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Shepherd's Crook deformity is a severe form of coxa vara where the proximal femur is severely deformed with a reduction in the neck shaft angle beyond 90 degrees. It is most commonly a sequela of osteogenesis imperfecta , Paget's disease, osteomyelitis, tumour and tumour-like conditions (e.g. fibrous dysplasia ).
Total hip replacement is most commonly used to treat joint failure caused by osteoarthritis.Other indications include rheumatoid arthritis, avascular necrosis, traumatic arthritis, protrusio acetabuli, [5] certain hip fractures, benign and malignant bone tumors, [6] arthritis associated with Paget's disease, [7] ankylosing spondylitis [8] and juvenile rheumatoid arthritis. [9]
Coxa valga is a deformity of the hip where the angle formed between the head and neck of the femur and its shaft is increased, usually above 135 degrees.. The deformity may develop in children with neuromuscular disorders (i.e. cerebral palsy, spinal dysraphism, poliomyelitis), skeletal dysplasias, and juvenile idiopathic arthritis.
A thigh-foot angle less than 10 degrees internal, and up to 30 degrees of external rotation is considered normal. [6] Femoral Anteversion. Femoral anteversion is diagnosed by physical exam. [6] The principle physical exam maneuver is an assessment of hip mobility. [6] The child is evaluated in the prone position with knees flexed to 90 degrees. [6]
Alpha angle Measured in 45° Dunn view. Degree of bulging of the femoral head-neck junction: In normal conditions there is a symmetric concave contour at the junction of the femoral head and neck. Loss of this concavity or bone bulging may lead to cam type impingement. The degree of this deformity can be measured by the alpha angle.
The condition is most commonly found in children between the ages of 4 and 10. Common symptoms include pain in the hip, knee, or ankle (since hip pathology can cause pain to be felt in a normal knee or ankle), or in the groin; this pain is exacerbated by hip or leg movement, especially internal hip rotation (with the knee flexed 90°, twisting the lower leg away from the center of the body).
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On projectional radiography, the degree of varus or valgus deformity can be quantified by the hip-knee-ankle angle, [7] which is an angle between the femoral mechanical axis and the center of the ankle joint. [8] It is normally between 1.0° and 1.5° of varus in adults. [9] Normal ranges are different in children. [10]
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