Background Coxa vara is a radiological term describing a
decrease in the neck–shaft angle to 120 or less. Coxa vara
is associated with pathomechanical changes that can
manifest clinically. If left untreated, coxa vara can affect
the normal development of the pediatric hip. Valgus
osteotomy is the standard surgical treatment for coxa vara,
but there is no consensus regarding the optimal osteotomy
technique and fixation method. The work reported here
aimed to highlight transfixing wires as a fixation method
for valgus osteotomy applied as treatment for various types
of pediatric coxa vara.
Materials and methods This study included 16 cases of
pediatric coxa vara with different etiologies in 9 patients
with a mean age of 39.9 ± 15.2 months. Radiological and
clinical evaluations and scoring of the condition of each
patient according to the Iowa Hip Score were performed
pre- and postoperatively. Transfixing wires and a protective
spica were used for the fixation of a V-shaped, laterally
based, closing-wedge valgus osteotomy in all cases. The
postoperative follow-up period ranged from 14 to
102 months, with a mean duration of 33.3 ± 27.7 months.
Results The mean Hilgenreiner epiphyseal angle (HEA)
was corrected from 81.7 ± 2.2 to 24.3 ± 3.5 and the
mean femoral neck–shaft angle (FNSA) was improved
from 86.9 ± 4.2 to 138.6 ± 3.5. No recurrence of the
deformity was observed during the follow-up periods
considered here. The osteotomy site united after an average
of 11.7 ± 2.2 weeks with no secondary displacement, and
in cases of developmental coxa vara there was progressive
ossification of the neck defect with no surgery-related
complications. Clinical results were markedly improved by
the osteotomy, with a mean postoperative Iowa Hip Score
at last follow-up of 95.06 ± 2.6, compared to a mean
preoperative score of 57.4 ± 3.6.
Conclusions Transfixing wires protected in a hip spica cast
represent a simple, easy, and reliable fixation method for
valgus osteotomies performed to correct pediatic coxa vara.
It assures stable fixation and rapid healing of the osteotomy
without loss of the achieved correction, it completely
avoids the femoral neck affording marked protection to the
growth plate. |
