Topic 5 of 43 in the MU Plovdiv syllabus for Orthopaedics and Traumatology (Medicine, Year 4). The free AceMed note covers it in 4 sections, about 369 words (3 min of reading), with 16 flashcards.
Coxa vara congenita is a congenital disease characterized by a reduced neck-diaphysal angle under 120°
Etiology
Congenital
Developmental
Metabolic bone diseases (e.g. Paget's disease of bone)
Osteomyelitis
Post traumatic
Symptoms
The first symptoms appear after children learn to walk.
Pain and hardening of joints
Children remain shorter
Diagnosis
X-ray:
Neck-diaphyseal angle under 120°, sometimes as little as only 90°
The neck is generally shortened and seems fragmented.
A bony triangular fragment at the bottom of the neck is seen, which is attached to the head - a very important diagnostic sign in the X-ray image.
There is also some deformation of the acetabulum.
Treatment
Aims to restore the neck-diaphysal angle, normalise gait and cure the positive Trendelenburg symptom.
This is done by surgery- valgus osteotomy!
Coxa vara epiphysarea, Coxa vara adolescentium
Etiology
Rachitis
Trauma
Osteomalacia
Endocrine disorders
Symptoms
With adolescents- endocrine insufficiency, obesity, adipose-genital dystrophy, underdeveloped external primary and secondary sexual characteristics
What is characteristic is the sliding of the epiphysis relative to the neck as the link between them is broken due to the softening of the epyphiseal gap.
Children- easily tired, feeling light pain in the hip joint, limping, various degrees of flexional-adductional contracture and external rotation, difficulty with abduction.
Diagnosis
X-ray:
Projection of sliding and rotation of the epiphysis around the axis of the neck
Reduced height of the epiphysis and increased cross size.
Treatment
When the cause is rachitis, treatment is with Vitamin D
Endocrine causes are treated hormonally
Under general anesthetic the epiphysis is fitted back in position and fixed with Kierschner needles.
A plaster bandage is put for a few months on the belt and legs
Some severe cases require operation to pin with nails or osteotomy of the neck
Complications
Avascular necrosis
Perteso-like changes in the head
Joint contractures
Coxarthrosis
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