Dome Osteotomy with a Contoured DCP Plate to Correct Coxa Vara after SCFE in an Overweight Adolescent: Case Report from a Resource-limited Setting

Background: Coxa vara, defined as a femoral neck–shaft angle <120º, alters hip biomechanics and predisposes adolescents to slipped capital femoral epiphysis (SCFE). Severe coxa vara deformity presents surgical challenges, particularly in resource-limited settings where implant availability is restricted. Dome intertrochanteric osteotomy offers multiplanar correction, preserves limb length, and can be stabilized with widely available implants, making it a preferred option in such contexts. Case Report: A 14-year-old male (BMI 32.8 kg/m²) with a three-month history of left groin pain radiating to the knee after a fall, had a painless limp since age eight. The exam revealed an antalgic gait, a positive Trendelenburg sign, limited hip motion, and a 4 cm leg-length discrepancy. Radiographs revealed SCFE with coxa vara (neck–shaft 110º left, 135º right; Southwick angles: 18º AP, 38º frog-leg). MRI confirmed epiphyseal slip with a viable femoral head. He underwent dome intertrochanteric valgus osteotomy via lateral approach, fixed with a 9-hole DCP and screw due to the unavailability of locking/blade plates. Post-op, neck–shaft angle improved to 132∘, discrepancy reduced to 1.5 cm, with no complications. Recovery was uneventful; partial weight-bearing for six weeks. At three months, signs of healing; at six months, pain-free ambulation with slight limp and heel lift. CHOHES scores improved from 26 pre-op to 64 at three months and 84 at six months. Conclusion: Dome osteotomy is a reliable surgical option for correcting SCFE-associated coxa vara and leg-length discrepancy, particularly in resource-poor settings where implant choice is constrained. It provides multiplanar correction, restores the mechanical axis, and preserves limb length. Long-term follow-up remains essential to monitor for avascular necrosis, chondrolysis, or degenerative changes.