Transcript Coxa Vara in a Patient of Osteopetrosis – Treated Successful by

Coxa Vara in a Patient of
Osteopetrosis – Treated Successful
by Valgus Subtrochanteric
Osteotomy
Sunit Hazra MS
Prof Hae Ryong Song MD PhD
Introduction
Osteopetrosis –
– Defect in osteoclastic resorption --sclerotic
bones
– Infantile malignant / adult benign ( type I,II)
– Autosomal recessive/ dominant
– Multiple transverse / short oblique fractures
Case description
A 7 year male
Adult benign Osteopetrosis
Coxa vara (R)ICNF # (2001)- CR&IF by
cannulated screws
LLD of 2.5 cm
Past H/O- subtrochanteric # L femur-- 2006
Treated by OR & IF
Fracture united
Coxa vara
Neck shaft angle-96’
Subtrochanteric valgus osteotomy
Follow up at 6 months post. op
Fracture union in progress
LLD  1cm shoe raise
Neck shaft angle 130°
Final Radiograph
• Neck Shaft angle: 122° (130 °)
• LLD: 3.6cm (1cm)
Discussion
Coxa vara – osteopetrosis
King and Lovejoy-- used a Bosworth spline to fix a
valgus osteotomy - "healing occurred normal rate,"
Kaibara et al -- proximal femoral osteotomy
Healing normal
Steinwender et al -- bilateral nonunited femoral neck
fractures and coxa vara-- Valgus osteotomies successful but technically difficult
Implant used
King and Lovejoy used a Bosworth spline
Steinwender et al. -- Internal fixation - Kwires for one hip and a blade-plate for the
other.
Plate and screw fixation was used by
Milgram and Jasty
Armstrong, D et al 1999 J Pediatr
Orthop. 1999
coxa vara -- valgus osteotomy, preferably
during childhood when the bone may be
more amenable to fixation.
Parents -- forewarned -- risks of delayed
union or nonunion
A period of bed rest or no weight bearing
may facilitate osteotomy and fixation
Do have potential to recur should
ordinarily require close follow-up for
several years.
Conclusion
Coxa vara in osteopetrosis should be
treated by valgus subtrochanteric
osteotomy – technically difficult– good
result.