Coxa Vara - Treatment And Prognosis

• The determining factor for progression is the epiphyseal angle
  - if remains less than 45?- usually spontaneously heal femoral neck defect and do not progress
• - if more than 45? progression, ultimately resulting in the development of a stress fracture related nonunion of the femoral neck as well as premature degenerate changes in the hip jt by late teens

• correct neck-shaft angle to a more physiologic range
• change load from shear to compression at physis
• correct LLD
• restore proper length -tension relation for the abductors

1. Indications

• Epiphyseal angle 45-60? - observe- if progresses reccomend operation
  
• >60? recommend operation
• Shaft- neck angle less than ~ 90?
  

1. Development of Trendelenberg gait

• aim is to overcorrect to a neck- shaft angle of more than 160?, an epiphyseal angle of 30? or less
• Operate when child is younger - do not wait- remodelling better in young pt

• spontaneous healing of metaphyseal defect within 3-6 mths if adequate valgus achieved
• 50- 89% - operated hips develop premature closure of the prox femoral physis- usually within 2 yrs of surgery- if it occurs, need to mnitor for recurrence of deformity or LLD. To prevent recurrence of deformity due to premature closure of physis, greater trochanteric apophyseodesis or advancement can be performed

Category: Orthopedics Notes