Abstract
Coxa vara is an abnormality of the proximal femur with a decreased neck-shaft angle and resulting leg-length discrepancy, has been associated with conditions such as congenital coxa vara, traumatic injury, sepsis, rickets, vascular damage, or metabolic disorders; however its possible relationship with extracorporeal membrane oxygenation has been recently reported.A full term girl was born with a total infradiaphragmatic anomalous pulmonary venous drainage, at the age of 12 days, an anastomosis of the pulmonary venous trunk with the left auricle and closure of the auricular septal defect was performed; during this procedure extracorporeal membrane oxygenation was used during 104 minutes, no neonatal sepsis was developed. She had no orthopedic issues until she was 3 years and 10 months old, when she presented with limp related to the right lower limb, with no pain. She had a leg-length discrepancy of 2 cm (right - left), limited right hip abduction to 25°, and internal rotation to 5°, also had a positive Trendelenburg test. No flexion/extension abnormalities. Anteroposterior radiographs and magnetic resonance revealed coxa vara with proximal femoral growth arrest. A valgus osteotomy with greater trochanteric epiphysiodesis was performed. At the eight month follow-up, she had no hip pain, better hip range of motion, no difficulties with recreational activities and the osteotomy healed.Another four similar cases had been reported with similar outcome, we think that it will be recommendable to take images in patients with this background and limb leg-length discrepancy or abnormal range of motion.
Highlights
Coxa vara may refer descriptively to any varus deformity of the femoral neck or it may refer to more specific entities which have been commonly designed as congenital coxa vara, developmental coxa vara [1,2] and acquired coxa vara [3].The roentgenographic appearance of coxa vara is distinctive in the AP view of the pelvis
Case presentation A full term Caucasian Spanish girl was born via vaginal delivery, her birth weight was 1800 g, she had a total infradiaphragmatic anomalous pulmonary venous drainage and for that reason she was managed at the intensive care unit until the age of 12 days when an anastomosis of the pulmonary venous trunk with the left auricle and closure of the auricular septal defect was performed; during this procedure extracorporeal membrane oxygenation was used during 104 minutes, the patient did well during Extracorporeal membrane oxygenation (ECMO), the wound was clear without effusions, the platelet count was within normal range (150-400×103/ml), WBC count was normal (10-20×103/ml) no fever was registered
Congenital coxa vara is caused by an embryonic limb bud abnormality and is present at birth [3], developmental coxa vara usually occurs as an isolated deformity of the proximal femur and goes unnoticed until the child reaches walking age and is brought for assessment of a leg length discrepancy or abnormal gait, and acquired coxa vara results from an underlying condition such as fibrous dysplasia, rickets, or traumatic proximal femoral epiphyseal plate closure [3], this is important because the definitive treatment depends on which type of coxa vara are we talking about
Summary
Coxa vara may refer descriptively to any varus deformity of the femoral neck or it may refer to more specific entities which have been commonly designed as congenital coxa vara, developmental coxa vara [1,2] and acquired coxa vara [3]. Case presentation A full term Caucasian Spanish girl was born via vaginal delivery, her birth weight was 1800 g, she had a total infradiaphragmatic anomalous pulmonary venous drainage and for that reason she was managed at the intensive care unit until the age of 12 days when an anastomosis of the pulmonary venous trunk with the left auricle and closure of the auricular septal defect was performed; during this procedure extracorporeal membrane oxygenation was used during 104 minutes, the patient did well during ECMO, the wound was clear without effusions, the platelet count was within normal range (150-400×103/ml), WBC count was normal (10-20×103/ml) no fever was registered She subsequently did well and met all of her early developmental milestones, including walking at age 12 months. Congenital coxa vara is caused by an embryonic limb bud abnormality and is present at birth [3], developmental coxa vara usually occurs as an isolated deformity of the proximal femur and goes unnoticed until the child reaches walking age and is brought for assessment of a leg length discrepancy or abnormal gait, and acquired coxa vara results from an underlying condition such as fibrous dysplasia, rickets, or traumatic proximal femoral epiphyseal plate closure [3], this is important because the definitive treatment depends on which type of coxa vara are we talking about
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