Secondary coxa vara, accompanying old dislocations of the hip, has already been mentioned in the discussion of congenital dislocations of the hip (Spitzy).
Treatment.—Prophylaxis is the most important factor in treatment of coxa vara.
Rachitic children are to be kept in a resting position as much as possible during the florid stage to prevent curvatures. In fractures of the femoral neck the plaster-of-Paris bandage must be applied in over corrective position and only a gradual increase of weights allowed on account of the softness of the callus tissue (apparatus to relieve the weight).
In coxa vara statics, at the very onset of the initial symptoms a relief of the increasing demands upon the leg must be sought (rest, change of employment).
Further experiments to correct a developed ease of coxa vara by means of a bloodless operation were less successful. Lorenz's suggestion of inversion may be attempted in eases of faulty reduction of fractures of the femoral neck. After breaking up the fibrous sear tissue, he places the trochanter below the spine in abduction without concern about any osseous remnants left in the acetabulum. His idea is that the attitude of adduction and the deficient support are the chief causes of the dis turbances of locomotion.
After transposition, fixation is brought about with the aid of per manent bandages.
In other cases operative treatment is indispensable.
Frontal osteotomy is performed in the vicinity of the joint to allow an increase of the angle of the neck by the application of subsequent correction bandages (Hofmeister, Hoffa, Opening of the joint must be avoided on account of resulting stiffness. In cases of
depression of traumatic origin, suture of the bone or resection of the fragment of the head may be employed (Whitman).
In developed cases of rachitic coxa vara, Lange advocates extension with heavy weights overnight and exercises to increase the range of abduction.
The opposite depression of the, femoral neck, so-called coza rabic, after 'runner, is of no practical importance in pediatrics and may be mentioned here just for the sake of completeness.
The deformities of the femoral diaphysis are the result of exaggera tion of the normal curvature; they imply, therefore, an increase of the normal eurvature of the femoral bone with the convexity toward the front. It is produced by a predominance of the flexors, which, as rem nants of the biologically older and constantly flexed attitude of the knees, arc more strongly developed than the extensors.
Compared with the deformities of the leg they very seldom neces sitate operative intervention; eases of less marked degree are bet ter left to themselves for correction during growth (see Deformities of the leg).
A deformity of the bones forming the knee-joint is of greater impor tance because of the marked disturbances of the creel posture and gait.