Pauwels' osteotomy for surgical correction of infantile coxa vara

Area of Science:

• Pediatric Orthopedics
• Surgical Techniques
• Hip Development Disorders

Background:

• Infantile coxa vara is a hip condition often treated with valgus osteotomies.
• High recurrence rates are a significant challenge in managing infantile coxa vara.
• Maintaining a specific physeal inclination is crucial for preventing recurrence.

Purpose of the Study:

• To evaluate the efficacy of Pauwels' osteotomy in correcting infantile coxa vara.
• To confirm that achieving a Hilgenreiner epiphyseal angle (HEA) of 40° or less prevents recurrence.
• To assess the long-term stability of valgus osteotomies using rigid fixation.

Main Methods:

• A cohort of 31 hips with infantile coxa vara underwent intertrochanteric Y-shaped valgus osteotomy.
• Pauwels' osteotomy was employed and stabilized using a rigid fixation method.
• The primary outcome measured was the correction of the physeal inclination to an HEA of 40° or less.

Main Results:

• In 27 out of 31 hips, the HEA was successfully corrected to 40° or less.
• No recurrence of infantile coxa vara was observed in the hips with corrected HEA.
• Rigid fixation provided stable correction of the physeal inclination.

Conclusions:

• Correction of the Hilgenreiner epiphyseal angle (HEA) to 40° or less is effective in preventing recurrence of infantile coxa vara.
• Pauwels' intertrochanteric Y-shaped valgus osteotomy, when stabilized rigidly, achieves this critical angle.
• This surgical approach confirms previous recommendations for managing infantile coxa vara and reducing recurrence rates.