Paediatric orthopaedics: developmental coxa vara: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Paediatric orthopaedics: developmental coxa vara

Sample item

A 3-year-old walks with a painless Trendelenburg limp. The leg is slightly short and abduction is limited. The radiograph shows a reduced neck-shaft angle, a vertical physis and an inverted-V metaphyseal fragment, with a markedly raised Hilgenreiner-epiphyseal angle. Which treatment is preferred?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Valgus osteotomy of the proximal femur

In developmental coxa vara the neck-shaft angle is reduced and the physis is vertical, so shear forces prevent healing of the neck defect. Surgery by valgus osteotomy restores the angle and makes the physis horizontal when the Hilgenreiner-epiphyseal angle is high or the deformity progresses.

Option by option

  • A. Varus derotation osteotomy

    Varus osteotomy would worsen an already varus neck.

  • B. Pavlik harness in abduction

    A Pavlik harness treats infantile dysplasia, not a neck-shaft deformity.

  • C. Valgus osteotomy of the proximal femur (correct)

    Correct. A valgus osteotomy corrects the neck-shaft angle and redirects the physis.

  • D. In situ screw fixation of the neck

    In situ fixation is used for a slipped capital femoral epiphysis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is C, Valgus osteotomy of the proximal femur. In developmental coxa vara the neck-shaft angle is reduced and the physis is vertical, so shear forces prevent healing of the neck defect.

Why is "Varus derotation osteotomy" not the answer?

Varus osteotomy would worsen an already varus neck.

Why is "Pavlik harness in abduction" not the answer?

A Pavlik harness treats infantile dysplasia, not a neck-shaft deformity.

Why is "In situ screw fixation of the neck" not the answer?

In situ fixation is used for a slipped capital femoral epiphysis.

What concept does this question test?

It tests Paediatric orthopaedics: developmental coxa vara in Orthopaedics. Surgery by valgus osteotomy restores the angle and makes the physis horizontal when the Hilgenreiner-epiphyseal angle is high or the deformity progresses.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric orthopaedics: developmental coxa vara?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.