eMedicine Specialties > Orthopedic Surgery > Pediatrics

Congenital Coxa Vara: Multimedia

Author: Robert Mervyn Letts, MD, FRCS(C), FACS, Former Chief, Department of Surgery, Division of Pediatric Orthopedics, Children's Hospital of Eastern Ontario, University of Ottawa; Consultant Pediatric Orthopedic Surgeon, Sheikh Khalifa Medical City, UAE
Coauthor(s): Ken K Kontio, MD, FRCSC, Assistant Professor, Department of Surgery, University of Ottawa; Consulting Surgeon, Department of Surgery, Division of Orthopedics, Children's Hospital of Eastern Ontario, Ottawa Children's Treatment Centre
Contributor Information and Disclosures

Updated: Jan 27, 2009

Multimedia

Congenital coxa vara (CCV). Hip biomechanics in c...
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Media file 1: Congenital coxa vara (CCV). Hip biomechanics in coxa vara. (A, B) Normal hip. (C) Abnormal varus hip. Biomechanically, the sheer effect causing progressive varus deformity is best understood in relation to the resultant force (R) at the femoral/acetabular articulation. In the normal hip, this resultant force would be perpendicular and compressive (C) in nature with respect to the physis. The force transmitted to the proximal femoral neck would include a net tension force (T) at the superior or lateral cortex and a net compressive force (C) at the inferior or medial cortex. In the case of CCV, the more vertical position of the proximal femoral physis would increase not only the sheer component (S) of the hip articulation resultant force but also the net medial compressive force (C) on the metaphyseal bone of the femoral neck. These forces overwhelm the mechanical strength of the abnormally ossified bone in this area. This may lead to a relentless and progressive cycle of deformity that oftencontinues unless these forces are corrected with surgical intervention.
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Congenital coxa vara (CCV). Hip biomechanics in c...

Congenital coxa vara (CCV). Hip biomechanics in coxa vara. (A, B) Normal hip. (C) Abnormal varus hip. Biomechanically, the sheer effect causing progressive varus deformity is best understood in relation to the resultant force (R) at the femoral/acetabular articulation. In the normal hip, this resultant force would be perpendicular and compressive (C) in nature with respect to the physis. The force transmitted to the proximal femoral neck would include a net tension force (T) at the superior or lateral cortex and a net compressive force (C) at the inferior or medial cortex. In the case of CCV, the more vertical position of the proximal femoral physis would increase not only the sheer component (S) of the hip articulation resultant force but also the net medial compressive force (C) on the metaphyseal bone of the femoral neck. These forces overwhelm the mechanical strength of the abnormally ossified bone in this area. This may lead to a relentless and progressive cycle of deformity that oftencontinues unless these forces are corrected with surgical intervention.

Characteristic radiographic findings of congenita...
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Media file 2: Characteristic radiographic findings of congenital coxa vara. (A) Decreased neck shaft angle. (B) Smaller and flatter femoral head. (C) More vertical orientation of physeal plate. (D) Coxa brevis. (E) Abnormal bony fragment inferolateral to physeal plate and contained in inverted Y-shaped lucency.
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Characteristic radiographic findings of congenita...

Characteristic radiographic findings of congenital coxa vara. (A) Decreased neck shaft angle. (B) Smaller and flatter femoral head. (C) More vertical orientation of physeal plate. (D) Coxa brevis. (E) Abnormal bony fragment inferolateral to physeal plate and contained in inverted Y-shaped lucency.

Congenital coxa vara. Determination of the Hilgen...
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Media file 3: Congenital coxa vara. Determination of the Hilgenreiner epiphyseal angle, using the Hilgenreiner line as the horizontal axis and a line through the defect adjacent to the metaphysis as the diagonal axis.
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Congenital coxa vara. Determination of the Hilgen...

Congenital coxa vara. Determination of the Hilgenreiner epiphyseal angle, using the Hilgenreiner line as the horizontal axis and a line through the defect adjacent to the metaphysis as the diagonal axis.

Congenital coxa vara. Natural history of untreate...
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Media file 4: Congenital coxa vara. Natural history of untreated progressive developmental coxa vara with premature degeneration of hip joint.
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Congenital coxa vara. Natural history of untreate...

Congenital coxa vara. Natural history of untreated progressive developmental coxa vara with premature degeneration of hip joint.

Congenital coxa vara. Surgical methods of valgus-...
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Media file 5: Congenital coxa vara. Surgical methods of valgus-producing proximal femoral osteotomies. (A) Pauwels Y-shaped osteotomy. (B) Langenskiöld intertrochanteric osteotomy. (C) Borden subtrochanteric osteotomy.
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Congenital coxa vara. Surgical methods of valgus-...

Congenital coxa vara. Surgical methods of valgus-producing proximal femoral osteotomies. (A) Pauwels Y-shaped osteotomy. (B) Langenskiöld intertrochanteric osteotomy. (C) Borden subtrochanteric osteotomy.

Surgical treatment of congenital coxa vara. Progr...
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Media file 6: Surgical treatment of congenital coxa vara. Progression from preoperative radiographs at ages 2 and 5 years, with characteristic bony changes. Postoperative radiographs at ages 6 and 12 years, with early and late follow-up results.
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Surgical treatment of congenital coxa vara. Progr...

Surgical treatment of congenital coxa vara. Progression from preoperative radiographs at ages 2 and 5 years, with characteristic bony changes. Postoperative radiographs at ages 6 and 12 years, with early and late follow-up results.

Greater trochanteric overgrowth in treated congen...
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Media file 7: Greater trochanteric overgrowth in treated congenital coxa vara.
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Greater trochanteric overgrowth in treated congen...

Greater trochanteric overgrowth in treated congenital coxa vara.

More on Congenital Coxa Vara

Overview: Congenital Coxa Vara
Workup: Congenital Coxa Vara
Treatment: Congenital Coxa Vara
Follow-up: Congenital Coxa Vara
Multimedia: Congenital Coxa Vara
References
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References

  1. Trigui M, Pannier S, Finidori G, Padovani JP, Glorion C. Coxa vara in chondrodysplasia: prognosis study of 35 hips in 19 children. J Pediatr Orthop. Sep 2008;28(6):599-606. [Medline].

  2. Hart ES, Grottkau BE, Marino JC. Congenital coxa vara deformity. Orthop Nurs. Nov-Dec 2007;26(6):349-51; quiz 352-3. [Medline].

  3. Trigui M, Pannier S, Finidori G, Padovani JP, Glorion C. Coxa vara in chondrodysplasia: prognosis study of 35 hips in 19 children. J Pediatr Orthop. Sep 2008;28(6):599-606. [Medline].

  4. Fiorani F. Concerning a rare form of limping. Gazz Osp. 1881;2:717.

  5. Hofmeister F. Coxa Vara: a typical form of curvature of the femoral neck. Beitr Klin Chir. 1894;12:245.

  6. Hoffa A. Die angeborenen coxa vara. Dtsch Med Wochenschr. 1905;31(32):1257.

  7. Fairbank HAT. Infantile or cervical coxa vara. In: The Robert Jones Birthday Volume. A Collection of Surgical Essays. London, England: Oxford University Press;1928:225.

  8. Duncan GA. Congenital and developmental coxa vara. Surgery. 1938;3:741.

  9. Amstutz HC. Developmental (infantile) coxa vara--a distinct entity. Report of two patients with previously normal roentgenograms. Clin Orthop. Sep-Oct 1970;72:242-7. [Medline].

  10. Pylkkanen PV. Coxa vara infantum. Acta Orthop Scand. 1960;48(supp):1.

  11. Chung SM, Riser WH. The histological characteristics of congenital coxa vara: a case report of a five year old boy. Clin Orthop. May 1978;(132):71-81. [Medline].

  12. Bos CF, Sakkers RJ, Bloem JL, et al. Histological, biochemical, and MRI studies of the growth plate in congenital coxa vara. J Pediatr Orthop. Nov-Dec 1989;9(6):660-5. [Medline].

  13. Ranade A, McCarthy JJ, Davidson RS. Acetabular changes in coxa vara. Clin Orthop Relat Res. Jul 2008;466(7):1688-91. [Medline].

  14. Weinstein JN, Kuo KN, Millar EA. Congenital coxa vara. A retrospective review. J Pediatr Orthop. Jan 1984;4(1):70-7. [Medline].

  15. Amstutz JC, Freiberger RH. Coxa vara in children. Clinical Orthop. 1962;22:73.

  16. Amstutz JC, Wilson PO Jr. Dysgenesis of the proximal femur (coxa vara) and its surgical management. J Bone Joint Surg Am. 1962;44:1.

  17. Carroll K, Coleman S, Stevens PM. Coxa vara: surgical outcomes of valgus osteotomies. J Pediatr Orthop. Mar-Apr 1997;17(2):220-4. [Medline].

  18. Weighill FJ. The treatment of developmental coxa vara by abduction subtrochanteric and intertrochanteric femoral osteotomy with special reference to the role of adductor tenotomy. Clin Orthop. May 1976;(116):116-24. [Medline].

  19. Serafin J, Szulc W. Coxa vara infantum, hip growth disturbances, etiopathogenesis, and long-term results of treatment. Clin Orthop. Nov 1991;(272):103-13. [Medline].

  20. Desai SS, Johnson LO. Long-term results of valgus osteotomy for congenital coxa vara. Clin Orthop. Sep 1993;(294):204-10. [Medline].

  21. Borden J, Spencer GE Jr, Herndon CH. Treatment of coxa vara in children by means of a modified osteotomy. J Bone Joint Surg Am. Sep 1966;48(6):1106-10. [Medline].

  22. Cordes S, Dickens DR, Cole WG. Correction of coxa vara in childhood. The use of Pauwels'' Y-shaped osteotomy. J Bone Joint Surg Br. Jan 1991;73(1):3-6. [Medline].

  23. De Pellegrin MP, Mackenzie WG, Harcke HT. Ultrasonographic evaluation of hip morphology in osteochondrodysplasias. J Pediatr Orthop. Sep-Oct 2000;20(5):588-93. [Medline].

  24. DiFazio RL, Kocher MS, Berven S. Coxa vara with proximal femoral growth arrest in patients who had neonatal extracorporeal membrane oxygenation. J Pediatr Orthop. Jan-Feb 2003;23(1):20-6. [Medline].

  25. Fassier F, Sardar Z, Aarabi M, Odent T, Haque T, Hamdy R. Results and complications of a surgical technique for correction of coxa vara in children with osteopenic bones. J Pediatr Orthop. Dec 2008;28(8):799-805. [Medline].

  26. Fisher RL, Waskowitz WJ. Familial developmental coxa vara. Clin Orthop. Jul-Aug 1972;86:2-5. [Medline].

  27. Hau R, Dickens DR, Nattrass GR. Which implant for proximal femoral osteotomy in children? A comparison of the AO (ASIF) 90 degree fixed-angle blade plate and the Richards intermediate hip screw. J Pediatr Orthop. May-Jun 2000;20(3):336-43. [Medline].

  28. Hughes LO, Aronson J, Smith HS. Normal radiographic values for cartilage thickness and physeal angle in the pediatric hip. J Pediatr Orthop. Jul-Aug 1999;19(4):443-8. [Medline].

  29. Ito H, Minami A, Suzuki K. Three-dimensionally corrective external fixator system for proximal femoral osteotomy. J Pediatr Orthop. Sep-Oct 2001;21(5):652-6. [Medline].

  30. Johanning K. Coxa vara infantum II: Clinical appearance and aetiological problems. Acta Orthop Scand. 1951;21:273.

  31. Kehl DK, LaGrone M, Lovell WW. Developmental coxa vara. Orthop Trans. 1983;7:475.

  32. Kim HT, Chambers HG, Mubarak SJ. Congenital coxa vara: computed tomographic analysis of femoral retroversion and the triangular metaphyseal fragment. J Pediatr Orthop. Sep-Oct 2000;20(5):551-6. [Medline].

  33. LeMesurier AB. Developmental coxa vara (correspondence). J Bone Joint Surg Br. 1951;33:478.

  34. Letts RM, Shokeir MH. Mirror-image coxa vara in identical twins. J Bone Joint Surg Am. Jan 1975;57(1):117-8. [Medline].

  35. Magnusson R. Coxa vara infantum. Acta Orthop Scand. 1954;23:284.

  36. Nillsone H. On congenital coxa vara. Acta Chir Scand. 1929;64:217.

  37. Pavlov H, Goldman AB, Freiberger RH. Infantile coxa vara. Radiology. Jun 1980;135(3):631-40. [Medline].

  38. Sabharwal S, Mittal R, Cox G. Percutaneous triplanar femoral osteotomy correction for developmental coxa vara: a new technique. J Pediatr Orthop. Jan-Feb 2005;25(1):28-33. [Medline].

  39. Say B, Taysi K, Pirnar T, et al. Dominant congenital coxa vara. J Bone Joint Surg Br. Feb 1974;56(1):78-85. [Medline].

  40. Zadek I. Congenital coxa vara. Arch Surg. 1935;30:62.

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Further Reading

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Keywords

coxa vara, congenital coxa vara, CCV, developmental coxa vara, infantile coxa vara, cervical coxa vara, childhood coxa vara, proximal femoral varus, proximal femoral focal deficiency, PFFD, congenital short femur, congenital bowed femur

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Contributor Information and Disclosures

Author

Robert Mervyn Letts, MD, FRCS(C), FACS, Former Chief, Department of Surgery, Division of Pediatric Orthopedics, Children's Hospital of Eastern Ontario, University of Ottawa; Consultant Pediatric Orthopedic Surgeon, Sheikh Khalifa Medical City, UAE
Disclosure: Nothing to disclose.

Coauthor(s)

Ken K Kontio, MD, FRCSC, Assistant Professor, Department of Surgery, University of Ottawa; Consulting Surgeon, Department of Surgery, Division of Orthopedics, Children's Hospital of Eastern Ontario, Ottawa Children's Treatment Centre
Ken K Kontio, MD, FRCSC is a member of the following medical societies: Canadian Medical Association, Canadian Orthopaedic Association, Christian Medical & Dental Society, Ontario Medical Association, and Pediatric Orthopaedic Society of North America
Disclosure: Nothing to disclose.

Medical Editor

Mininder S Kocher, MD, MPH, Associate Professor of Orthopedic Surgery, Harvard Medical School/Harvard School of Public Health; Associate Director, Division of Sports Medicine, Department of Orthopedic Surgery, Children's Hospital Boston
Mininder S Kocher, MD, MPH is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the History of Medicine, American Medical Association, American Orthopaedic Society for Sports Medicine, and Massachusetts Medical Society
Disclosure: Smith & Nephew Endoscopy Consulting fee Consulting; ConMed Linvatec Consulting fee Consulting; Covidian Consulting fee Consulting; EBI Biomet Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

George H Thompson, MD, Director, Pediatric Orthopedics, Rainbow Babies and Children's Hospital
George H Thompson, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Pediatric Orthopaedic Society of North America, and Scoliosis Research Society
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dennis P Grogan, MD, Clinical Professor, Department of Orthopedic Surgery, University of South Florida College of Medicine; Chief of Staff, Department of Orthopedic Surgery, Shriners Hospital for Children of Tampa
Dennis P Grogan, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Eastern Orthopaedic Association, Irish American Orthopaedic Society, Pediatric Orthopaedic Society of North America, and Scoliosis Research Society
Disclosure: Nothing to disclose.

 
 
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