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Coxa Vara and Acquired Coxa Vara

- 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, 

- 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.

Developmental (infantile) Coxa Vara-a distinct entity. Report of two patients with previously normal roentgenograms.

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.