- Discussion:
- decreased neck shaft angle from defect in ossification of femoral neck;
- it is bilateral in 1/3 to 1/2 of cases;
- it can be congenital (noted at birth & differenitated from CDH by MRI), developmental (AD-progressive), or acquired (trauma, LCP,
SCFE)
- Differential Dx:
- Congenital:
- Cleidocranial Dysplasia
- Chondrodysplasia Punctata
- Metaphyseal Chondrodysplasia
- Gaucher's Disease
- Multiple Epiphyseal Dysplasia
- Proximal Focal Femoral Deficiency
- Spondyloepiphyseal Dysplasia Congenita:
- Aquired:
- AVN: (DDH or Perthes)
- Fibrous Dysplasia
- SCFE
- Rickets
- Osteomyelitis of Hip and Septic Arthritis
- Traumatic:
- Paget's Disease:
- Clinical Manifestation:
- most pts affected present between ages 2-6 years;
- may present w/ waddling gait (bilateral) or painless limp (unilateral)
- in congenital coxa vara, look for leg length descrepancy and fibular hemimelia;
- range of motion of hip is usually restricted in all planes, w/ most significant limitations occuring in abduction and internal rotation;
- Radiographs:
- typically the deformity will lie in the subtrochanteric region of the femur;
- in developmental coxa vara, there will often be a triangular ossification in the inferomedial femoral neck (calcar);
- evaluation of Hilgenreiner's epiphyseal < (angle between Hilgenreiner's line & line thru proximal femoral physis) is key to treatment;
- normally this angle is 25 deg or less;
- angle < 45 deg will spontaneously correct, where as angle of > 60 deg (& neck shaft angle of < 110 deg) will usually require surgery;
- Indications for Treatment:
- proximal femoral epiphyseal angle > 45 to 60 deg;
- proximal femoral (valgus) +/- deroational osteotomy (Pauwel) is indicated for neck shaft angle less than 90 - 100 deg;
- vertically oriented physeal plate
- progressive deformities, or with significant gait abnormalities
Long-term results of valgus osteotomy for congenital coxa vara.
Congenital coxa vara: a retrospective review.
The Fate of the Capital Femoral Physis and Acetabular Development in Developmental Coxa Vara.
Coxa vara: a retrospective review. ME McCall. Orthop Trans. Vol 19. 1995. p 854.