Coxa Vara, meaning, classification, clinical features, Radiography, Treatment.

It is the abnormality of the proximal end of the femur, which is characterized by decreased neck shaft angle (Normal angle is 125-132degrees) It can be either congenital (present at birth) Developmental (manifests clinically during early childhood and progresses with growth) or Acquired (mal-united and non-united fractures, a slipped upper femoral epiphysis, Perthes' disease and bone softening  eg.., osteomalacia , Paget's disease).

Classification:-
congenital
  •  Congenital coxa vara
  •  Congenital short femur with coxa vara
  •  Congenital bowed femur with coxa vara.
Acquired (according to the site of disturbance)
  •  Capital coxa vara this is seen in perthes disease ,chondro osteodystrophy, cretinism, septic arthritis , of hip .,etc.
  •  Epiphyseal coxa vara Slipped capital femoral epiphysis.
  •  Cervical coxa vara this is seen in malunited trochanteric fracture, pathological hip conditions like
            ---Children --Rickets,bony dystrophies,etc.,
            ---Adult--Osteomyelitis, Osteoporosis, Paget's disease, fibrous dysplasia, etc.

Part of generalized skeletal dysplasias This is seen in mucopolysaccharidosis, multiple epiphyseal dysplasias, achondroplasia, cleidocranical dyssostosis,etc.

Disadvantages of coxa vara 
  •   Normal apposition between joint surfaces is lost.
  •    Trochanter is displaced upwards, impinges on the side of pelvis.
  •    Marked shortening of limb.
  •    Waddling gait.
Clininal Features:-
Small stature, limp, waddling gait, upward shift of greater trochanter, decreased rotation and abduction of hip, pain, stiffness and flexion contractures are some  of the important clinical features of coxa vara.

Radiograph:-
Radiographic features are neck shaft angle is less that 90degrees, length of the neck is decreased, head is unusually translucent, and triangular fragment of bone is seen occupying lower part of the head close to the neck.

Treatment :-
It consists of corrective osteotomy at the intertrochanteric level. Usually a lateral wedge osteotomy is preferred. Macewen and Shand's corrective osteotomy corrects both coxa vara and retroversion of the femoral neck.

Physiotherapy Measures after surgery:-
The following measures are suggested:
  • Sutures are removed after two weeks.
  • As soon as the pain permits, a non-weight-bearing crutch walking is permitted.
  • Full weight-bearing may be allowed after 8-12 weeks

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