Coxa valga and coxa vera

Iqra rai 9218

Fatima ghaffar
Ayesha Shafiq
Rafia ehsaan
Ayesha mubarik
Dpt 7th sec B
Submitted to Dr .Rizwan
 Definiton:-
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.
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.
 Acquired coxa vara is caused by an underlying
condition such as fibrous dysplasia, rickets, or
traumatic proximal femoral epiphyseal plate
closure
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.
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:

Limb length discrepancy

Prominent greater trochanter
Limitation of abduction and internal rotation of the hip.
1. Patients may also show femoral retroversion or decreased
anteversion
Diagnostic Procedures
Radiography 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.
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
Medical Management
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.
It is almost impossible to treat Coxa Vara using
conservative methods. All tactics are aimed at
improving the quality of life. This includes massages,
exercise therapy, drugs aimed to relieve inflammation.
Many patients require psychological support.
Therefore, if the pathology was found in a child, it is
better to perform the operation at an early age.
Non surgical management
including Spica cast
immobilization and
skeletal pin traction with
bed rest, with generally
unsatisfactory results.
There are two ways: joint prosthetics and osteotomy. It is known that the
development of a child is directly related to the start of walking. The
method of prosthetics significantly postpones this process, and as a
result, emotions, psyche, speech apparatus and other body functions
suffer. Osteotomy is a gentler procedure which is no less effective at the
same time. It restores the natural position of bones and joints. The
operation is performed under anesthesia, and rehabilitation takes 1-4
months. Just after a couple of weeks, a person can walk on their own.
The only inconvenience is the fixation device worn on the legs. It is
installed during surgery to support the anatomical position of the joint.
Coxa Valga
Coxa valga is increased in femoral neck-shaft angle to more than
140 degrees. Like coxa vara, coxa valga could be congenital or
acquired.
But it is quite rare as compared to coxa vara.
Coxa valga is often associated with shallow acetabular angles and
femoral head subluxation.
It can be associated with genu varum and lead to increased stress
and early degenerative changes in the medial compartment of the
knee.
Types of Coxa Valga
The commonest cause of progressive coxa valga is cerebral palsy along with
other neuromuscular disorders. The increased muscular pull on the femoral
head due to spasticity and abnormal forces eventually may cause subluxation
or dislocation. Coxa valga can be
True
this deformity may occur after the arrest of the greater trochanter apophysis or
neck cartilage following surgical procedures. It gives an appearance of
elongation of the neck on AP radiographs.
Apparent
This appears due to femoral antetorsion which gives the appearance of
increased neck-shaft angle.
Combinations
In neuromuscular disorders such as cerebral palsy, the deformity is usually a
combination of femoral antetorsion and true coxa valga.
Causes of Coxa Valga
Bilateral
Neuromuscular disorders, e.g. cerebral palsy
often have concurrent femoral anteversion
Skeletal dysplasias, e.g. Turner syndrome, mucopolysaccharidoses
Unilateral
Trauma causing growth plate arrest
Plain X-rays
The angle formed between the neck of the femur and its shaft is increased
beyond >140 degrees
Femoral anteversion and rotation can affect measurement accuracy and should be
considered when measuring angles.
Treatment of Coxa Valga
Treatment for Coxa valgum depends on the cause and severity of your
symptoms.
Your doctor may also prescribe prescription-strength nonsteroidal
anti-inflammatory drugs if over-the-counter options,
like naproxen (Aleve, Naprosyn), aren’t providing relief.
A typical treatment plan will include one or more of the following:
Weight loss
Obesity can put added stress on your knees, worsening Coxa
valgum. If you’re overweight, your doctor will work with you to
develop a healthy weight loss plan.
Physical Therapy Interventions

In Dysplastic Hip structural deviations of femoral anteversion, coxa valga, and

a shallow acetabulum can result in increased articular exposure of the femoral
head, less congruence and reduced stability of the hip joint in neutral weight
bearing position.

If hip dysplasia is diagnosed in infancy then frog leg positioning can help using
something like Frejka pillow or Pavlik harness to decrease the deformity by
increasing the contact between the femoral head and acetabulum. The position
of combined flexion, abduction and rotation is commonly used for
immobilization of the hip joint when the goal is to improve articular contact
and joint congruence in conditions such as congenital dislocation of the hip and
in Legg-Calve-Perthes disease
For most people with Coxa valgum, exercise can
help realign and stabilize their thigh. Your doctor or
physical therapist can evaluate your gait and
suggest exercises designed to strengthen your leg,
hip, and thigh muscles. Specific stretches may also
be useful in relieving symptoms.
Strengthening exercises can be simple, such as leg
raises while seated or lying down. As you progress
with an exercise routine, you may add leg weights
to make it more effective.
Orthotics
If your legs are of unequal length as a
result of coxa valgum, a heel insert into
the shoe on the shorter side can equalize
your leg length and help regularize your
gait. It may also relieve leg pain.
For children whose coxa valgum doesn’t
resolve by age 8, a brace or a splint may
help guide bone growth.
Treatment
Coxa valga in a child is not necessarily a pathological condition
which needs treatment as long as the acetabulum shows adequate
development for the patient’s age and constitution. Varus
osteotomy is not indicated in these cases and may even result in
poor development of the hip following operation.
When required, it can be treated with corrective osteotomy.
Rotational correction for anteversion if present should also be
considered.
Varus derotation osteotomy and angled blade-plate fixation is
quite effective. The osteotomy is done at an intertrochanteric or
subtrochanteric osteotomy is performed.
Varus Deterioration
Osteotomy
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