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
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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