Slide 016 — Developmental coxa vara

Q1 What are the radiographic findings for Developmental coxa vara?

Bilateral coxa vara deformity

•Vertical physis: Increased HE angle (Hilgenreiner epiphyseal angle) (>25 abnormal)

•Decreased neck shaft ankle (<125 abnormal)

•Coxa breva

•Inverted Y shape lucency in inf femoral neck (fairbank triangle) → ossification defect

•Acetabulum and tear drop normal

•Developmental coxa vara (AD)

Q2 What are the differential diagnoses for Developmental coxa vara?

Acquired: Perthes, chronic SCFE, trauma, infection

•Dysplasia: MED, SED, OI

•Metabolic: Cretinism (abnormal mental and physical development resulting from a deficiency of thyroid hormone in fetal or early life) Congenital: PFFD

•Bilateral in 30-50%

Q3 What history should be elicited for Developmental coxa vara?

Previous hip trauma or infection

•Associated skeletal abnormalities

Q4 What examination findings should be assessed in Developmental coxa vara?

Trendelenburg gait

•LLD

•High riding GT

•Excessive lumbar lordosis

•Restrict hip ROM

Q5 How is Developmental coxa vara managed?

Observe

•VDRO (subtrochanteric <3 yo, intertroch >3yo) in HE > 60 , NSA <110

•CT preop – look for other associated deformities: coxa breva, femoral retroversion, acetabular dysplasia, GT overgrowth

•Goal: OVER correct NSA, correct LLD, correct version, restore abductor tension

Lateral approach

•Protect physis and periosteum

Aim HE <30

•Coxa vara = A decreased neck-shaft angle that is associated with an ossification defect in inferior femoral neck → vertical physis → increased shearing force

Q6 What operative steps, indications, and risks are listed for Lateral approach?

Protect physis and periosteum

Q7 What are the management aims for Developmental coxa vara?

•Coxa vara = A decreased neck-shaft angle that is associated with an ossification defect in inferior femoral neck → vertical physis → increased shearing force

#	lvl	marL	indent	logical	original note line
1	0	None	None	0	AP Xray pelvis of skeletally immature patient
2	0	None	None	0	Bilateral coxa vara deformity
3	0	0	0	0	Vertical physis: Increased HE angle (Hilgenreiner epiphyseal angle) (>25 abnormal)
4	0	None	None	0	Decreased neck shaft ankle (<125 abnormal)
5	0	None	None	0	Coxa breva
6	0	None	None	0	Inverted Y shape lucency in inf femoral neck (fairbank triangle) → ossification defect
7	0	None	None	0	Acetabulum and tear drop normal
8	0	None	None	0	Developmental coxa vara (AD)
9	0	None	None	0	Ddx
10	0	None	None	0	Acquired: Perthes, chronic SCFE, trauma, infection
11	0	None	None	0	Dysplasia: MED, SED, OI
12	0	None	None	0	Metabolic: Cretinism (abnormal mental and physical development resulting from a deficiency of thyroid hormone in fetal or early life) Congenital: PFFD
13	0	None	None	0	Bilateral in 30-50%
14	0	None	None	0	Hx:
15	0	None	None	0	Previous hip trauma or infection
16	0	None	None	0	Associated skeletal abnormalities
17	0	None	None	0	Perinatal history
18	0	None	None	0	FHx
19	0	None	None	0	PE:
20	0	None	None	0	Trendelenburg gait
21	0	None	None	0	LLD
22	0	None	None	0	High riding GT
23	0	None	None	0	Excessive lumbar lordosis
24	0	None	None	0	Restrict hip ROM
25	0	None	None	0	Mx:
26	0	None	None	0	Prognosis by HE angle
27	0	171450	-171450	1	<45 20% resolve
28	0	171450	-171450	1	45-60 uncertain
29	0	171450	-171450	1	>60 will progress
30	0	None	None	0	Treatment is
31	0	228600	-228600	1	Observe
32	0	228600	-228600	1	VDRO (subtrochanteric <3 yo, intertroch >3yo) in HE > 60 , NSA <110
33	1	457200	0	1	CT preop – look for other associated deformities: coxa breva, femoral retroversion, acetabular dysplasia, GT overgrowth
34	1	457200	0	1	Goal: OVER correct NSA, correct LLD, correct version, restore abductor tension
35	1	628650	-171450	2	Lateral approach
36	1	628650	-171450	2	Protect physis and periosteum
37	1	628650	-171450	2	Aim HE <30
38	0	0	0	0	Coxa vara = A decreased neck-shaft angle that is associated with an ossification defect in inferior femoral neck → vertical physis → increased shearing force

#	semantic level	section?	rewritten line
1	0	yes	AP Xray pelvis of skeletally immature patient
2	1		Bilateral coxa vara deformity
3	1		Vertical physis: Increased HE angle (Hilgenreiner epiphyseal angle) (>25 abnormal)
4	1		Decreased neck shaft ankle (<125 abnormal)
5	1		Coxa breva
6	1		Inverted Y shape lucency in inf femoral neck (fairbank triangle) → ossification defect
7	1		Acetabulum and tear drop normal
8	1		Developmental coxa vara (AD)
9	0	yes	Differential diagnosis
10	1		Acquired: Perthes, chronic SCFE, trauma, infection
11	1		Dysplasia: MED, SED, OI
12	1		Metabolic: Cretinism (abnormal mental and physical development resulting from a deficiency of thyroid hormone in fetal or early life) Congenital: PFFD
13	1		Bilateral in 30-50%
14	0	yes	History
15	1		Previous hip trauma or infection
16	1		Associated skeletal abnormalities
17	0	yes	Perinatal history
18	1		FHx
19	0	yes	Examination
20	1		Trendelenburg gait
21	1		LLD
22	1		High riding GT
23	1		Excessive lumbar lordosis
24	1		Restrict hip ROM
25	0	yes	Management
26	0	yes	Prognosis by HE angle
27	1		<45 20% resolve
28	1		45-60 uncertain
29	1		>60 will progress
30	0	yes	Treatment is
31	1		Observe
32	1		VDRO (subtrochanteric <3 yo, intertroch >3yo) in HE > 60 , NSA <110
33	1		CT preop – look for other associated deformities: coxa breva, femoral retroversion, acetabular dysplasia, GT overgrowth
34	1		Goal: OVER correct NSA, correct LLD, correct version, restore abductor tension
35	2	yes	Lateral approach
36	3		Protect physis and periosteum
37	2	yes	Aim HE <30
38	3		Coxa vara = A decreased neck-shaft angle that is associated with an ossification defect in inferior femoral neck → vertical physis → increased shearing force

016. Developmental coxa vara

Clean FRCS notes with inline figures

AP Xray pelvis of skeletally immature patient

Differential diagnosis

History

Perinatal history

Examination

Management

Prognosis by HE angle

Treatment is

Lateral approach

Aim HE <30

Direct Q&A

Bilateral coxa vara deformity

Acquired: Perthes, chronic SCFE, trauma, infection

Previous hip trauma or infection

Trendelenburg gait

Observe

Lateral approach

Aim HE <30

Protect physis and periosteum

Raw speaker-note hierarchy audit

Improved semantic hierarchy used for the study notes