Coxa vara is a deformity of the hip, whereby the angle between the head and the shaft of the

femur The femur (; ), or thigh bone, is the proximal bone of the hindlimb in tetrapod vertebrates. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates wit ...

is reduced to less than 120 degrees. This results in the leg being shortened and the development of a

limp A limp is a type of asymmetric abnormality of the gait. Limping may be caused by pain, weakness, neuromuscular imbalance, or a skeletal deformity. The most common underlying cause of a painful limp is physical trauma; however, in the absence ...

. It may be congenital and is commonly caused by injury, such as a fracture. It can also occur when the bone tissue in the neck of the

is softer than normal, causing it to bend under the weight of the body. This may either be

congenital A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities c ...

or the result of a bone disorder. The most common cause of coxa vara is either

or developmental. Other common causes include metabolic bone diseases (e.g. Paget's disease of bone), post-Perthes deformity,

osteomyelitis Osteomyelitis (OM) is an infection of bone. Symptoms may include pain in a specific bone with overlying redness, fever, and weakness. The long bones of the arms and legs are most commonly involved in children e.g. the femur and humerus, while the ...

, and post traumatic (due to improper healing of a fracture between the greater and lesser trochanter). Shepherd's Crook deformity is a severe form of coxa vara where the proximal femur is severely deformed with a reduction in the neck shaft angle beyond 90 degrees. It is most commonly a sequela of osteogenesis imperfecta, Pagets disease,

tumour A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

and tumour-like conditions (e.g. fibrous dysplasia). Coxa vara can happen in

cleidocranial dysostosis Cleidocranial dysostosis (CCD), also called cleidocranial dysplasia, is a birth defect that mostly affects the bones and teeth. The collarbones are typically either poorly developed or absent, which allows the shoulders to be brought close togethe ...

Anatomy

In early skeletal development, a common physis serves the greater trochanter and the capital femoral epiphysis. This physis divides as growth continues in a balance that favors the capital epiphysis and creates a normal neck shaft angle (angle between the femoral shaft and the neck). The corresponding angle at maturity is 135 ± 7 degrees. Another angle used for the measurement of coxa vara is the cervicofemoral angle which is approximately 35 degrees at infancy and increases to 45 degrees after maturity.

Types

Developmental

* primary defect in endochondral ossification of the medial part of the femoral neck (Most common cause) * Excessive interuterine pressure on the developing fetal hip * vascular insult * Faulty maturation of the cartilage and metaphyseal bone of the femoral neck Clinical feature: presents after the child has started walking but before six years of age. Usually associated with a painless hip due to mild abductor weakness and mild limb length discrepancy. If there is a bilateral involvement the child might have a waddling gait or trendelenburg gait with an increased lumbar lordosis. The greater trochanter is usually prominent on palpation and is more proximal. Restricted abduction and internal rotation. X-ray: decreased neck shaft angle, increased cervicofemoral angle, vertical physis, shortened femoral neck decrease in femoral anteversion. HE angle (Hilgenriener epiphyseal angle- angle subtended between a horizontal line connecting the

triradiate cartilage The triradiate cartilage (in Latin cartilago ypsiloformis) is the 'Y'-shaped epiphyseal plate between the ilium, ischium and pubis to form the acetabulum of the os coxae. Human development In children, the triradiate cartilage closes at an a ...

and the epiphysis); normal angle is <30 degrees. Treatment: HE angle of 45–60 degrees: observation and periodic follow up. Indication for surgery: HE angle more than 60 degrees, progressive deformity, neckshaft angle <90 degrees, development of Trendelenburg gait Surgery: subtrochanteric valgus osteotomy with adequate internal rotation of distal fragment to correct anteversion; common complication is recurrence. If HE angle is reduced to 38 degrees, less evidence of recurrence; post operative spica cast is used for a period of 6–8 weeks. Coxa vara is also seen in

Niemann–Pick disease Niemann–Pick disease is a group of severe inherited metabolic disorders, in which sphingomyelin accumulates in lysosomes in cells (the lysosomes normally degrade material that comes from out of cells). These disorders involve the dysfunctional ...

Congenital

Presence at birth is extremely rare and associated with other congenital anomalies such as proximal femoral focal deficiency, fibular hemimelia or anomalies in other part of the body such as cleidocranial dyastosis. The femoral deformity is present in the subtrochanteric area where the bone is bent. The cortices are thickened and may be associated with overlying skin dimples. External rotation of the femur with valgus deformity of knee may be noted. This condition does not resolve and requires surgical management. Surgical management includes valgus osteotomy to improve hip biomechanics and length and rotational osteotomy to correct retroversion and lengthening.

References

* S.Swischuk, S.John: Differential Diagnosis in Pediatric Radiology, Williams & Wilkins 1995, * D Resnick: Diagnosis of Bone and Joint Disorders Vol V, Saunders 1995,

External links