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Orthopaedics and Fractures
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
This is the most common major congenital lower limb deformity (1:20–30,000 live births) (Figs 21.37, 21.38). It is characterised by the following features, which highlight the fact that this is due to a ‘field defect’ during embryonic/fetal life: Absent or deficient lateral rays of the foot.Tarsal coalitions.Ball and socket ankle joint.Deficient or absent fibula.Short and angulated tibia (apex anterior bow to be distinguished from the less troublesome apex posterior bow).Absent/deficient knee ligaments.Deficient formation of the femoral lateral condyle.Short and externally rotated femur.Coxa vara and/or hip instability.
Femoral valgus osteotomies
Published in K. Mohan Iyer, Hip Preservation Techniques, 2019
Developmental coxa vara (also known as cervical or infantile coxa vara)4: Represents coxa vara not present at birth but rather developing in early childhood.Coxa vara is defined as any decrease in the femoral neck-shaft angle less than 120–135° (Figure 14.2).
Musculoskeletal trauma and soft tissue injuries
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Purudappa Prasad, Gleeson Rebello
Children 6 years of age or younger with type IV fractures can usually be treated with closed reduction and spica casting. Percutaneous internal fixation with pins or screws is an option for older children after a closed reduction or for younger children when the reduction cannot be maintained with a spica cast. However, for larger children or when closed reduction is not possible, open reduction and internal fixation is necessary. The goal is anatomical reduction that will help prevent coxa vara formation postoperatively.
Commentary on “Better Prognosis of Senile Patients with Intertrochanteric Femoral Fracture by Treatment with Open Reduction Internal Fixation than by Hip Arthroplasty”
Published in Journal of Investigative Surgery, 2018
Due to severe osteoporosis, premature loading, frailty and concomitant diseases, complications following internal fixation of IFFs, including coxa vara, implant breakage and nonunion, cutting-out, traumatic osteoarthritis and osteonecrosis, are commonly seen [6]. Even with anatomic reduction and rigid stabilization, immediately leaving bed and partially loading are not recommended. Additionally, some patients have degenerative hip diseases before intertrochanteric fractures. Therefore, hip arthroplasty emerges at the right moment to conquer the deficiency of internal fixation [7]. Can early loading and free ambulation exercise be achieved following hip arthroplasty due to intertrochanteric fractures?
Extra-articular hip impingement: clinical presentation, radiographic findings and surgical treatment outcomes
Published in The Physician and Sportsmedicine, 2019
Standard hip radiographs can be evaluated for risk factors for trochanteric impingement listed above, including coxa breva, coxa vara and trochanteric overgrowth for direct lateral impingement, or coxa valga with excessive femoral antetorsion for posterolateral impingement. Pertinent negative findings often include the absence of any traditional FAI radiographic findings, such as cam or pincer deformities. MRI or CT imaging can be helpful to evaluate for femoral anteversion and to rule out other causes of pain, such as ischiofemoral impingement, which may also be a concern with some of the anatomic risk factors listed above (i.e. coxa valga, increased anteversion).
Pharmacological resources, diagnostic approach and coordination of care in joint hypermobility-related disorders
Published in Expert Review of Clinical Pharmacology, 2018
Review of systems and stratification of reported complaints/issues by clinical-molecular phenotype is paramount for an evidence -based management of patients with JHRDs. In JHRDs, medical implications directly related to JH (point 1 manifestations) and primary involvement of the other systems/organs (point 2 manifestations) can be grouped in five domains: Musculoskeletal: recurrent/chronic arthralgias, neuropathic pain, widespread pain, clumsiness, abnormal motor development (children), muscle weakness, reduced transfer autonomy (adults and elders).Bone/orthopedic: multiple/recurrent/habitual dislocations, reduced bone mass/proneness to fractures, scoliosis, coxa vara/valga, flexible flatfoot, contractures, long bone deformities.Cardiovascular and respiratory: aortic root dilatation, cardiomyopathy, heart valve disease (both congenital and progressive), proneness to arterial ruptures/dissections, pulmonary emphysema, nocturnal upper airways obstruction.Skin/soft tissues/internal organs: skin fragility, delayed wound healing (comprising surgical complications), fragility/ruptures of internal organs.Craniofacial: specific eye anomalies (e.g. lens dislocation, vitreal and retinal features, myopia), occipitoatlantoaxial instability, Chiari malformation, temporomandibular joint dysfunction/disorder, deafness, retrognathia/malocclusion, gingival retractions/fragility.