Coxa Valga dnbid

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Coxa Valga :

Coxa Valga D. N. Bid

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Fig. 1: AP Pelvis. Bilateral superior and lateral subluxation. Right greater than left. Note secondary hip dysplasia on right side.

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Introduction: Coxa valga is defined by an increase in the femoral neck-shaft angle, compared �to age-appropriate standards. � It is commonly present in patients with cerebral palsy and may lead to such complications as femoral head dislocation.

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Presentation: Coxa valga is generally noted in patients with known underlying neuromuscular or skeletal disease. � Commonly, Spasticity in the adductor muscles of the hip will overpower the hip abductors and extensors, leading to deformity. � They may have impaired ambulation and sitting balance secondary to bilateral adduction contractures or windswept deformities. � Decubitus ulcers and pain may also be present, secondary to the resultant positioning.

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Diagnostic Evaluation: The diagnosis of coxa valga depends on the measurement of the femoral neck-shaft angle on a true anterioposterior radiograph. � The angle is present between the midaxis of the femoral shaft and a line along the midaxis of the femoral head/neck. � Femoral anteversion (which is also commonly present in patients with cerebral palsy) and rotation may have projectional effects on the radiograph, causing the false appearance of coxa valga as well. � Therefore, one must take care to recognize the possible geometric distortions of the true angle when reading films. � Once subluxation occurs, medial/lateral flattening of the femoral head can be seen. � In dislocation, a pseudoacetabulum can be seen along the lateral margin of the ilium. � CT and MRI have also been suggested as imaging modalities. � However, slice orientation and thickness must be accounted for when calculating the degree of torsion.

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Differential Diagnosis: Neuromuscular disorders (i.e. cerebral palsy, spinal dysraphism, poliomyelitis); skeletal dysplasias; juvenile idiopathic arthritis

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Treatment/Course: Severe coxa valga may lead to lateral subluxation or dislocation of the femoral head. � Subluxation occurs superolaterally due to the forces of the spastic flexors and adductors of the hip. � Chronic subluxation /dislocation can result in acetabular dysplasia and secondary degenerative joint disease. � Non-surgical measures to prevent subluxation include physical therapy and exercises, aimed at stretching the spastic agonist muscles and strengthening the weaker antagonist muscles. � Orthotic devices and casting may also be employed to ensure better positioning. � Newer therapies to reduce spasticity in cerebral palsy include intrathecal baclofen and local injections of botulinum toxin. � Surgical therapies may also be required, including tenotomy, neurectomy/dorsal rhizotomy, and varus derotation osteotomy.

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