Femur. Inborn malformations according to Ranier are divided into five groups:
the hip with an arrest of development and coxa vara is shortened;
the hip remains above and below are kept, the diaphysis is absent;
only the lower end of a hip which is jointed by a tibial bone is kept;
the head and neck of a hip are not differentiated, the upper end is slightly bent and is in a condition of an incomplete dislocation;
coxofemoral and knee joints are developed well. The diaphysis of a hip is considerably shortened.
At an inborn malformation of a hip lameness which sizes depend on weight of defect and size of shortening of extremities is observed. With age or at the birth together with an underdevelopment of a hip its vicious installation and contractures in a hip joint come to light. At preservation of part of a hip and shin patients adapt to circulation, especially if pathology is expressed on the one hand, attempt to extend an extremity in the surgical way was not widely adopted. Prosthetics at major defects is more shown. Recently when shortening a hip at children at the age of 4 — 5 change a way of distraktsionny devices in combination with an osteotomy of the shortened segment. Hip, inborn deformations of a neck of a hip (coxa vara, coxa valga).
Fig. 1. The cervical and diaphyseal corner of a femur is normal (And), reduction (B) and increase of it (In). B — a varus curvature of proximal department of a hip; In — valgus. Normal the cervical and diaphyseal corner of a femur is equal 127 ° (fig. 1, A). The varus curvature (coxa vara) of proximal department of a hip with reduction of a sheechnodiafizarny corner is presented on fig. 1, B, valgus (coxa vara) — in fig. 1, B. The disease comes to light from the beginning of walking of the child, it meets at girls more often; defeat is usually bilateral. Inborn deformation of proximal department is observed less than acquired (a traumatic origin). There are following coxa vara forms;
inborn (disturbance of development of a femur) — coxa vara congenita;
children's, or dystrophic — coxa vara infantum;
teenage (juvenile) — coxa vara juvenilis or a youthful epiphysiolysis of a head of a hip;
traumatic — coxa vara posltraumatica;
Coxa vara is observed also at general diseases of a skeleton (system dysplasias), such as inborn fragility of bones, chondrodystrophia, dyschondroplasia, etc. It meets also after inflammatory diseases and other pathological processes of a bone tissue in the specified area. Lameness which degree depends on disease severity and extent of shortening of an extremity is characteristic of coxa vara. With age vicious installation of a hip and a contracture in a hip joint are noted. At the expense of a hip there are a shortening of an extremity, a distortion and omission of a basin in its party, a smoothness of contours of the affected extremity, its rotation in lateral face, an atrophy of muscles of a rump on the party of deformation, ekvinusny installation of foot. Gait is "duck", the symptom of Trendelenburga, restriction of assignment and rotation in a hip joint is positive. Radiological extent of change of a cervical and diaphyseal corner is defined. Operational treatment provides change of an acute cervical and diaphyseal angle to stupid. It is reached by a corrective subtrochanterian osteotomy of a hip with the subsequent assignment it. After accretion of a bone at the level of an osteotomy in the taken-away position of a hip (an immobilization the plaster bandage within 2 months) quite often makes bringing down of a big spit therefore gluteuses stretch. Apply a metal core of Bogdanov or a plate with screws to fixing of fragments. Operation is shown from 5-year age. Coxa valga — a valgus deviation of a cervical and diaphyseal corner more than 130 °, is observed less often, is connected with inborn pathology, hypotonia of muscles or has a paralytic origin. The symptomatic treatment, is reduced generally to strengthening of muscles, increase of the general tone. Surgical treatment — a femur osteotomy — is shown at sharply expressed coxa valga.