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Research Article Volume 18 Issue 4
The vertical growth plate of the proximal femur: distinguishing developmental coxa vara from trauma in a three-year-old female
Mazhar Abbas, Fazal Ur Rehman, Nusra Rahman, Dr. Yasir Salam Siddiqui, Julfiqar, Mohd Zeeshan
Received: July 31, 2026 | Published: August 27, 2026
Citation: Abbas M, Rehman FU, Rahman N, et al. The vertical growth plate of the proximal femur: distinguishing developmental coxa vara from trauma in a three-year-old female. MOJ Orthop Rheumatol. 2026;18(4):149-151. DOI: 10.15406/mojor.2026.18.00756
Abstract
Developmental coxa vara (DCV) is a rare paediatric hip deformity characterized by a progressive reduction in the femoral neck-shaft angle (NSA) and marked verticalization of the proximal femoral physis. Accurately differentiating DCV from traumatic physeal injuries or neglected femoral neck fractures is critical in toddlers presenting with an isolated, unilateral limp to avoid irreversible bio-mechanical failure. We present the case of a 3-yearold female who presented with a four-month history of a painless limp and 1.5 cm of left lower limb shortening. Radiographic evaluation revealed a reduced left femoral neck-shaft angle and a pathognomonic Hilgenreiner-Epiphyseal (H-E) angle of 86°, accompanied by a characteristic inverted Y-shaped radio-lucency and an inferior-medial triangular bone fragment. The absolute absence of trauma combined with these distinct, chronic structural changes definitively excluded an acute or neglected fracture mal-union. Given that an H-E angle of 86° represents extreme biomechanical shear instability; representing abnormal abductor mechanism. This serves as an absolute indication for surgical correction via valgus proximal femoral osteotomy to restore tension to the abductor mechanism, improve hip stability, and prevent progressive limb shortening and early joint degeneration.
Keywords: developmental coxa vara, femoral neck-shaft angle, hilgenreiner-epiphyseal angle, growth plate, vertical physis, abductor mechanism, limb length discrepancy
©2026 Abbas, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.
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