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1.
J Pediatr Orthop ; 38(4): 193-201, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-27261966

RESUMEN

BACKGROUND: Congenital coxa vara (CCV) is a rare hip condition with few long-term studies. The purpose of this study was to assess clinical, radiographic, and functional outcomes after operative and nonoperative treatment of CCV, assess reliability of radiographic parameters, and investigate risk factors for recurrence after surgery. METHODS: Retrospective review was performed of all CCV patients treated at 1 institution from 1980 to 2010. In addition, patients were recalled for additional follow-up x-rays, modified Harris Hip Score (mHHS), and gait analysis. Radiographic measurements [neck-shaft angle (NSA), head-shaft angle (HSA), Hilgenreiner-epiphyseal angle (HEA), and femoral neck length (FNL)] were assessed for reliability using intraclass correlation coefficients. Multivariate analysis was performed to identify risk factors for recurrence after surgery. RESULTS: Forty-six hips in 32 patients were reviewed. Mean age at presentation was 5.4±4.9 years. Mean follow-up was 11.8±5.8 years. Valgus proximal femoral osteotomy was performed in 27 hips (20 patients). Initial deformity was greater in the operative group (NSA 90±17 degrees, HEA 68±19 degrees) versus nonoperative patients (NSA 122±19 degrees, HEA 34±14 degrees) (P<0.0001), but radiographic outcomes were similar at follow-up. Most nonoperative hips had normal FNL growth rates (80%), but resolution of varus NSA occurred in only 21%. In contrast, 56% of operative hips showed decreased FNL growth rates. Interobserver reliability was excellent for HEA (0.98), NSA (0.90), and FNL (0.89), and good for HSA (0.79). Repeat osteotomy was performed in 6 cases (22%). No significant predictors for recurrence were identified. At long-term follow-up for recalled patients, 72% had significantly abnormal gait, and 50% had fair-poor functional outcomes (mHHS<79). CONCLUSIONS: Valgus osteotomy corrects severe deformity in CCV with improved clinical and radiographic outcomes. HEA and NSA are the most reliable radiographic measurements of proximal femoral deformity in CCV. Recurrence is not uncommon, but no predictors were identified. Many patients have persistent gait abnormalities and functional impairment at long-term follow-up, regardless of prior treatment. LEVEL OF EVIDENCE: Level III-retrospective cohort.


Asunto(s)
Coxa Vara/terapia , Cuello Femoral/cirugía , Articulación de la Cadera/cirugía , Osteotomía/estadística & datos numéricos , Adolescente , Niño , Preescolar , Coxa Vara/congénito , Coxa Vara/diagnóstico por imagen , Epífisis/diagnóstico por imagen , Epífisis/patología , Femenino , Cuello Femoral/patología , Estudios de Seguimiento , Articulación de la Cadera/anomalías , Humanos , Lactante , Masculino , Osteotomía/efectos adversos , Radiografía , Recurrencia , Estudios Retrospectivos
2.
J Pediatr Orthop B ; 24(6): 511-4, 2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-26110218

RESUMEN

Slipped capital femoral epiphysis in patients younger than 10 years is rare and is often associated with some identifiable metabolic or endocrinologic abnormality. We present a case of a 5-year-old girl with an acute, unstable, severe slipped capital femoral epiphysis associated with congenital coxa vara and its surgical management. This association has not been described in previous literature. Surgical treatment is proposed and described.


Asunto(s)
Coxa Vara/congénito , Epífisis Desprendida de Cabeza Femoral/etiología , Enfermedad Aguda , Preescolar , Coxa Vara/complicaciones , Coxa Vara/diagnóstico por imagen , Femenino , Humanos , Procedimientos Ortopédicos/métodos , Radiografía , Epífisis Desprendida de Cabeza Femoral/diagnóstico , Epífisis Desprendida de Cabeza Femoral/cirugía
3.
Turk J Pediatr ; 56(6): 684-6, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-26388606

RESUMEN

Camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome is a rare autosomal recessive congenital disorder that includes childhood-onset camptodactyly, synovial hyperplasia-related arthropathy, progressive coxa vara deformity and noninflammatory pericarditis. A seven-year-old male patient had a diagnosis of CACP. He had pericardial effusion and underwent surgical tube drainage. CACP syndrome is seen very rarely, and differential diagnosis is very important. CACP is usually treated medically, but surgery may sometimes be preferred, as in our patient.


Asunto(s)
Coxa Vara/congénito , Deformidades Congénitas de la Mano/diagnóstico , Artropatías/congénito , Pericarditis/congénito , Niño , Humanos , Masculino , Síndrome
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