tomography 11(5):799-803.  September/October 1987

Hindfoot & Forefoot

Normal Angular Relationships of the Hindfoot & Forefoot

View Angle Newborn 2 years 4 years Birth to 9
AP Talocalcaneal 42° (27°-56°) 40° (26°-50°) 34° (24°-44°) 15°-56°
AP Calcaneal-fifth metatarsal -1° -10° to 14°
AP Talar-first metatarsal 20° 13° 10° -9° to 31°
Lateral Talocalcaneal 39° (23°-55°) 41° (27°-56°) 44° (31°-57°) 23° to 56°
Lateral Talocalcaneal w/ maximum dorsiflexion 45° (35°-56°) 44° (33°-54°) 33° (32°-52°) 25° to 55°
Lateral Tibiocalcaneal 77° 71° 67° 56° to 95°
Lateral Tibiocalcaneal w/ maximum dorsiflexion 42° 46° 50° 25° to 73°
Lateral Tibiotalar 115° 114° 113° 86° to 145°
Lateral Talar-first metatarsal 19° 21° -7° to 39°
Lateral Talar- horizontal 34° 31° 30° 14° to 55°
Talocalcaneal index 76° 76° 76° 45° to 103°



References:

  1. Vanderwilde R, Staheli LT, Chew DE, Malagon V: Measurements on radiographs of the foot in normal infants and children.  J Bone Joint Surg 70A:407, 1988. Modified by from Ozonoff MB.
  2. Pediatric Orthopedic Radiology. W.B. Saunders Company: Philadelphia. 1992.  (Used with permission from M.B. Ozonoff;  publisher's permission requested)

Hip

Jump down under Hip to:
US Hip Types
Medial Joint Space
Center Edge Angle

Normal Acetabular Angles*1


Age Acetabular Angle --Female (Degrees) Acetabular Angle --Male (Degrees)
Newborn 28.8 ± 4.8 26.4 ± 4.4
3 Month Old 25 ± 3.5 22 ± 4
6 Month Old 23.2 ± 4.0 20.3 ± 3.7
1 Year Old 21.2 ± 3.8 19.8 ± 3.6
2 Year Old 18 ± 4 19 ± 3.6

AP Radiograph of Pelvis


AP view of Pelvis highlighting the Acetabular angle



*Acetabular angle defined as the angle made from line through the Y synchondroses and another line through the superior and inferior points of the iliac portion of the acetabulum.

Reference:

  1. Caffey in Ozonoff MB.  Pediatric Orthopedic Radiology.  W.B. Saunders Company: Philadelphia.  1992.  p181. (Used with permission from M.B. Ozonoff;  publisher's permission requested)
 

Jump back to Acetabular Angle

 

Normal Sonographic Appearance of Infant Hip

Sonographic Hip Type Alpha angle*
1 Normal > 60°
2A Physiologic Immaturity
< 3 months old
50° - 59°
2B Delayed ossification
> 3 months old
50° - 59°

Transducer held at alpha angle for Pediatric Hip scan

*The alpha angle is the geometric complement of the acetabular angle, derived from a line drawn along the lateral bony margin of the ilium and from a  line drawn across the bony acetabular roof.

Reference:

  1. Modified from Graf R, Schuler P.  in Sonography of the infant hip: an atlas.  Weinheim: VCH Verlagsgesellschaft, 1986 and Schlesinger AE, Hernandez RJ.  Diseases of the musculoskeletal system in children: imaging with CT, sonography, and MR.  AJR 1992; 158: 729-741.
 

Jump back to Acetabular Angle

 

Medial Joint Space

The medial joint space is used to determine lateral displacement of the femoral  head.  It is defined as the distance measured from the medial edge of the femoral ossific nucleus (where it is broadest just above the growth plate) to the adjacent acetabular wall.  When the ossific nucleus is absent or asymmetric, measurement is made from the femoral neck metaphysis just below the growth plate.  This measurement is best made on the frog-lateral projection.

Normal range: 6 months to 11 years = 5-12 mm.  From side to side, the medial joint space of both hips should be within 1.5 mm of each other.

AP Radiograph of Pelvis showing medial joint space

AP radiograph of pelvis

Medial joint space = distance from widest portion of femoral head to adjacent acetabulum

Reference:

  1. Eyring et al., 1965 in reference:  Ozonoff MB.  Pediatric Orthopedic Radiology.  W.B. Saunders Company: Philadelphia.  1992.  p181. (Used with permission from M.B. Ozonoff;  publisher's permission requested)
 

Jump back to Acetabular Angle

 

Center-Edge Angle (Wiberg)

The center edge angle is used to evaluate the relationship of the femoral head to the acetabulum.  It is defined as the angle formed by a line drawn through the center of the femoral head and the edge of the acetabulum and another line perpendicular to a line drawn through the center of the femoral heads.  The value of this is limited if the femoral head is deformed or if the ossific center is small or eccentric.

AP radiograph of pelvis with Center-Edge angle

AP radiograph of pelvis highlighting the center-edge angle

Normal center-Edge Angles

Age Center Edge Angle (°)
3 months 18° - 20°
2 years 30°
lowest limit of normal, age 5 to 8 years 19°
lowest limit of normal, age 9 to 12 y 25°
lowest limit of normal, age 13 to 20 y 26° - 30°

 

Reference:

  1. Ozonoff MB.  Pediatric Orthopedic Radiology.  W.B. Saunders Company: Philadelphia.  1992.  p181. (Used with permission from M.B. Ozonoff;  publisher's permission requested)
 

Jump back to Acetabular Angle

Kyphosis and Lordosis

Standing Lateral Radiograph Normal Angles for

Thoracic Kyphosis and Lumbar Lordosis 

Thoracic Kyphosis
Normal Angle - 21° to 33º
measured from T3 to T12

Thoracic kyphosis is usually measured using the superior end plate of T3 and the inferior end plate of T12.

 

 

Lumbar Lordosis
Normal Angle 31 to 50º
measured from L1 to L5

Lumbar lordosis is measured using the superior end plate of L1 and the inferior end plate of  L5

  1. Reference:
    Ozonoff MB.  Pediatric Orthopedic Radiology.  W.B. Saunders Company: Philadelphia.  1992.  p. 68.

Metaphyseal- Diaphyseal Angle

Measurement of the Metaphyseal- Diaphyseal Angle for Differentiation between Physiologic Bowing and Tibia Vara

Age (months) Metaphyseal- Diaphyseal Angle (°) 
Physiologic bowing Average (Range)
11 - 20 5.1 ± 2.8 (0 -11)
21 - 30 5.1 ± 2.8 (0 -11)
Tibia vara Average (Range)
11 - 20 5.1 ± 2.8 (0 -11)
11 - 20 5.1 ± 2.8 (0 -11)

Reference:

  1. Keats TE  Atlas of Roentgenographic Measurement.  Mosby Year Book: St. Louis. 1990. p. 314..

Tibial Torsion

Tibial Torsion Angle (Computed Tomography)

External torsion of malleolar plane relative to proximal tibial condyles

+25 to +55 degrees

(see reference for method)

Reference:

  1. Laasonen EM, Jokio P, Lindholm TS.  Tibial Torsion measured by computed tomography.  Acta Radiologica Diagnosis 25 (1984) Fasc 4.  325-329