Coxa vara

From a coxa vara (Latin coxa " hip " varus " bent outward " ) occurs when the CCD angle, ie the angle between the femoral neck and shaft of the femur is below 120 °. It may be a shortened leg, a limping gait and other leg deformities as a Einwärtsstellung the knee and thus an X - position of the legs ( genu valgum ) result.

In massive expression with a CCD angle of less than 90 ° is called a Hirtenstabdeformität.

The opposite is the coxa valga, which often occurs in infants and newborns and represents a magnification of the CCD angle to more than 135 °.

The causes of coxa vara can be distinguished by age of onset.

Newborns and infants

  • Very rare congenital coxa vara usually associated with other congenital malformations such as Proximal Femurdefekt ( PFFD ), fibular hemimelia or kleidokranialer dysostosis.
  • Impaired endochondral ossification on the medial side of the femoral neck.
  • Position due to in utero due to abnormally increased pressure on the joint
  • From genetic disposition

Childhood

Common causes of acquired coxa vara in childhood are

  • Young Hüftkopflösung, ECF ( slipped capital femoral epiphysis )
  • Knochenerweichende system disease (eg rickets )
  • Perthes disease

More are sickle cell disease, fibrous dysplasia, osteogenesis imperfecta, achondroplasia, Gaucher's disease, Kniest syndrome, Morquio disease, spondyloepiphyseal dysplasia, pseudohypoparathyroidism, various forms of the dwarfism

Adult

  • Osteitis deformans ( Paget's disease )
  • Niemann -Pick disease.

In all age groups

Post-traumatic femoral fractures healed in the wrong position, femoral neck fracture, Schenkelhalsnekrose with steroid therapy or radiation treatment, a result of osteomyelitis

Clinic

Depending on cause and age

  • Leg shortening
  • Limping gait ( Trendelenburg sign )
  • When bilateral, change also increased lumbar lordosis.
  • Limited abduction and internal rotation decreased ability

The change increases the likelihood of femoral neck fracture ( femoral neck fracture ), since the stability of the femoral neck ( collum femoris ossis ) decreases with smaller CCD angle, so there is an imbalance of load and resistance. Heaped there may be formation of a femoral neck nonunion.

Diagnostics

In infancy, the coxa vara already falls mostly on at the U3 - examination of the infant hip, as a normal representation of the joint is hardly possible. It can also come to confusion with a hip dislocation. Diagnosis is done in advanced ossification normally means radiograph Beck overview. Under 120 ° reduced CCD angle, horizontal position of the epiphysis, shortened femoral neck. In yet low bone nucleation magnetic resonance imaging ( MRI) can provide further insights.

Treatment

Treatment depends on the underlying cause.

Genu varum Toddler Congenital disorder Morquio syndrome Paget's disease of bone Trendelenburg's sign
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