Adolescent coxa vara

995 views

Published on

0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
995
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
66
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

Adolescent coxa vara

  1. 1.  It is also known as Slipped Capital Femoral Epiphysis  Or Epiphysiolysis  It is displacement of the proximal femoral epiphysis
  2. 2. •10 – 16 yrs •Boys •Obese or tall & thin •Blacks •Left > Right
  3. 3.  Local trauma  Obesity  Endocrine disease (hypothyroidism, hypopituitarism, chronic renal disease)  Genetic
  4. 4. H/O Injury Pain in groin thigh or knee Limp
  5. 5.  Leg is externally rotated  1-2cm short  Limitation of flexion, abduction and internal rotation  Classic Sign – there is increasing external rotation as the hip is flexed
  6. 6. RADIOLOGICAL FEATURES
  7. 7.  In AP view-Normal head-shaft angle is 1450  In Lateral view-Normal head-shaft angle is 1700  Lateral view – most reliable sign – femoral epiphysis is tilted backwards
  8. 8. AP view – a line drawn on the superior surface of the neck remains superior to the head instead of passing through it (TRETHOWAN’S SIGN)
  9. 9.  It is helpful to confirm the diagnosis in early, mild slipping X ray- Trethowan’s Sign positive
  10. 10. A. Acute slips – sudden onset of severe symptoms, <2 weeks, Xray shows no evidence of bone healing B. Chronic slips – gradual onset, >2 weeks, Xray shows some bony healing and remodelling along postr. and med. femoral neck C. Preslip – Xray finding of irregularity, widening and indistinctness of physis
  11. 11. D . Acute on Chronic – symptoms >1 month, recent exacerbation of pain following trivial trauma
  12. 12.  MILD (GRADE I) - Neck displaced <1/3rd of diameter of femoral head, angle deviation <300  MODERATE (GRADE II) – Displacement btw 1/3rd and 1/2, angle deviation btw 300 and 600  SEVERE (GRADE III) – Displacement >1/2, angle deviation more than 600.
  13. 13.  UNSTABLE – Severe pain prevents walking even with crutches  STABLE – Walking is possible with orwithout crutches
  14. 14.  Preserve epiphyseal blood supply  Stabilize the physis  To correct any residual deformity
  15. 15.  Traction and spica cast immobilisation  Prevents further slipping  Results in premature physeal closure  More complications
  16. 16.  Deformity is minimal  Insert one or two screws or threaded pins along the femoral neck and into the epiphysis  Now recommended – single larger diameter central pin or screw  Pins should not be removed for atleast 12 months or until epiphysis closes
  17. 17.  Fix epiphysis in situ – short threaded pins  After 1 year, if deformity present, corrective osteotomy done  Alternatively bone graft epiphyseodesis  Trim anterosuperior metaphysis to prevent impingement
  18. 18.  Open reduction by Dunn’s Method – small segment of femoral neck is removed to reposition the epiphysis, once reduced it is held by 2 or 3 pins.  Alternatively, fix epiphysis followed by compensatory intertrochanteric osteotomy 1. Tri plane osteotomy 2. Geometric flexion osteotomy
  19. 19.  It is done for contralateral slips  Indicated in rare instances  High risk  Non compliant patients  Patients with epiphysiolysis from renal failure or irradiation therapy
  20. 20.  Done in severe acute unstable slips  Technically difficult or impossible to pin in situ  Earlier- Internal rotation alone  Gradual reduction by skin traction and internal rotation over 3-4 days  Avascular necrosis more
  21. 21.  Dunn’s in severe acute or chronic slip  Heyman – Herndon epiphysiodesis procedure in moderate slips
  22. 22.  Done by using hollow mill to create tunnel across physis, sandwiched iliac bone grafts driven across the physis  More complications than in situ pinning  Disadvantages-graft insufficiency, longer operating time,increase blood loss
  23. 23. A CLOSING WEDGE OSTEOTOMY-through femoral neck • Cuneiform Osteotomy femoral neck (Fish) • Cuneiform Osteotomy femoral neck (Dunn) • Compensatory Basilar Osteotomy of femoral neck • Extracapsular Base-of-neck osteotomy
  24. 24. B. Compensatory osteotomy Intertrochanteric osteotomy C. Cheilectomy resection of the part impinging against acetabulum
  25. 25. More common in-  Unstable (acute) slips  Forceful repetitive manipulation  Open reduction  Osteotomy of femoral neck  Superolateral placement of pins
  26. 26.  More common in-  Pin penetration into joint  Trochanteric osteotomy,  open reduction,  femoral neck osteotomy  Closed reduction and pin fixation
  27. 27.  Joint space <3mm wide and decreased range of motion of hip joint  Fibrous ankylosis follows  Treatment- intraarticular cortisone injecton surgical manipulation
  28. 28.  Thermal injury caused by reaming of femoral neck before screw insertion.  Prevention- avoid unnecessary drilling, pins removed after physeal fusion
  29. 29.  Head slips backwards-femoral neck retroversion  Secondary effects a. External rotation deformity of hip b. Shortening of femur c. Secondary osteoarthritis
  30. 30.  If not treated  Screws not placed proximally enough  Removed before complete fusion of physis

×