BACKGROUND: Although the valgus subtrochanteric osteotomy is considered as a standard surgical treatment for coxa vara, there is no consensus on the optimal method of fixation and osteotomy technique. Fixation of the osteotomy has been achieved by various methods including external fixation and internal fixation with pins and cerclage and a variety of plates. The aim of this study is the evaluation of the results of developmental coxa treated by Y intertrochanteric valgus osteotomy fixed with a T-buttress plate compared with other methods of fixation in the literature. METHODS: Eighteen corrective valgus intertrochanteric femoral osteotomies were performed in 18 patients (18 hips) for treatment of unilateral developmental coxa vara deformity and fixed with a T plate. There were 12 males and 6 females. The right hip was affected in 10 patients and the left hip in 8 patients. Clinically, patients were evaluated by Larson hip score. Radiographically, anteroposterior view of the pelvis and frog leg lateral views of the affected hip were taken preoperatively and compared with the findings at the final follow-up. RESULTS: The average follow-up was 29 months (range, 24 to 36 months). Clinical results showed improvement of the mean Larson hip score from 57.8 to 97.0 (p < 0.001). Radiological results showed that all osteotomies were completely united in 2.4 months (range, 2 to 3 months) with the achievement of the planned correction angle. The average correction of Hilgenreiner's epiphyseal angle improved from 78.2° to 27.8° (p < 0.001) at the final follow-up. The femoral neck shaft angle was improved from 93.7° to 129.9° (p < 0.001) at the final follow-up. Shortening of the affected limb was corrected from 2.8 cm to 1.3 cm (p < 0.001) at the last follow-up. No major serious complications were recorded in the present study. CONCLUSIONS: Intertrochanteric valgus osteotomy of the proximal femur fixed with a T plate may be efficient for treatment of developmental coxa vara. With careful planning, it can result in a low complication rate and insignificant or minimal recurrence rate.
*Bone Plates ; Child ; Child, Preschool ; Coxa Vara/*surgery ; Female ; Femur Neck/*surgery ; Follow-Up Studies ; *Fracture Fixation, Internal/instrumentation/methods/statistics & numerical data ; Humans ; Male ; *Osteotomy/methods/statistics & numerical data

Spondyloepiphyseal dysplasia congenita (SEDC) is a kind of skeletal dysplasia, inheritable condition. The clinical features of SEDC are dwarfism, myopia with or without retinal detachment, coxa vara, thoracic dysplasia with respiratory failure and laryngotracheal stenosis. A point of particular concern to anesthetists is odontoid hypoplasia which, combined with ligamentous laxity, leads to atlantoaxial instability. We report successful general anesthesia for cervical spine fusion of a patient with SEDC.
Anesthesia, General ; Constriction, Pathologic ; Coxa Vara ; Dwarfism ; Humans ; Ligaments ; Myopia ; Osteochondrodysplasias ; Respiratory Insufficiency ; Retinal Detachment ; Spine

Arthropathy, Neurogenic ; Child ; Coxa Vara ; Hand Deformities, Congenital ; Humans ; Male ; Synovitis

Developmental coxa vara is a rare disease and the symptoms do not appear at birth, but rather, they appear at the age of walking. Clinically, the symptoms include a waddling gait, limb length discrepancy and frequent weariness. Developmental coxa vara is sometimes associated with skeletal dysplasia. Especially, it is associated with spondylometaphyseal dysplsia and the vertebral bodies and long bones are affected. The authors report here on diagnosing and treating this rare disease and we review the relevant literatures.
Coxa Vara ; Extremities ; Gait ; Hip ; Osteochondrodysplasias ; Parturition ; Rare Diseases ; Walking

PURPOSE: To investigate the results of treatment of reverse oblique trochanteric fractures with compression hip screw. METHODS: We reviewed the results of 12 cases of reverse oblique trochanteric fracture treated with compression hip screw from January 2000 to December 2006 which could be followed up for more than 1 year. The mean follow up period was 26 months (15~40). The mean age was 48 years old. Injury mechanism was composed of 6 cases of traffic accident and 6 cases of fall down. 8 persons were man. We investigated the union time, degree of neck-shaft angle change, amount of sliding of compression hip screw, complications, functional and clinical results. RESULTS: 10 cases were united and the mean union time were 5 months (3~8). The mean neck-shaft angle change was 3.5 degrees (0~12). The amount of sliding of compression hip screw was 8.9 mm (2~24). There were six coxa vara, six leg due to coxa vara shortening, two nonunion, and one superficial infection. Unsatisfactory results of Jensen's social function score and Parker and Palmer's mobility score were studied. CONCLUSION: The results of treatment of reverse oblique trochanteric fractures with compression hip screw were relatively unsatisfied.
Accidents, Traffic ; Coxa Vara ; Femur ; Follow-Up Studies ; Hip ; Hip Fractures ; Humans ; Leg

PURPOSE: Single or multiple fibrous dysplasia of the proximal femur can cause coxa vara, Shepherd's crook deformity and a leg length discrepancy for those patients who require surgical treatment. We wanted to evaluate the efficiency of surgical treating fibrous dysplasia of the proximal femur. MATERIALS AND METHODS: Among the patients who underwent surgical treatment at our hospital during the period of June, 2001 to October, 2007, we selected 18 patients who underwent curettage and bone graft or valgus osteotomy and internal fixation due to proximal femur involvement. The clinical results were analyzed based on the patients' clinical records and radiologic findings. RESULTS: The group of patients with a normal neck-shaft angle (Group 1) could achieve satisfactory results by undergoing curettage, bone graft and internal fixation. The other group of patients who progressed to Shepherd's crook deformity (Group 2) could have satisfactory results when they underwent valgus osteotomy and soft tissue release or both proximal femur shortening osteotomy and valgus osteotomy, but not with undergoing valgus osteotomy only. CONCLUSION: Varus deformity in patients with fibrous dysplasia may progress even though they undergo valgus osteotomy. It is important to consider the preoperative biomechanical condition of the proximal femur before performing surgery.
Congenital Abnormalities ; Coxa Vara ; Curettage ; Femur ; Humans ; Leg ; Osteotomy ; Transplants

PURPOSE: To report the preliminary clinical results for arthroscopic treatment of osseous abnormalities as a cause of femoroacetabular impingement (FAI). MATERIALS AND METHODS: We evaluated 26 patients diagnosed with FAI who were treated by arthroscopic debridement of the labrum, spur resection, and bump resection from March 2004 to March 2005. Osseous abnormalities of FAI were evaluated for the presence or absence of asphericity, pistol grip deformity, coxa vara, coxa valga, retroversion of the acetabulum, and protrusion of acetabulum were present or not. We evaluated the clinical manifestations based on patient satisfaction, sequential JOA pain scores and ranges of motion of the hips. RESULTS: 24 patients were satisfied postoperatively. The average JOA pain score preoperatively and postoperatively at 2 weeks, 6 weeks, 3 months, and 6 months, were 0.85, 0.71, 1.50, 1.71, and 1.86, respectively. At 2 weeks preoperatively, the clinical symptoms were aggravated and 6 months postoperatively, the clinical symptoms were improved. 11 patients could not take a cross-legged position preoperatively: but 10 of the 11 patients could take a cross-legged position postoperatively. CONCLUSION: Preliminary clinical results for arthroscopic treatment of osseous abnormalities were satisfactory. We need to perform a follow-up study of the clinical results about the early detection of which findings and decompression of which osseous abnormalities will prevent or delay the progression of osteoarthritis through mid and long-term follow up.
Acetabulum ; Congenital Abnormalities ; Coxa Valga ; Coxa Vara ; Debridement ; Decompression ; Femoracetabular Impingement* ; Follow-Up Studies ; Hand Strength ; Hip ; Humans ; Osteoarthritis ; Patient Satisfaction

Purpose: The purpose of this study was to evaluate the clinical and radiological results of total hip arthroplasty using a proximal modular femoral stem in patients who had secondary coxarthrosis associated with a deformed femur. Materials and Methods: Forty-two patients (45 hips) with secondary coxarthrosis were evaluated after primary total hip arthroplasty using an S-ROM proximal modular femoral stem, between January 2001 and March 2004. The average follow-up was 44 months (range, 24 to 60 months). The mean age of the patients was 48.5 years old and there was a predominance of female patients (65.5%). The preoperative diagnoses included 26 cases of developmental dysplasia of the hip, 13 cases of sequalae of LCP, 2 cases of epiphyseal dysplasia, 3 cases of sequalae of pyogenic arthritis, and 1 case of congenital coxa vara. Results: The average Harris hip score improved from 52.2 points to 85.5 points. All the femoral stems demosntrated stable fixation, which included 37 cases by bony ingrowth and 8 cases by stable fibrous ingrowth. Neither osteolysis nor progressive radiolucent lines around the femoral stems were found at the latest follow-up. Postoperative complications included: 2 cases of hip dislocations, 1 case of periprosthetic fracture, 1 case of infected cup loosening, and 1 case of sciatic nerve palsy. Overall, forty-one hips (91.9%) exhibited excellent or good clinical results at the most recent follow-up. Conclusion: For advanced secondary coxarthrosis, total hip arthroplasty with use of a proximal modular femoral stem yielded good mid-term results based on clinical and radiological criteria.
Arthritis ; Arthroplasty, Replacement, Hip* ; Coxa Vara ; Diagnosis ; Female ; Femur* ; Follow-Up Studies ; Hip Dislocation ; Hip* ; Humans ; Osteoarthritis, Hip* ; Osteolysis ; Periprosthetic Fractures ; Postoperative Complications ; Sciatic Neuropathy

PURPOSE: To determine the developmental patterns of 4 major deformities of femoral head commonly observed in Legg-Calve-Perthes disease (LCPD): coxa plana, coxa magna, coxa vara, subluxation. MATERIALS AND METHODS: We reviewed the clinical records and radiographs of 85 unilateral LCPD children who were followed up from the early stage of disease to full skeletal maturity. Four major deformities were measured and observed during 3 periods: the active disease stages of avascular necrosis and fragmentation, the healing stage, and skeletal maturity. RESULTS: All four deformities were first observed at early stages of the disease, avascular or fragmentation stage. Appearance rates were 79% in coxa plana, 28% in coxa magna, 35% in coxa vara, and 27% in subluxation. The gradual progression of deformities with time which was demonstrated at the healing stage and at skeletal maturity were observed in all except subluxation. And this gradual increase was supposed to be dependent on the normal bony growth with aging. CONCLUSION: We determined the developmental pattern of major deformities of the femoral head. And this determination will help to understand the natural course of deformity which is clinically important in terms of late osteoarthritis.
Aging ; Child ; Congenital Abnormalities* ; Coxa Vara ; Head* ; Hip ; Humans ; Legg-Calve-Perthes Disease* ; Necrosis ; Osteoarthritis

PURPOSE: To analyze complications and their effects on prognoses of children hip fractures. MATERIALS AND METHODS: 26 childhood hip fractures (6 type I, 7 type II, 10 type III, 3 type IV) were studied for 11 years (1986-1997) . We analyzed factors possibly related to complications and their effects on prognoses, especially avascular necrosis (AVN) of the femoral head. RESULTS: Of 26 patients, there were 7 AVN (27%) , 2 nonunions (8%) , 3 coxa vara (12%) , 9 premature epiphyseal closures (35%) , and 2 infections (8%) . Of 7 patients with AVN, 3 patients had type I fracture and 4 patients had type II fracture. No AVN developed in type III and IV fractures. Of 2 patients who had type I fracture with dislocation, all patients had AVN (100%) . Four of 14 patients who had displacement of the fracture site and one in 10 patients who had non-displacement fracture developed AVN. In our study of the incidence of AVN according to surgical reduction time after injury, 3 (60%) of 5 patients who were treated by surgical reduction within 6 hours and 4 (19%) out of 21 patients who were treated by surgical reduction after 6 hours developed AVN. CONCLUSION: In childhood hip fracture, surgical reduction time after trauma (<6 hours) did not seem to be a critical factor in preventing AVN. Force of injury and level of fracture site which jeopardize the blood supply to the femoral head were important factors. Age at time of injury was also important. Containment treatment of younger children (<10 years) and surgical treatment of older children (>10 years) were found to be an effective treatment of AVN. AVN concomitant with pyogenic infection had the worst prognosis.
Child* ; Containment of Biohazards ; Coxa Vara ; Dislocations ; Head ; Hip Fractures ; Hip* ; Humans ; Incidence ; Necrosis ; Prognosis