Coxa Vara

Coxa Vara

 Painless limp , LLD - gradually worsening

 Unilateral or B/l in 30 -50 % cases

 Prominent trochanters

 Pelvic tilt - LLD

 Trendelenburg test or delayed trendelenburg

 Waddling B/l

 High GT - supratrochanteric shortening

 Decreased abduction

  (decreased articular trochanteric distance )

Decreased IR ( due to decreased antversion )


may have out -toeing

rule out cervical instability causing limping


Types                         Pathology                                   Site                                                   Progression

Congenital               Dysgenesis                             Subtrochanteric                                        progresses


Developmental        Growth abnromality                physological                                           resolves


Acquired             Dysplastic;Fibrous dysplasia            metaphysis                                         progresses


                          metabolic ; rickets                            Physis                                                   progresses

                          vascular ; sepsis & CPD                   Physis and epiphysis                            progresses

                          Trauma                                             Physis  ;SUFE,

                                                                                 Metaphysis,Subtrochanteric                may resolve                           


Management

HEA
 
 > 60 degrees - surgery

 45- 60 degrees - wait and watch

 Goals of surgery

       neck shaft angle >/== 140 degrees

       correct version

       ossification and healing of inferomedial fragment

       restore Articular Trochanteric distance and abductor mechanism

       to resotre length- tension relationship

        abduction tenotomy

        Osteotomy - 3 types

                       1. Pauwel's Y-shpaed

                        2. Langenskiold Intertrochanteric Osteotomy

                       3. Borden subtrochanteric Osteotomy



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