Cervical deformation of the neck of the femoral bone. Congenital dislocation of hips. Hip deformations vius thigh treatment treatment

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An analysis of the treatment of 47 children withcongenital breast deformation (VDSHBK), which was treated in rhini them. G.I. Turner and RSDCRC from 1975 to 2005. The age of patients was from 1 month to 19 years, boys were 14, girls - 33. Right-sided localization was observed in 31, left-sided - in 14, two-sided was marked in 2 patients.

The pathological symptom complex included the shortening of the limb from 3 to 25 cm, the external rotational, leading or flexible contracture in the hip joint. The radiological manifestations of the congenital varetle deformation of the neck of the femoral bone were characterized by a violation of the spatial position and the pathological state of the structure of bone tissue of the proximal end of the femoral bone. The cervical deformation of the femur (SCBC) was from up to 30 °. The state of the bone structure was to delay the ossification of the neck and head of the femoral bone, the cervix dystrophy of varying degrees against the background of its dysplasia, intersective false joint, and alsofear cervical defect. Based on the studies, a classification of congenital breeding of the femur neck, taking into account the magnitude of the shode, the state of the bone structure and shortening value: 1st degree of gravity: shode 90-110 °, delay of osxification or cervical dystrophy 1-2 degrees, shortening thighs up to 30%; 2nd degree of gravity: the shine of less than 90 °, the cerviff dystrophy 2-3 degrees or a false joint in the frequency region, the shortening of the hip is 35-45%; 3rd degree: The shode is less than 70 °, the cervix defect of the femoral bone, the shortening of the thigh by more than 45%.

The above classification of the congenital varestic deformation of the neck of the femoral bone served as the basis for the development of indications, firstly, the method of treatment (conservative or operational), and secondly, to the choice of a particular method of surgical intervention.

An indication of the conservative treatment was the degree of severity of congenital varetle deformation of the neck of the femoral bone in children under 3 years of age. Conservative treatment was to create a favorable position of the head of the femoral bone in the hip joint with the help of a fary cushion, Mirzoyeva tires, and in children older than a year - in carrying an orthopedic apparatus with a landing for a sedlicated hill (like Thomasa). Massage was carried out and physical animation aimed at improving blood supply in the hip joint. The testimony for the surgical treatment method was II and III degree of gravity of congenital breeding cervical deformation of the femoral bone, as well as the degree in children over the age of 2-3 years old at the magnitude of the shield less than 110 °.

1 The degree of congenital varetle deformation of the neck of the femur with signs of the cervix dystrophy and the shode less than 110 ° was an indication for the operation on the method developed by us. The basis of the operation was the transposition of the fragment of the femoral bone of the trapezoidal form with a small spit under the dystrophy of the neck of the femoral bone and the simultaneous correction of the shield. II-III The severity of the congenital varetle deformation of the neck of the femoral bone was indicated to the early surgical treatment, which was aimed at eliminating the vicious installation of the thigh and was in operations on the soft tissues surrounding the hip joint. The second severity of the congenital breeding strain of the neck of the femoral bone in children over 2-3 years old was a testimony for the correction of the spatial position of the proximal femoral bone department for the methodology developed by us (patent for the invention No. 2183103). The basis of the operation was the interstate deictioning and valgizing osteotomy of the femoral bone, accompanied by the myotomy leading, lumbosy-iliac, straight and tailoring muscles, cutting off the fibrous tightness of the front portion of the middle jagged muscle and disseminate the wide fascia of the hip in the transverse direction. III The degree of severity of the lesion (cervical defect) in children over 6 years old was a testimony for osteosynthesis of the head and the proximal end of the femur using (for the cervical plastic) of the tissue musculoskeletal complex on the supply vascular leg with the fragments of the knitting or screws.

The absence of the head, a pronounced leading contracture in the hip joint in children over 12 years of age and adolescents, was the basis for the reconstructive operation at the proximal department of the femoral bone with the formation of an additional point of the thigh support in the pelvis.

According to the proposed surgical methods, 39 children were operated on, 8 patients received only conservative treatment. When applying the tactics developed by us, the treatment of children with congenital vius deformation of the femoral bone, good and satisfactory functional results were obtained in 93.6%.


Vorobev S.M., Pozdeev A.P., Tikhomirov S.L.
Republican specialized children's clinical orthopedo-neurological rehabilitation center, Vladimir, Rnidoi them. G. I. Turner, St. Petersburg

Ticket 36:

1 ) Fractures of the fractures of hips and tibia: classification, diagnosis, treatment. There are fractures of one of the summers and both of the femoral bone syslots (intermatic Y- and T - shaped). Isolated fractures of the mysteries usually occur with a sharp deviation of the shin knutrice (fracture of the inner satellite) or the dust (fracture of the outdoor math). Fractures of both mysteries often occur as a result of falling from a high height on the straightened leg. Clinic. With an isolated FRONE Outdoor Matcher with a displacement of fragments, a valgus deviation of the leg (Genu Valgum) occurs, with a fracture of an internal displacement with a displacement - the genu varum). When fractures of both mysteries with displacement, anatomical shortening of the limb may be detected. In addition, the joint is sharply increased in the amount due to hemarrosis, the limb occupies a forced position: the foot is slightly bent in the knee and hip joints. Active and passive movements in the knee joint are sharply painful. When palpation is an increase in pain and a symptom of a patella. For fractures of this localization, the following clinical symptoms are characteristic: Knee pain and the lower part of the hip, increasing when feeling and pressure on the sideways. Vius or valgus deformation knee joint. Hip circity in the field of Myshlekov enharged.Contours Knee Sustava smoothed.Fluctuation In the knee joint ( gemarthrosis).Charlotting of the patella.Passive movement In the knee joint possible but painful.Sometimes You can determine bone crunch. Diagnosis is specified by radiographs produced in two projections. Treatment. Fractures of the distal femoral bone without displacement of fragments are treated by immobilization with a gypsum bandage (3-5 weeks) or by I. R. Voronovich: Apply side compression osteosynthesis with knitting vessels with stubborn sites. This method allows you to fulfill all 4 principle treatment of intra-articular damage: Perfect reposit The fracture (with accuracy to 2 mm., Since only with such a shift of the joint surfaces is possible to regenerate the hyaline cartilage). Reliable fixation Frances for the entire consolidation period. Early function (For the full function of cartilage and its metabolic processes). on damaged joints. Fixations are carried out puncture of the knee joint In order to evacuate the blood and administration to the joint of 20-30 ml, 1% of the novocaine solution. During the first 7-10 days after the injury, the need for repeated punctures of the joint and evacuation of blood often arises, which is one of the ways of preventing post-traumatic arthrosis. The local infiltration anesthesia is carried out by the Kirschner's knocker through the tibia jergis, the superior area or through the heel bone and impose pullout.Cargo at a fracture without a displacement of 2-4 kg, with a displacement - 4-8 kg. The term of stretching b weeks, the head of the head is fixed Circular gypsum bandageup to groin for a period of 6 weeks. After removing the dressing, proceeding with restorative treatment: baths, paraffin, massage, leafc, mehanotherapy. Restorationdisability during fractures without displacement of fragments after 3-3.5 months; When bothering fragments - in 5-6 months. Operational treatment:showing when closed by bone fragments are not compared. Bone fragments are exposed, they will repure and fix them either with a plate or 1-2 metal rods. The operated leg is fixed with a gypsum bandage before the formation of bone corn. Then proceed to restorative treatment. Operational intervention allows you to more accurately repure fragments, to carry out their solid fixation and, thanks to this, before starting functional treatment (2-3 weeks from the date of operation). The full load on the damaged limb is allowed not earlier than after 3.5-4.5 months. Fractures of the main bone syslots. The fractures of the TBLICE mysteries are intra-articular damage and occur most often when falling on straight legs or when the shin is deviated to the dust or knutrice. There are fractures of the outdoor mystery, internal mumout, as well as T- and U-shaped fractures of both mysteries. Fractures of the mysteries can be impressive and by type of twisting. They may be accompanied by damage to the meniscoves, the ligament apparatus of the knee joint, the interomal interim elevation of the tibia, fractures of the head of the mulberry bone, etc. Clinical picture Under the fractures of the tibia mysteries corresponds to intra-articular damage: the joint is increased in the volume, the leg is slightly bent, hemarthrosis is detected along the symptoms of the patella. The shin is deflected by the dudder during the fracture of the outer math or knutrice at the fracture of the inner satellite. The transverse size of the tibia in the field of the sumpers is increased in comparison with a healthy foot, especially with T- and U-shaped fractures. When palpation of the fracture region is sharply painful. Characteristic side mobility in the knee joint with a dispersed leg. Active movements in the joint are absent, passive movements cause sharp pain. You can't raise the straightened foot. Sometimes damage to the outdoor math is accompanied by a fracture of the head or cervical cervix. At the same time, a small-terror nerve may be damaged, which is recognized on the impaired sensitivity, as well as motor disorders of the foot. Radiographic research allows you to clarify the diagnosis and identify the features of the fracture. Treatment. In the fractures of the tights of the tibia, without displacement, the joint is produced to aspirate the blood and the introduction of 20-40 ml of 1% of the novel solution. The damaged limb is fixed with circular gypsum bandage. From the 2nd day, exercises are recommended for the four-headed muscles of the thigh. Walking with the help of crutches without load on the sore leg is allowed in a week. Gypsum bandage is removed after 6 weeks. To load the leg is allowed 4-4.5 months after the fracture. With an early load, impression of a damaged math can occur. With a fracture, the displacement is used both conservative and operational treatment. In some cases, permanent skeletal extract can be used for fractures with displacement, especially in case of condiscular, T and V-shaped fractures. At the same time, the finiteness of the patient is laid on the Beller tire, the needle is carried out through the heel bone, the cargo along the tibony axis is 4-5 kg. The duration of treatment with this method is 4-5 weeks, after which the limb is fixed with a passive gypsum bandage. Further treatment is the same as when the fracture of the mysteries without displacement of fragments. The physiological method with good results of treatment suggested I. R. Voronovich. Operational treatment is shown in unsuccessful conservative treatment. The operation is produced on 4-5 days after injury: open reposition of fracture and osteosynthesis with metal structures. The seams are removed by 12-14 days, and further maintaining a patient, as in the fractures of the sumpers without displacement.

2) Conservative treatment of osteoarthrosis of large joints. Methods of the department. Patients with deforming arthrosis It is necessary to observe a certain motor mode aimed at unloading the patient joint. They should avoid long walking, long standing on the legs or stay in one position should not be severity. With pronounced pain syndrome, during walking, you need to use the cane or walk with crutches. For the unloading of the sore joint, even at home, it is necessary to use bidding with a load on the axis of the foot 2-3kg. With sharp pains that are not passing from the above measures, it is possible to apply the fixation of the joint gypsum bandage for 2-4 weeks, but at the same time the movements are even more limited, and the contractures are exacerbated. The purpose of the conservative treatment of arthrosis - Restoration of blood circulation in the tissues of the sore joint. Therapy should be complex and include not only medication treatment, but also physiotherapeutic, sanatorium-resort. The described conservative treatment should be comprehensive and comply with the stage of development of the disease. Means of microcircular exposure Used to restore the microcirculation system. For this purpose, various funds are used, the pharmachenise of which is not They are appointed in the first stage of the disease in patients without sinovitia phenomena within 3 weeks. In the development of inflammation in the tissues of the joint, it is better to use funds that inactivate the kinine system - conflict, zalvan, trasilol, etc.

It is to change the cervic and diaphysic corner. This angle is formed from the intersection of the axes of the diaphysis and neck of the thigh.

In the vius deformation of the hip neck, the cervical-diaphysicular angle is less than average (120-130 °) and often turns out to be sharp.

The reasons for the breast deformation of the neck of the thigh are diverse. It is distinguished by congenital, children's or dystrophic, youthful, traumatic and richite deformations. In addition, the viil curvature of the hip neck is observed in systemic diseases: fibrous osteodysisplasia, pathological incidence of bones, dischondroplasia. The deformation may be a consequence of operational interventions in the neck of the hip or any pathological bones in this area (the consequences of osteomyelitis, tuberculosis, subcorticate osteochondropathy, etc.).

An innate virus deformation of the hip neck is more likely to be bilateral, and then the disease is detected with the start of the child's walking on a characteristic "duck" gait, which often suggests the congenital dislocation of the thigh. In addition, during the inspection there is a limitation of leg breeding and high standing of large spit. X-ray study makes it possible to diagnose the disease - often the deformation of the hip neck is combined with other congenital defects: shortening the limb, violation of the shape of other joints.

Children's virus deformation of the hip neck is more likely one-sided and is associated with dystrophic processes as a result of trophic disorders and is accompanied by a restructuring of bone tissue according to the type of aseptic necrosis. The disease begins at the age of 3-5 years, under the influence of the load deformation of the hip neck progresses. The clinically disease is manifested by chromota, pain, especially after a long walk, running. The affected limb can be shorter and thinner, the disgrace of the thigh is limited. The large spit is located above the Rozere-Nelaton line, a positive symptom of Trendelen-Burg is noted. In other words, clinical manifestations are largely identical to the congenital dislocation of the thigh. However, there will be no such symptoms inherent to dislocation as the displacement of the hip along the longitudinal axis (symptom of Dupyutrena), the symptom of an unproken pulse at a pressure of the femoral artery in the Skarpovsky triangle, etc.

At the beginning of the disease, the treatment is conservative: unloading limb with a load of 1.5-2 kg, physiotherapy, drug therapy to improve metabolic processes and a lining therapy. Due to the duration of the disease and the need to unload the limb of children should be directed to integrated treatment in children's bone sanatoriums. In Samara, this is the Sanatorium "Volzhsky Dawns". With the derived processes of the restructuring and the remaining brewing deformation of the neck, the hip is recommended for the operational correction of the seed-diaphysicular angle, which will extend the shortened limb, restore the congruence of the joint surfaces in the hip joint, and therefore will warn the development of deforming coxarrosis.

Often, the hip cervical strain is a consequence of youth epiphysiolization (slaughtering the head of the femoral bone), which occurs in girls aged 11-14 years, in the boys in 12-16 years. In 30% of observations, pathology is two-way. The beginning of the development of the disease falls on the period of the most intensive growth, precedes sexual maturation, i.e. corresponds to the transition age when there is a general restructuring of the body and individual sections of the skeleton become especially vulnerable. Therefore, in the ethiology of youth epiphysolysis of the head of the femur, hormonal violations are of great importance. In some patients, the features of infancelism are pronounced (there are no secondary sexual signs, the girls have a latency of the menstrual cycle), delay the osenation of epiphyseal sprout areas than the high growth in a number of patients is explained. Often there are signs of obesity in the type of adiposogenital dystrophy. In 20-25%, youth epiphysiolysis of the femoral head develops in children with the lack of visible endocrine disorders.

The essence of the disease is that as a result of a number of reasons in the field of proximal sprouting zone of the femoral bone, it develops a pathological restructuring of bone tissue, its softening and loosening. Under the influence of the pelviotro-chicken muscles and the physical load of the neck of the femoral bone mixes the klesed, upstairs and the duck, and the head slides the stop, book and knutrice.

Valgus deformation of hip joints is extremely rare and most often this disease is found in children with a planned examination at an orthopedic, conducting an additional x-ray study. Boys and girls are equally. In 1/3 of patients, this congenital bilateral defect.

The cause of the occurrence is considered partial damage to the lateral part of the epiphyseal cartilage under the head, as well as damage to the apophysis of a large spit. The hughus deformation of the femoral neck (COXA VALGA) often occurs in the process of the growth of the child due to the untreneable dysplasia of the hip joints.

At the birth of a child, the head with the neck of the femoral bone is in the physiological Valgus and deployed back, gradually during the growth of the child, as a result of physiological torsion (reversal), the ratios are changing, and in an adult, a cervic-diaphysarial angle is 127 °, and annexia angle - 8-10 °. With the above disorders in epiphysery cartilage in the process of growth, this physiological process is violated, which causes the occurrence of COXA VALGA.

In addition, the Valgus deformation is "symptomatic":

• with the predominance of muscle-adductors (leading) hips;
• in Little's disease;
• after polio;
• with progressive muscle dystrophy;
• and also with tumors and exacts that violate the normal growth of epiphyseal cartilage.

Very rarely racking deformations occur after rickets, improper treatment of the fracture of the femoral bone and the untreneable hip dysplasia.

The main in the diagnosis of COXA VALGA is a x-ray examination, which is necessarily carried out with internal rotation (rotation) of the limb, since the lateral rotation of the thigh on the radiograph always increases the angle of the valgus cervix deviation.

Clinic

Clinically Valgus deformation can not be displayed when bilateral defeat, that is, there are no symptoms. While one-sided defeat can cause functional extensions of the limb, resulting in a gait, chromoty one leg.

Walgus hip cervical is clinically difficult to detect, since the function of the hip joint is saved.

As a rule, there are conservative treatment in people with minor Valgus deformation. Personal deformations with the growth of the child are self-correcting, which is also observed with the proper treatment of children about the displays of the hip joints, when well-centered (fixed) head in the swivelty depression.

Also conservatively treat children with COXA VALGA, which occurred during the defeat of the sprout cartilage. Since the process has a long course, comprehensive treatment is carried out by courses.

Cervical Deformation of the Feed Bone (Coxa Vara)

cOXA VARA called "COXA VARA" understand the deformation of the proximal end of the femur, when the cervic-diaphylastic angle is reduced, sometimes to straight, with simultaneous shortening of the neck.

The varestic deformation of the proximal end of the femoral bone in children and adolescents is 5-9% of all diseases of the hip joint.

The cervical deformations of the femoral neck are congenital and acquired.

Diagnostics

X-ray at the birth of a child is not visible cartilage swivels and femur heads. Only in 5-6 months the secondary ossification of the heads of the heads appears. In the process of the growth of the child, these kernels are increasingly omitted and the neck of the femur grows in length. This process is interconnected with epiphyseal cartilage spit, which are also gradually being used.

Between the fifth and eighth years of life, the proximal end of the femoral bone is fully formed. The shak-diaphysicular angle, which at birth is 150 °, becomes less and equal to 142 °. Also, the retrovers of the cervix due to the torsion during growth goes to the Ansivia (location to the forefront). These physiological changes pass slowly until the end of human growth.

Congenital disorders of the ossification of the neck of the femoral bone are due to the wrong arrangement of the epiphyseal (articular) cartilage, while normal it is located more horizontally and perpendicular to the axis of the cervix and the direction of its load. This causes the cervical strain and its slow growth in length.

Sometimes congenital vius deformation of the neck can be combined:

• with hypoplasia (underdevelopment) of the femoral bone;
• with a disadvantage of the proximal end of the femoral bone;
• with multiple epiphyseal dysplasia.

The third group may have the acquired shape of the cervical deformation:

• post-traumatic at an early age;
• due to the suffered Rahita;
• combine with perthes disease;
• after the congenital dislocation of the femoral bone or the displays of the hip joint.

There is another group of patients with isolated cervical strain, in which there is no combination of congenital defects, injuries or metabolic disorders that would explain deficiency in a neck or violation in the growth of cartilage. These patients do not see the shortening of the limb at birth, so the diagnosis is put only when the weight of the child's body increases and the endurance of the neck is reduced. It happens more often when the child begins to walk.

There are still several classifications of the cervical deformation of the femoral bone. For example, radiologically distinguish between four types of deformations:

• congenital isolated varestic deformation (COXA VARA Congenita);
• children's deformation (Coxa Vara Infantilis);
• junior deformation (Coxa Vara Adolescentium);
• symptomatic deformation (COXA VARA SUMPOMATICA).

(COXA VARA Congenita) without any combination with other skeleton diseases today is recognized by everyone. It happens extremely rarely and detected immediately at birth, since the shortening of the hip and the high standing of a big spit is seen. Sometimes in such cases it is possible to suspect congenital dislocation of the thigh, so the diagnosis of additional surveys is checked.

When inspection, the shortening of the lower limb is detected by the thigh. Large spit is palpable above the opposite. The thigh is reference, since the head of the femoral bone is in the swivelty depression.

When a child begins to walk, a chromoty appears. Then you can reveal a positive symptom of Trendelenburg. In one-biennial child, X-ray detects typical signs of congenital varetle deformation of the neck of the femoral bone, which is bent down to a direct angle and somewhat shorter. Epiphyseal cartilage is almost vertically, and the head of the femoral bone is sometimes enlarged, deployed and tilted down, but is in the spindle. The spindle varietia is small and flat when the ceride-diaphylastic angle is less than 110 °. When this angle is corrected to 140 ° and more, then the catch is developing normally. A large spit is above the level of the neck and is somewhat inclined medially, and its size increases during the progression of cervical deformation.

Infantile Varetle Deformation of the Feed Bone (Coxa Vara Infantilis) in children arises in three to five years. Parents turn to the doctor due to the fact that the child began to lame on foot and throws away when walking, although the pain in the leg is not experiencing. From the anamnesis it is mostly known that the child was born a normal and leg before it was healthy.

Timely appeal to the orthopedic doctor to install the diagnosis and the beginning of treatment significantly reduce the periods of recovery. The treatment is carried out conservative, in very rare cases, a surgical operation is assigned. If not to be treated, a person over time will be a "duck gait" with rolling on one side to another, which affects the reduction of ability to work and fatigue. Therefore, treatment should be started from childhood.

/ Q65-Q79 congenital anomalies of malformations of development and deformation of the musculoskeletal system / Q68 other congenital bone-muscular deformations

Congenital breast cervical strain

Congenital varetle deformation of the neck of the femur (Coxa Vara Congenita) is a symptom complex of development anomalies. The main manifestations of pathology are the routine deformation of the neck of the femoral bone, shortening the lower limb, the contracture of the hip joint, as well as the dysplasia and dystopia of the muscles of the affected limb of various degrees of severity.

Epidemiology

Congenital varetle deformation of the femoral neck - the rare pathology of the musculoskeletal system is 0.3-0.8% of all the defects of the skeleton development, not exceeding one case by 52,000 newborns.

Etiology, pathogenesis

The main reasons for the development of the disease are disturbed by the disorders of the enchondral ossification of the proximal metaeping of the femoral bone and the formation of the pelvic belt muscles in the embryonic period, anomalies of the development of the vascular bed, as well as the changes in the spinal cord in the type of myelodysplasia, manifesting neurodistrophic disorders of bone and soft tissues.

Clinical picture and diagnostics

The characteristic clinical manifestations of the congenital varestic deformation of the neck of the femur - shortening the lower limb, mainly due to the femur segment, the contracture of the hip joint, the hypotrophy of the soft tissues of the hip and the legs.

The shortening of the lower limb on the side of the defeat, even the babies can achieve a significant amount. Attention is drawn from the X-ray signs. As well as the inconsistency of the size of the proximal and distal departments of the shortened femoral bone.

A significant role in the diagnosis of these pathology is distinguished by ultrasonography (ultrasound), which allows to determine the shape, size of the head and neck of the femur, their spatial position, the presence or absence of their connection between themselves, as well as the density of bone and cartilage tissues of these anatomical formations.

Treatment

Treatment of children with congenital vius deformation of the neck of the femoral bone begins from the moment of detection of the disease.

a) conservative treatment

Conservative treatment is carried out by all children up to 2-3 months of age. It is aimed at improving the blood supply and acceleration of the health of the head and neck of the femoral bone, a decrease in the tone of leading and subcupinal muscles and reduce their compression effect on the hip joint. To this end, a newborn is prescribed wide swaddling for 2 weeks, and then - a non-fastened fancy pillow for a period of up to 2-2.5 months. Soluxes are shown, paraffin, and from 6-8-week age - electrophoresis with calcium and phosphorus preparations on the hip joint No. 10-15, electrophoresis with aminoophyllin and pentoxyphylin on the lumbar-sacral spine Parablebral No. 10.

b) surgical treatment

Surgical treatment is shown to children over 2-3 months, having mildly fixed hip contractures. It allows you to create favorable conditions for the development of the femoral head and thereby prevent the formation of secondary deformation of the seed-diaphysicular angle.

Operational treatment lies in the myotomy long, short and large thigh muscles, transverse dissection of wide fascia of the hip and the tendon part of the ileum-tibial tract, intersection of fibroids in the anterior portion of the middle jagged muscle, the motomy of subcupulic and lumbays. In children over 2-3 years old, the operation complements the corrective osteotomy of the femoral bone.

Corrigative osteotomy is shown only with radiological signs of the ossification of the neck of the femoral bone. It should not be performed if there is a false joint of the neck or disruption of it. In recently, the first stage of surgical treatment is shown plastic of the femoral cervix by migrating bone-muscular complex of tissues from a large spit (front portion of the middle jagged muscle) or the ridge of the iliac (tailoring muscle). The corrective osteotomy of the femoral bone is performed by the second stage of surgical treatment after the normalization of the bone bone bone structure.

c) rehabilitation treatment

Recovery treatment involves the use of physiotherapy techniques, physiotherapy, tensile treatment and climatotherapy.

Restoration of the length of the lower limb in children with congenital vapor deformation of the neck of the femoral bone is carried out by the method of distraction osteosynthesis only in the restoration of normal anatomical ratios in the hip joint.

In order to prevent secondary static deformations, children should use orthosis products. In extremely severe cases, prosthetics are shown.

Treatment of children with congenital vius deformation of the neck of the femoral bone is long, staged and complex. The dispensary observation is carried out annually by 18 years.

Forecast

In the absence of pathogenetically substantiated treatment, the cervical deformation of the femoral cervix progresses and in part leads to the formation of the false joint of the neck, and in some cases - to its defect. The number of unfavorable results in the treatment of this pathology reaches 40-80%.

Walgus Deformation of the Feed Bone (Coxa Valga)

Valgus deformation of the neck of the femur - pathology, manifested in an increase in the seed-diaphysic corner. In 80% of patients wears a bilateral character, as a rule, combined with the deviation of the proximal end of the femur together with the head of the Kepende from the frontal plane (transcondiral plane) - the antiettorsia.

Etiology

The causes of the occurrence of deformation can be:

Hip dysplasia;

Intrauterine damage to the epiphyseal cartilage of the neck of the femur;

Disorders of the ossification of the neck of the femoral bone;

Impairment of muscle balance with mesenchymal failure;

Late origin of the child's walking;

Long bedding in the period of intensive growth.

Clinical picture

Normally, there are significant individual fluctuations in the angle of the anterassia. The isolated COXA VALGA (without the adoption of the neck), as a rule, proceeds asymptomatic, is a random find with a x-ray examination. At the same time, COXA Valga Antetorta has a known practical value, manifested in the pronounced internal rotation of the lower limbs when walking, with a clinical examination, excessive internal rotation of the thighs is revealed.

Diagnostics

X-ray study

When diagnosing COXA Valga Antetorta, which arose due to the displays of the hip joint, an in-depth radiological analysis is needed with the interpretation of radiography data in direct, axial and sagittal projections.

Treatment

The deviation from the norm of integral radiographic parameters (VIberg angle, an angle of the forefront), accompanied by complaints about the feeling of fatigue by the end of the day, pain, positive IMPINGEMENT-TEST, requires surgical correction. Apply deictioning and varizable, deictioning interrobal mediating osteotomy of the femoral bone. When identifying signs of dysplastic coxarrouse shows the transposition of the godded depression after the osteotomy of the pelvis (by Salter, double, triple osteotomy pelvis).