Congenital Coxa Vara ICD-10
- Q65.82 Congenital coxa vara
Congenital Coxa Vara Etiology / Epidemiology / Natural History
- Defined as any decrease below the normal values of the neck-shaft angle of the proximal femur.
- Congital, progressive autosomal dominant developmental disorder, or a result of trauma, LCP diesae, SCFE, metabolic disorder, or neoplasm.
- Male = female, right = left
- 30%-50% bilateral
- Developmental coxa vara, represents coxa vara not present at birth but develops early in childhood and produces progressive deterioration of the proximal femoral neck-shaft angle during growth
Congenital Coxa Vara Anatomy
- Slip occurs on the metaphyseal side of the epiphyseal plate, breaking away from the plate at its distal end to separate off a flake (triangular fragment) of metaphysis (the inverted 'Y')
Congenital Coxa Vara Clinical Evaluation
- Painless waddling or Trendelberg gait generally noted between 2-6 years old.
- Decreased hip abduction
- Limb-length discrepancy is unilateral.
Congenital Coxa Vara Xray / Diagnositc Tests
- AP and lateral pelvis films, lateral can be frog-legged or cross table .
- Inverted Y pattern of the proximal formoral physis.
- Fairbanks Fragment: fragment at the inferior neck associated with invertd Y pattern.
- Hilgenreiner epiphyseal angle: angle between hilgenreiner's line and a lone drawn throught the proximal femoral phsis on AP pelvic view.
- Classic Radiographic findings:
-decreased femoral neck-shaft angle
-vertical position of the physeal plate
- triangular metaphyseal fragment in the inferior femoral neck surrounded by an inverted radiolucent Y pattern ( sine qua non of this condition)
-decrease in normal anteversion of the proximal femur, may become true retroversion; coxa breva; and in some patients acetabular dysplasia
Congenital Coxa Vara Classification / Treatment
- Neck shaft angle >90° or Hilgenreiner angle < 45°
-Treatment = observation
- Neck shaft angle <90° or Hilgenreiner angle >60° or 45° -60° with documented progression of varus deformity
-Treatment: corrective intertrochanteric or subtrochanteric valgus osteotomy. Goal = Hilgenreiner's angle of 25° , neck shaft angle between 150° and 160°. Consider concomittant adductor tentomy, proximal femoral shortening. (Carroll J Pediatr Othrop 17:220;1997)
- Higenreiner physeal angle should be corrected to >38 degrees to minimize recurrence. (Carroll J Pediatr Othrop 17:220;1997)
Congenital Coxa Vara Associated Injuries / Differential Diagnosis
- Proximal femoral focal deficiency
- Fibular hemimelia
Congenital Coxa Vara Complications
- Premature physeal closure
- Greater tochanteric overgrowth
- Recurrence of deformity
- Limb-length discrepancy, Degenerative arthritis
Congenital Coxa Vara Follow-up Care
Congenital Coxa Vara Review References
- Weinstein JN, JPO 1984;4:70