Results of Surgical Treatment of Coxa Vara in Children: Valgus Osteotomy with Angle Blade Plate Fixation
Chatupon Chotigavanichaya MD*, Duangjai Leeprakobboon MD*, Perajit Eamsobhana MD*, Kamolporn Kaewpornsawan MD*
Affiliation : * Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Coxa vara is a rare condition. Surgical correction of coxa vara has been challenging. A few reports present
correction coxa vara in multiple causes. In this retrospective study, the authors reported the results of surgical treatment of
coxa vara by valgus osteotomy with angle blade plate fixation in 11 children with 12 hips.
Material and Method: Since 2002-2011, 11 children with 12 hips with coxa vara were reviewed retrospectively by medical
chart and radiographic data after surgical treatment. All of them were operated by valgus osteotomy and fixation with angle
blade plate. All of them had been hip spica cast between 8-12 weeks after surgery. Neck-shaft angle, Hilgenreiner-epiphyseal
angle, leg-length discrepancy and Harris hip score were evaluated at preoperative, postoperative, and final follow-up.
Results : Twelve coxa vara; 4 malunion femeral neck fracture, 4 congenital coxa vara, 2 spondyloepiphyseal dysplasia and 1
multiple epiphyseal dysplasia were operated on in 11 patients. One spondyloepiphyseal dysplasia had bilateral coxa vara. The
average age at surgery was 9.5 years (range, 7-12 years). The average time of follow-up was 4.2 years (range, 3-7 years).
The average neck-shaft angle was changed significantly from 79.8 to 123.7 degrees, the Hilgenreiner-epiphyseal angle was
changed significantly from 70 to 39.3 degrees and leg-length discrepancy was changed significantly from 2.2 to 1.7 centimeters
at final follow-up. The average Harris Hip score was improved significantly from 68 at preoperative to 96 at final follow-up.
No complication or recurrence was found.
Conclusion : Surgical treatment of coxa vara is uncommon treatment. The aims of treatment were to change the stress in the
neck femur from shearing force to compression force and also improving shortening that could reduce incidence of further
fracture and osteoarthritis. The Hilgenreiner-epiphyseal angle should be closed to 38-40 degree or less after surgery.
Keywords : Coxa vara, Neck-shaft angle, Hilgenreiner-epiphyseal angle, Angle blade plates
