Coxa Vara / Coxa Valga: Difference between revisions

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== Search Strategy  ==


''<u>'''Searched databases:'''</u>''<u></u> Pubmed, PEDRo, Web of Knowledge, Science Direct<br>
Due to the low incidence of coxa vara which is even lower for coxa valga little recent literature is currently available. Therefore, this page will predominently discribe the complete pathology of coxa vara.


== Definition/Description  ==
== Definition/Description  ==
'''''Coxa valga'''''<u></u> is defined as the femoral neck shaft angle being greater than 139 °&nbsp;<ref>John C. Clohisy, MD, Ryan M. Nunley, MD, Jack C. Carlisle, MD, and Perry L. Schoenecker, MD. Incidence and Characteristics of Femoral Deformities in the Dysplastic Hip. Clin Orthop Relat Res. 2009, 467(1): 128–134.</ref>


''<u>'''Coxa valga'''</u>''<u></u> is defined when the femoral neck shaft angle as greater than 139 °.&nbsp;&nbsp;<ref>John C. Clohisy, MD, Ryan M. Nunley, MD, Jack C. Carlisle, MD, and Perry L. Schoenecker, MD. Incidence and Characteristics of Femoral Deformities in the Dysplastic Hip. Clin Orthop Relat Res. 2009, 467(1): 128–134.</ref>
'''''Coxa vara'''''<u></u> is as a varus deformity of the femoral neck. It is defined as the angle between the neck and shaft of the femur being less than 110 – 120 ° (which is normally between 135 ° - 145 °) in children. <ref>Lam F, Hussain S, Sinha J. Emerg Med J. An unusual cause of a limp in a child: developmental coxa vara. 2001,18(4):314.</ref>  
 
 
 
''<u>'''Coxa vara'''</u>''<u></u> is as a varus deformity of the femoral neck. It may be defined when the angle between the neck and shaft of the femur is less than 110 – 120 ° (which is normally between 135 ° - 145 °) in children. <ref>Lam F, Hussain S, Sinha J. Emerg Med J. An unusual cause of a limp in a child: developmental coxa vara. 2001,18(4):314.</ref>  


'''''Coxa vara''''' is classified into several subtypes:  
'''''Coxa vara''''' is classified into several subtypes:  


*''Congenital coxa vara'' is present at birth and is caused by an embryonic limb bud abnormality.  
*''Congenital coxa vara,'' which is present at birth and is caused by an embryonic limb bud abnormality.  
*''Developmental coxa vara ''occurs as an isolated deformity of the proximal femur. It tends to go unnoticed until walking age is reached, when the deformity results in a leg length difference or abnormal gait pattern.  
*''Developmental coxa vara ''occurs as an isolated deformity of the proximal femur. It tends to go unnoticed until walking age is reached, when the deformity results in a leg length difference or abnormal gait pattern.  
*''Acquired coxa vara ''is caused by an underlying condition such as fibrous dysplasia, rickets, or traumatic proximal femoral epiphyseal plate closure. <ref>DiFazio R, Kocher M, Berven S, Kasser J. Coxa vara with proximal femoral growth arrest in patients who had neonatal extracorporeal membrane oxygenation. J Pediatr Orthop 2003, 23: 20 – 26</ref><br>
*''Acquired coxa vara ''is caused by an underlying condition such as fibrous dysplasia, rickets, or traumatic proximal femoral epiphyseal plate closure. <ref>DiFazio R, Kocher M, Berven S, Kasser J. Coxa vara with proximal femoral growth arrest in patients who had neonatal extracorporeal membrane oxygenation. J Pediatr Orthop 2003, 23: 20 – 26</ref>


== Clinically Relevant Anatomy  ==
== Clinically Relevant Anatomy  ==


''Congenital coxa vara'' results in a decrease in metaphyseal bone as a result of abnormal maturation and ossification of proximal femoral chondrocyte. As a result of ''congenital coxa vara'', the inferior medial area of the femoral neck may be fragmented. A progressive varus deformity might also occur in ''congenital coxa vara'' as well as excessive growth of the trochanter and shortening of the femoral neck. <ref>Javad Parvizi MD, FRCS, Gregory K. Kim MD, and Associate Editor. Coxa Vara. High Yield Orthopaedics, 2010, Page 125</ref><br>
''Congenital coxa vara'' results in a decrease in metaphyseal bone as a result of abnormal maturation and ossification of proximal femoral chondrocyte. As a result of ''congenital coxa vara'', the inferior medial area of the femoral neck may be fragmented. A progressive varus deformity might also occur in ''congenital coxa vara'' as well as excessive growth of the trochanter and shortening of the femoral neck. <ref>Javad Parvizi MD, FRCS, Gregory K. Kim MD, and Associate Editor. Coxa Vara. High Yield Orthopaedics, 2010, Page 125</ref>


A review on the ''development of coxa vara ''shows an association with spondylometaphyseal dysplasia, demonstrating that stimulated corner fractures were present in most instances. <ref>Currarino G, Birch JG, Herring JA. Developmental coxa vara associated with spondylometaphyseal dysplasia (DCV/SMD): “SMD – corner fracture type” (DCV/SMD – CF) demonstrated in most reported cases. Pediatr Radiol. 2000 Jan;30(1):14-24.</ref><br>
A review on the development of coxa vara by ''Currarino et al'' showed an association with spondylometaphyseal dysplasia, demonstrating that stimulated corner fractures were present in most instances. <ref>Currarino G, Birch JG, Herring JA. Developmental coxa vara associated with spondylometaphyseal dysplasia (DCV/SMD): “SMD – corner fracture type” (DCV/SMD – CF) demonstrated in most reported cases. Pediatr Radiol. 2000 Jan;30(1):14-24.</ref>


A case study shows also that a varus position of the neck is believed to prevent hip subluxation associated with femoral lengthening. An associated dysplastic acetabulum can lead to a hip subluxation.<br>This case study shows also that the acetabulum is abnormal in coxa vara. Acetabular index (AI) and sourcil slope (SS) are significantly different than in the normal acetabulum. <ref>Ashish Ranade MD, James J., McCarthy MD, Richard S. Davidson MD. Acetabular changes in Coxa Vara. Clin. Orthop. Relat. Res (2008) 466: 1688 - 1691</ref>
''Ashish Ranade et al'' also showed that a varus position of the neck is believed to prevent hip subluxation associated with femoral lengthening. An associated dysplastic acetabulum can lead to a hip subluxation. In this case study, the acetabulum is abnormal in coxa vara. Acetabular index (AI) and sourcil slope (SS) are significantly different than in the normal acetabulum. <ref name=":0">Ashish Ranade MD, James J., McCarthy MD, Richard S. Davidson MD. Acetabular changes in Coxa Vara. Clin. Orthop. Relat. Res (2008) 466: 1688 - 1691</ref>  
 
<br>


== Epidemiology /Etiology  ==
== Epidemiology /Etiology  ==


Femoral neck fractures (&lt; 1&nbsp;% of all pediatric fractures in children) are associated with a high incidence of complications. The most serious ones with high and long–term morbidity being osteonecrosis and coxa vara. <ref>Robert E., Georg S., Peter F., Annelie M W., and Michael E H. Post – traumatic coxa vara in children following screw fixation of the femoral neck. Acta Orthopaedica 2010; 81 (4): 442 - 445</ref><br>
Femoral neck fractures, less than 1&nbsp;% of all pediatric fractures in children, are associated with a high incidence of complications. The most serious ones with high and long term morbidity being osteonecrosis and coxa vara. <ref name=":1">Robert E., Georg S., Peter F., Annelie M W., and Michael E H. Post – traumatic coxa vara in children following screw fixation of the femoral neck. Acta Orthopaedica 2010; 81 (4): 442 - 445</ref>
 
<br>
 
A retrospective study of femoral neck fractures in children show the following complications: <ref>Togrul E, Bayram H, Gulsen M, Kalaci A, Ozbarlas S. Fractures of the femoral neck in children: long – term follow – up in 62 hip fractures. Injury. 2005 Jan ;36(1):123-30.</ref><br>1) avascular necrosis (14.5%)<br>2) limb shortening in seven (11.3%)<br>3) coxa vara (8%) and premature epiphysis fusion (8%)<br>4) coxa valga (3.2%), arthritic changes (3.2%).<br>5) non-union in one (1.6%)<br>
 
<br>
 
Premature epiphyseal closure is described as one of the ethiological factors of coxa vara. Incidences of premature physeal closure reported in the literature range from 6&nbsp;% to 62&nbsp;%. <br>Another possible explanation for the high occurrence of coxa vara is the loss of reduction after initial fracture reduction of implant failure in unstable fractures.&nbsp;
 
<br>


A study shows that developmental coxa vara is a rare condition with an incidence of 1 in 25 000 live births. <ref>Lam F, Hussain S, Sinha J. Emerg Med J. An unusual cause of a limp in a child: developmental coxa vara. 2001,18(4):314.</ref>
A retrospective study of femoral neck fractures in children show the following complications: <ref>Togrul E, Bayram H, Gulsen M, Kalaci A, Ozbarlas S. Fractures of the femoral neck in children: long – term follow – up in 62 hip fractures. Injury. 2005 Jan ;36(1):123-30.</ref><br>1) avascular necrosis (14.5%)<br>2) limb shortening in seven (11.3%)<br>3) coxa vara (8%) and premature epiphysis fusion (8%)<br>4) coxa valga (3.2%), arthritic changes (3.2%).<br>5) non-union in one (1.6%)  
 
 
 
Recent reports shows that the incidence of coxa vara can be decreased by using internal fixation such as pins or screws. <ref>Robert E., Georg S., Peter F., Annelie M W., and Michael E H. Post – traumatic coxa vara in children following screw fixation of the femoral neck. Acta Orthopaedica 2010; 81 (4): 442 - 445</ref>


Premature epiphyseal closure is described as one of the ethiological factors of coxa vara. Incidences of premature physeal closure reported in the literature range from 6&nbsp;% to 62&nbsp;%. Another possible explanation for the high occurrence of coxa vara is the loss of reduction after initial fracture reduction of implant failure in unstable fractures.&nbsp;Developmental coxa vara is a rare condition with an incidence of 1 in 25 000 live births. <ref>Lam F, Hussain S, Sinha J. Emerg Med J. An unusual cause of a limp in a child: developmental coxa vara. 2001,18(4):314.</ref> Incidence of coxa vara can be decreased by using internal fixation such as pins or screws. <ref name=":1" />
== Characteristics/Clinical Presentation  ==
== Characteristics/Clinical Presentation  ==


Clinically the condition presents itself as an abnormal but painless gait pattern. A Trendelenburg limp is sometimes associated with unilateral coxa vara and a waddling gait is often seen when bilateral coxa vara is present. Patients with coxa vara often show:
Clinically, the condition presents itself as an abnormal, but painless gait pattern. A Trendelenburg limp is sometimes associated with unilateral coxa vara and a waddling gait is often seen when bilateral coxa vara is present. Patients with coxa vara often show:


*Limb length discrepancy
*Limb length discrepancy
*Prominent greater trochanter
*Prominent greater trochanter
*Limitation of abduction and internal rotation of the hip.
*Limitation of abduction and internal rotation of the hip.


Patients may also show femoral retroversion or decreased anteversion.<ref>Javad Parvizi MD, FRCS, Gregory K. Kim MD, and Associate Editor. Coxa Vara. High Yield Orthopaedics, 2010, Page 125</ref> <br>
Patients may also show femoral retroversion or decreased anteversion.<ref>Javad Parvizi MD, FRCS, Gregory K. Kim MD, and Associate Editor. Coxa Vara. High Yield Orthopaedics, 2010, Page 125</ref> <br>
== Differential Diagnosis  ==


== Diagnostic Procedures  ==
== Diagnostic Procedures  ==


'''''Radiography''''' (AP view of the pelvis) can be utilized to determine the HEA (Hilgenreiner Epiphyseal Angle). Signs to look out for are as follows:  
'''''Radiography''''' (AP view of the pelvis) can be utilised to determine the HEA (Hilgenreiner Epiphyseal Angle). Signs to look out for are as follows:  


*The neck – shaft angle is less than 110 – 120°.
*The neck; shaft angle is less than 110 – 120°.
*The greater trochanter may be elevated above the femoral head.
*The greater trochanter may be elevated above the femoral head.
*A growth plate with an overly vertical orientation. <ref>Juan Pretell Mazzini, Juan Rodriguez Martin and Rafael Marti Ciruelos. Coxa vara with proximal femoral growth arrest as a possible consequence of extracorporeal membrane oxygenation: a case report. Cases Journal. 2009, 2: 8130</ref>
*A growth plate with an overly vertical orientation. <ref>Juan Pretell Mazzini, Juan Rodriguez Martin and Rafael Marti Ciruelos. Coxa vara with proximal femoral growth arrest as a possible consequence of extracorporeal membrane oxygenation: a case report. Cases Journal. 2009, 2: 8130</ref>


 
'''''MRI''''' can be used to visualise the epiphyseal plate, which may be widened in coxa vara.<br>'''''CT''''' can be used to determine the degree of femoral anteversion or retroversion.&nbsp;<ref>Javad Parvizi MD, FRCS, Gregory K. Kim MD, and Associate Editor. Coxa Vara. High Yield Orthopaedics, 2010, Page 125</ref>&nbsp;<br>
 
'''''Magnetic Resonance''''' Imaging can be used to visualise the epiphyseal plate, which may be widened in coxa vara.  
 
<br>'''''Computed Tomography''''' can be used to determine the degree of femoral anteversion or retroversion.&nbsp;<ref>Javad Parvizi MD, FRCS, Gregory K. Kim MD, and Associate Editor. Coxa Vara. High Yield Orthopaedics, 2010, Page 125</ref>&nbsp;<br>
 
== Outcome Measures  ==
 
add links to outcome measures here (also see [[Outcome Measures|Outcome Measures Database]])
 
== Examination  ==
== Examination  ==


add text here related to physical examination and assessment<br>  
AP radiographs in standing are taken, usually of both hips in a neutral position. Measuremenst are then taken: the Acetabular Index and the Sourcil Slope (the angle formed by a line joining the 2 ends of the sourcil with the horizontal line) <ref name=":0" />. Subluxation in children is measured by the Migration Index and the Centre edge Angle. <br>  


== Medical Management <br> ==
== Medical Management ==


According to a case study, the objective of medical interventions is to restore the neck-shaft angle and realigning the epiphysial plate to decrease shear forces and promote ossification of the femoral neck defect.  
The objective of medical interventions is to restore the neck-shaft angle and realigning the epiphysial plate to decrease shear forces and promote ossification of the femoral neck defect. This is achieved by performing a valgus osteotomy, with the valgus position of the femoral neck improving the action of the gluteus muscles, normalising the femoral neck angle, increasing total limb length and improving the joint congruence.  
 
<br>This is achieved by performing a valgus osteotomy, with the valgus position of the femoral neck improving the action of the gluteus muscles, normalising the femoral neck angle, increasing total limb length and improving the joint congruence.<br>


The following are indications for surgical intervention:
The following are indications for surgical intervention:


*Neck – shaft angle less than 90 °.
*Neck: shaft angle less than 90 °.
*Progressive development of deformity.
*Progressive development of deformity.
*Vertical physis and a significant limb.
*Vertical physis and a significant limb.


Other indications are based on the HE angle;


*HE angle &gt; 60 ° is an indication for surgery.
*HE angle 45 – 60 ° warrants close follow up.
*HE angle &lt; 45 ° warrants spontaneous resolution


Other indications are based on the HE – angle.
Except when the neck/shaft angle is less than 110°, progression of the varus angulation takes place, gait pattern abnormalties or degenerative changes take place.&nbsp;<ref>Juan Pretell Mazzini, Juan Rodriguez Martin and Rafael Marti Ciruelos. Coxa vara with proximal femoral growth arrest as a possible consequence of extracorporeal membrane oxygenation: a case report. Cases Journal. 2009, 2: 8130</ref>&nbsp;


*HE – hoek &gt; 60 ° is an indicatie for surgery.
== Physical Therapy Management  ==
*HE – hoek 45 – 60 ° warrants close follow – up.
*HE – hoek &lt; 45 ° warrants spontaneous resolution.


 
Literature is lacking, but surgical management appears to be the accepted treatment protocol for this condition.  
 
--&gt; Except when the neck–shaft angle is less than 110°, progression of the varus angulation takes place, gait pattern abnormalties or degenerative changes take place.&nbsp;<ref>Juan Pretell Mazzini, Juan Rodriguez Martin and Rafael Marti Ciruelos. Coxa vara with proximal femoral growth arrest as a possible consequence of extracorporeal membrane oxygenation: a case report. Cases Journal. 2009, 2: 8130</ref>&nbsp;<br>
 
== Physical Therapy Management <br> ==
 
In literature only the medical treatment for coxa vara was found.
 
== Key Research  ==
 
1. ↑ John C. Clohisy, MD, Ryan M. Nunley, MD, Jack C. Carlisle, MD, and Perry L. Schoenecker, MD. Incidence and Characteristics of Femoral Deformities in the Dysplastic Hip. Clin Orthop Relat Res. 2009, 467(1): 128–134.<u>'''2 A<br>'''</u>2. ↑ Lam F, Hussain S, Sinha J. Emerg Med J. An unusual cause of a limp in a child: developmental coxa vara. 2001,18(4):314. <u>'''5<br>'''</u>3. ↑ DiFazio R, Kocher M, Berven S, Kasser J. Coxa vara with proximal femoral growth arrest in patients who had neonatal extracorporeal membrane oxygenation. J Pediatr Orthop 2003, 23: 20 – 26 <u>'''4<br>'''</u>4. ↑ Javad Parvizi MD, FRCS, Gregory K. Kim MD, and Associate Editor. Coxa Vara. High Yield Orthopaedics, 2010, Page 125 <u>'''5<br>'''</u>5. ↑ Currarino G, Birch JG, Herring JA. Developmental coxa vara associated with spondylometaphyseal dysplasia (DCV/SMD): “SMD – corner fracture type” (DCV/SMD – CF) demonstrated in most reported cases. Pediatr Radiol. 2000 Jan;30(1):14-24. <u>'''1 A<br>'''</u>6. ↑ Ashish Ranade MD, James J., McCarthy MD, Richard S. Davidson MD. Acetabular changes in Coxa Vara. Clin. Orthop. Relat. Res (2008) 466: 1688 – 1691 <u>'''3 A<br>'''</u>7. ↑ Robert E., Georg S., Peter F., Annelie M W., and Michael E H. Post – traumatic coxa vara in children following screw fixation of the femoral neck. Acta Orthopaedica 2010; 81 (4): 442 – 445 <u>'''2 A<br>'''</u>8. ↑ Togrul E, Bayram H, Gulsen M, Kalaci A, Ozbarlas S. Fractures of the femoral neck in children: long – term follow – up in 62 hip fractures. Injury. 2005 Jan ;36(1):123-30. '''<u>2 A<br></u>'''9. ↑ Juan Pretell Mazzini, Juan Rodriguez Martin and Rafael Marti Ciruelos. Coxa vara with proximal femoral growth arrest as a possible consequence of extracorporeal membrane oxygenation: a case report. Cases Journal. 2009, 2: 8130 <u>'''4'''</u>
 
== Resources <br>  ==
 
add appropriate resources here <br>


== Clinical Bottom Line  ==
== Clinical Bottom Line  ==


add text here <br>
Due to the low incidence of coxa vara and even lower for coxa valga, there is little literature currently available. There are 3 types Coxa Vara, acquired, congenital and developmental, usually displaying greater acetabular dysplasia and an abnormal acetabulum. Surgery is the most effective treatment protocol. In the case of acquired coxa vara from a fracture, the proximal femur and femoral neck need accurate reduction and rigid fixation to avoid potential serious complications. <ref name=":1" />
 
== References  ==  
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
 
see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]]
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<rss>Feed goes here!!|charset=UTF-8|short|max=10</rss>
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== References  ==
 
see [[Adding References|adding references tutorial]].


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<references />  


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Latest revision as of 00:27, 26 January 2020

Original Editor - Sofie De Coster

Top Contributors - Sofie De Coster, Admin, Rachael Lowe, Mariam Hashem, Scott Cornish, WikiSysop and Kim Jackson


Definition/Description[edit | edit source]

Coxa valga is defined as the femoral neck shaft angle being greater than 139 ° [1]

Coxa vara is as a varus deformity of the femoral neck. It is defined as the angle between the neck and shaft of the femur being less than 110 – 120 ° (which is normally between 135 ° - 145 °) in children. [2]

Coxa vara is classified into several subtypes:

  • Congenital coxa vara, which is present at birth and is caused by an embryonic limb bud abnormality.
  • Developmental coxa vara occurs as an isolated deformity of the proximal femur. It tends to go unnoticed until walking age is reached, when the deformity results in a leg length difference or abnormal gait pattern.
  • Acquired coxa vara is caused by an underlying condition such as fibrous dysplasia, rickets, or traumatic proximal femoral epiphyseal plate closure. [3]

Clinically Relevant Anatomy[edit | edit source]

Congenital coxa vara results in a decrease in metaphyseal bone as a result of abnormal maturation and ossification of proximal femoral chondrocyte. As a result of congenital coxa vara, the inferior medial area of the femoral neck may be fragmented. A progressive varus deformity might also occur in congenital coxa vara as well as excessive growth of the trochanter and shortening of the femoral neck. [4]

A review on the development of coxa vara by Currarino et al showed an association with spondylometaphyseal dysplasia, demonstrating that stimulated corner fractures were present in most instances. [5]

Ashish Ranade et al also showed that a varus position of the neck is believed to prevent hip subluxation associated with femoral lengthening. An associated dysplastic acetabulum can lead to a hip subluxation. In this case study, the acetabulum is abnormal in coxa vara. Acetabular index (AI) and sourcil slope (SS) are significantly different than in the normal acetabulum. [6]

Epidemiology /Etiology[edit | edit source]

Femoral neck fractures, less than 1 % of all pediatric fractures in children, are associated with a high incidence of complications. The most serious ones with high and long term morbidity being osteonecrosis and coxa vara. [7]

A retrospective study of femoral neck fractures in children show the following complications: [8]
1) avascular necrosis (14.5%)
2) limb shortening in seven (11.3%)
3) coxa vara (8%) and premature epiphysis fusion (8%)
4) coxa valga (3.2%), arthritic changes (3.2%).
5) non-union in one (1.6%)

Premature epiphyseal closure is described as one of the ethiological factors of coxa vara. Incidences of premature physeal closure reported in the literature range from 6 % to 62 %. Another possible explanation for the high occurrence of coxa vara is the loss of reduction after initial fracture reduction of implant failure in unstable fractures. Developmental coxa vara is a rare condition with an incidence of 1 in 25 000 live births. [9] Incidence of coxa vara can be decreased by using internal fixation such as pins or screws. [7]

Characteristics/Clinical Presentation[edit | edit source]

Clinically, the condition presents itself as an abnormal, but painless gait pattern. A Trendelenburg limp is sometimes associated with unilateral coxa vara and a waddling gait is often seen when bilateral coxa vara is present. Patients with coxa vara often show:

  • Limb length discrepancy
  • Prominent greater trochanter
  • Limitation of abduction and internal rotation of the hip.

Patients may also show femoral retroversion or decreased anteversion.[10]

Diagnostic Procedures[edit | edit source]

Radiography (AP view of the pelvis) can be utilised to determine the HEA (Hilgenreiner Epiphyseal Angle). Signs to look out for are as follows:

  • The neck; shaft angle is less than 110 – 120°.
  • The greater trochanter may be elevated above the femoral head.
  • A growth plate with an overly vertical orientation. [11]

MRI can be used to visualise the epiphyseal plate, which may be widened in coxa vara.
CT can be used to determine the degree of femoral anteversion or retroversion. [12] 

Examination[edit | edit source]

AP radiographs in standing are taken, usually of both hips in a neutral position. Measuremenst are then taken: the Acetabular Index and the Sourcil Slope (the angle formed by a line joining the 2 ends of the sourcil with the horizontal line) [6]. Subluxation in children is measured by the Migration Index and the Centre edge Angle.

Medical Management[edit | edit source]

The objective of medical interventions is to restore the neck-shaft angle and realigning the epiphysial plate to decrease shear forces and promote ossification of the femoral neck defect. This is achieved by performing a valgus osteotomy, with the valgus position of the femoral neck improving the action of the gluteus muscles, normalising the femoral neck angle, increasing total limb length and improving the joint congruence.

The following are indications for surgical intervention:

  • Neck: shaft angle less than 90 °.
  • Progressive development of deformity.
  • Vertical physis and a significant limb.

Other indications are based on the HE angle;

  • HE angle > 60 ° is an indication for surgery.
  • HE angle 45 – 60 ° warrants close follow up.
  • HE angle < 45 ° warrants spontaneous resolution

Except when the neck/shaft angle is less than 110°, progression of the varus angulation takes place, gait pattern abnormalties or degenerative changes take place. [13] 

Physical Therapy Management[edit | edit source]

Literature is lacking, but surgical management appears to be the accepted treatment protocol for this condition.

Clinical Bottom Line[edit | edit source]

Due to the low incidence of coxa vara and even lower for coxa valga, there is little literature currently available. There are 3 types Coxa Vara, acquired, congenital and developmental, usually displaying greater acetabular dysplasia and an abnormal acetabulum. Surgery is the most effective treatment protocol. In the case of acquired coxa vara from a fracture, the proximal femur and femoral neck need accurate reduction and rigid fixation to avoid potential serious complications. [7]

References[edit | edit source]

  1. ↑ John C. Clohisy, MD, Ryan M. Nunley, MD, Jack C. Carlisle, MD, and Perry L. Schoenecker, MD. Incidence and Characteristics of Femoral Deformities in the Dysplastic Hip. Clin Orthop Relat Res. 2009, 467(1): 128–134.
  2. ↑ Lam F, Hussain S, Sinha J. Emerg Med J. An unusual cause of a limp in a child: developmental coxa vara. 2001,18(4):314.
  3. ↑ DiFazio R, Kocher M, Berven S, Kasser J. Coxa vara with proximal femoral growth arrest in patients who had neonatal extracorporeal membrane oxygenation. J Pediatr Orthop 2003, 23: 20 – 26
  4. ↑ Javad Parvizi MD, FRCS, Gregory K. Kim MD, and Associate Editor. Coxa Vara. High Yield Orthopaedics, 2010, Page 125
  5. ↑ Currarino G, Birch JG, Herring JA. Developmental coxa vara associated with spondylometaphyseal dysplasia (DCV/SMD): “SMD – corner fracture type” (DCV/SMD – CF) demonstrated in most reported cases. Pediatr Radiol. 2000 Jan;30(1):14-24.
  6. ↑ 6.0 6.1 Ashish Ranade MD, James J., McCarthy MD, Richard S. Davidson MD. Acetabular changes in Coxa Vara. Clin. Orthop. Relat. Res (2008) 466: 1688 - 1691
  7. ↑ 7.0 7.1 7.2 Robert E., Georg S., Peter F., Annelie M W., and Michael E H. Post – traumatic coxa vara in children following screw fixation of the femoral neck. Acta Orthopaedica 2010; 81 (4): 442 - 445
  8. ↑ Togrul E, Bayram H, Gulsen M, Kalaci A, Ozbarlas S. Fractures of the femoral neck in children: long – term follow – up in 62 hip fractures. Injury. 2005 Jan ;36(1):123-30.
  9. ↑ Lam F, Hussain S, Sinha J. Emerg Med J. An unusual cause of a limp in a child: developmental coxa vara. 2001,18(4):314.
  10. ↑ Javad Parvizi MD, FRCS, Gregory K. Kim MD, and Associate Editor. Coxa Vara. High Yield Orthopaedics, 2010, Page 125
  11. ↑ Juan Pretell Mazzini, Juan Rodriguez Martin and Rafael Marti Ciruelos. Coxa vara with proximal femoral growth arrest as a possible consequence of extracorporeal membrane oxygenation: a case report. Cases Journal. 2009, 2: 8130
  12. ↑ Javad Parvizi MD, FRCS, Gregory K. Kim MD, and Associate Editor. Coxa Vara. High Yield Orthopaedics, 2010, Page 125
  13. ↑ Juan Pretell Mazzini, Juan Rodriguez Martin and Rafael Marti Ciruelos. Coxa vara with proximal femoral growth arrest as a possible consequence of extracorporeal membrane oxygenation: a case report. Cases Journal. 2009, 2: 8130
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