COXA VARA

Coxa Vara

Painless limp, LLD gradually worsening , 

Unilateral or bilateral in 30-50 % cases

Prominent trochanters

Pelvic Tilt- LLD 

Trendelenburg test or delaye trendelenburg test + ve

B/L waddling 

High Greater trochnater - supratrochanteric shortening, 

Decreased abduction, (decrease in articular trochanteric distance ) and internal rotation (due to decreased anteversion)

may have out toeing

r/o cervical instability causing limping 

Types of Coxa Vara 

https://quizlet.com/au/304405013/coxa-vara-flash-cards/

Mangement 

    Depends on Hilgenreiner Angle (HEA )


https://www.orthobullets.com/pediatrics/4041/developmental-coxa-vara

 > 60 degrees - wait and watch 

  45-60 degrees - wait and watch 


Goals of surgery 

    Neck shaft angle  (more or equal ) to 140.              degrees

    Correct version 

    Ossification and healing of inferomedial.               fragment 

    Restore ATD (Articulo-trochanteric       

    distance   AND abductor mechanism  

            (length -tension relationship)

    

https://link.springer.com/chapter/10.1007/978-3-030-12003-0_7

Adductor Tenotomy 

Osteotomy 

  Valgus subtrochanteric osteotomy is the gold standard.But no one method is established the superiority  of one over the other. 

    three types 

    1. Pauwel's Y Subtrochanteric Osteotomy

https://www.slideshare.net/manojdas23/coxa-vara-86119919
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134016/figure/F1/
 Pauwel's  Y Osteotomy

    2. Langenskoid intertrochnateric Osteotomy

    3. Borden Subtrochanteric Osteotomy


 Also check 

https://orthonp.blogspot.com/2020/04/algorithm-6-for-osteonecrosis-of.html   

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