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
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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