Coxa vara
Coxa vara is a deformity of the hip, whereby the angle between the head and the shaft of the femur is reduced to less than 120 degrees. This results in the leg being shortened and the development of a limp. It may be congenital and is commonly caused by injury, such as a fracture. It can also occur when the bone tissue in the neck of the femur is softer than normal, causing it to bend under the weight of the body. This may either be congenital or the result of a bone disorder. The most common cause of coxa vara is either congenital or developmental. Other common causes include metabolic bone diseases, post-Perthes deformity, osteomyelitis, and post traumatic. Shepherd's Crook deformity is a severe form of coxa vara where the proximal femur is severely deformed with a reduction in the neck shaft angle beyond 90 degrees. It is most commonly a sequela of osteogenesis imperfecta, Paget's disease, osteomyelitis, tumour and tumour-like conditions.
Coxa vara can happen in cleidocranial dysostosis.
Anatomy
In early skeletal development, a common physis serves the greater trochanter and the capital femoral epiphysis. This physis divides as growth continues in a balance that favors the capital epiphysis and creates a normal neck shaft angle. The corresponding angle at maturity is 135 ± 7 degrees. Another angle used for the measurement of coxa vara is the cervicofemoral angle which is approximately 35 degrees at infancy and increases to 45 degrees after maturity.Types
Developmental
- primary defect in endochondral ossification of the medial part of the femoral neck
- Excessive interuterine pressure on the developing fetal hip
- vascular insult
- Faulty maturation of the cartilage and metaphyseal bone of the femoral neck
If there is a bilateral involvement the child might have a waddling gait or trendelenburg gait with an increased lumbar lordosis. The greater trochanter is usually prominent on palpation and is more proximal. Restricted abduction and internal rotation.
X-ray: decreased neck shaft angle, increased cervicofemoral angle, vertical physis, shortened femoral neck decrease in femoral anteversion. HE angle ; normal angle is <30 degrees.
Treatment:
HE angle of 45–60 degrees: observation and periodic follow up.
Indication for surgery: HE angle more than 60 degrees, progressive deformity, neck-shaft angle <90 degrees, development of Trendelenburg gait
Surgery: subtrochanteric valgus osteotomy with adequate internal rotation of distal fragment to correct anteversion;
common complication is recurrence. If HE angle is reduced to 38 degrees, less evidence of recurrence;
post operative spica cast is used for a period of 6–8 weeks.
Coxa vara is also seen in Niemann–Pick disease.