Coxa valga dnbid

3,887 views
3,690 views

Published on

Lecture Presentation

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
3,887
On SlideShare
0
From Embeds
0
Number of Embeds
16
Actions
Shares
0
Downloads
126
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Coxa valga dnbid

  1. 1. Coxa Valga D. N. Bid
  2. 4. <ul><li>Fig. 1: AP Pelvis. Bilateral superior and lateral subluxation. Right greater than left. </li></ul><ul><li>Note secondary hip dysplasia on right side. </li></ul>
  3. 5. <ul><li>Introduction: Coxa valga is defined by an increase in the femoral neck-shaft angle, compared </li></ul><ul><ul><li>� to age-appropriate standards. </li></ul></ul><ul><ul><li>� It is commonly present in patients with cerebral palsy and may lead to such complications as femoral head dislocation. </li></ul></ul>
  4. 6. <ul><li>Presentation: Coxa valga is generally noted in patients with known underlying neuromuscular or skeletal disease. </li></ul><ul><ul><li>� Commonly, Spasticity in the adductor muscles of the hip will overpower the hip abductors and extensors, leading to deformity. </li></ul></ul><ul><ul><li>� They may have impaired ambulation and sitting balance secondary to bilateral adduction contractures or windswept deformities. </li></ul></ul><ul><ul><li>� Decubitus ulcers and pain may also be present, secondary to the resultant positioning. </li></ul></ul>
  5. 7. <ul><li>Diagnostic Evaluation: </li></ul><ul><li>The diagnosis of coxa valga depends on the measurement of the femoral neck-shaft angle on a true anterioposterior radiograph. </li></ul><ul><ul><li>� The angle is present between the midaxis of the femoral shaft and a line along the midaxis of the femoral head/neck. </li></ul></ul><ul><ul><li>� 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. </li></ul></ul><ul><ul><li>� Therefore, one must take care to recognize the possible geometric distortions of the true angle when reading films. </li></ul></ul><ul><ul><li>� Once subluxation occurs, medial/lateral flattening of the femoral head can be seen. </li></ul></ul><ul><ul><li>� In dislocation, a pseudoacetabulum can be seen along the lateral margin of the ilium. </li></ul></ul><ul><ul><li>� CT and MRI have also been suggested as imaging modalities. </li></ul></ul><ul><ul><li>� However, slice orientation and thickness must be accounted for when calculating the degree of torsion. </li></ul></ul>
  6. 8. <ul><li>Differential Diagnosis: </li></ul><ul><ul><li>Neuromuscular disorders (i.e. cerebral palsy, spinal dysraphism, poliomyelitis); </li></ul></ul><ul><ul><li>skeletal dysplasias; </li></ul></ul><ul><ul><li>juvenile idiopathic arthritis </li></ul></ul>
  7. 9. <ul><li>Treatment/Course: </li></ul><ul><li>Severe coxa valga may lead to lateral subluxation or dislocation of the femoral head. </li></ul><ul><li>� Subluxation occurs superolaterally due to the forces of the spastic flexors and adductors of the hip. </li></ul><ul><li>� Chronic subluxation /dislocation can result in acetabular dysplasia and secondary degenerative joint disease. </li></ul><ul><li>� Non-surgical measures to prevent subluxation include physical therapy and exercises, aimed at stretching the spastic agonist muscles and strengthening the weaker antagonist muscles. </li></ul><ul><li>� Orthotic devices and casting may also be employed to ensure better positioning. </li></ul><ul><li>� Newer therapies to reduce spasticity in cerebral palsy include intrathecal baclofen and local injections of botulinum toxin. </li></ul><ul><li>� Surgical therapies may also be required, including tenotomy, neurectomy/dorsal rhizotomy, and varus derotation osteotomy. </li></ul>
  8. 11. The End

×