The disease is by no means often of traumatic origin, although traumatisms may produce an arthritis deformans, even in juvenile cases, and that this may simulate a non-symptomatic coxa valga is now well established ([Fig. 273]).
Symptoms.
—Coxa vara produces certain symptoms, among them pain in the joint, radiating down the front and inside of the thigh. If the deformity be very marked, joint function is impaired. Tenderness is rarely present. When pain or tenderness occur they may lead to the mistaken diagnosis of rheumatism or neuralgia. The condition may arise as the result of an acute ostitis, in which case patients will be confined to bed for some time. Actual shortening may vary from one to one and a half inches, while the limb will be found adducted, the gluteal region flattened, with a deep curve between the trochanter and the gluteal muscles.
Diagnosis.
—The diagnosis is to be made mainly between this condition and hip-joint disease or misplacement. When abnormalities in the shape or position of the limbs in the young occur in a comparatively short time, coxa vara may be suspected, especially in the absence of that disability which coxitis usually produces. The patient should be examined in both the upright and horizontal position. Coxa vara may have an abrupt onset, but it never produces abscess. It is practically self-limited and will be followed, sooner or later, by spontaneous cessation of all acute features, while coxitis is progressive, with a destructive tendency. In coxa vara we do not have the starting pains nor muscle spasms of coxitis, while the actual shortening is much more marked. In doubtful cases the cathode rays may be employed and will often greatly facilitate diagnosis. The condition may be bilateral, but will still fail to show the muscle atrophy so significant of tuberculous disease.
As between coxa vara and that senile form of coxitis already described in the chapter on Joints as arthritis deformans, it should be remembered that the latter is a disease of advanced life, while the former occurs rather in its earlier periods. Moreover, in the former there is no tendency to change in the femorocervical angle, no matter what changes may occur in other respects about the joint. When in the senile disease shortening really occurs it results from actual absorption of bone.
Coxa vara tends usually to spontaneous cessation, which may be considered recovery. Acute symptoms after a time subside, and function is regained to the full extent permitted by whatever changes have occurred in the shape of the bone. If symptoms are at all severe they demand physiological rest in bed, with traction, and the limb should not be used until pain has entirely subsided. Conspicuous deformity may call for correction by subcutaneous osteotomy made just below the trochanter. Only in exceedingly serious cases is exsection of the joint necessary.
DEFORMITIES CAUSED BY INFANTILE PALSIES.
Deformities induced by more or less acute affections of the cord and brain, or by hemorrhages, have assumed an ever-increasing importance in orthopedic work. Most of them resolve themselves into those due to acute anterior poliomyelitis and those due to cerebral hemorrhages.
Fig. 274