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What factors contribute to Choi IV sequelae? A retrospective analysis of 15 septic hips
Anil Agarwal1, Prateek Rastogi1
1Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, 11003, India.
Insights
Delayed treatment for septic hips, particularly when leading to dislocation or concurrent femoral osteomyelitis, significantly increases the risk of severe Choi IV sequelae in children.
Area of Science:
- Orthopedic Surgery
- Pediatric Infectious Diseases
- Radiology
Background:
- Septic hips can lead to severe sequelae, with Choi IV being one of the most debilitating outcomes.
- Identifying factors contributing to Choi IV sequelae is crucial for timely intervention and improved patient outcomes.
Purpose of the Study:
- To retrospectively review cases of Choi IV sequelae in septic hips.
- To identify demographic and radiological factors associated with the development of Choi IV sequelae.
Main Methods:
- Retrospective chart review of 15 hips in 13 patients with Choi IV sequelae.
- Analysis of patient demographics including age, time to arthrotomy, and causative organisms.
- Evaluation of radiological findings at the time of arthrotomy, such as concurrent arthritis, osteomyelitis, subluxation, or dislocation.
Main Results:
- The average age of patients at infection was 2.9 years; 5 were infants.
- Average time to arthrotomy was 21.6 days; 60% of hips had pathological subluxation or dislocation.
- Concurrent arthritis and osteomyelitis were present in 53% of hips; Staphylococcus aureus was the most common pathogen.
Conclusions:
- Delay in treatment, post-septic hip dislocation, and concurrent femoral osteomyelitis are significant risk factors for Choi IV sequelae.
- Choi IV sequelae development is independent of patient age.
Purpose:
Choi IV sequela is one of the most severe outcomes of septic hips. We undertook a retrospective chart review of 15 such hips in 13 patients to identify factors contributing to the formation of this sequelae.
Methods:
The study specifically focused on patient demographics (patient's age; time to arthrotomy from initial symptoms; causative organism; post arthrotomy duration when Choi IV changes were obvious) and radiological findings at the time of arthrotomy.
Results:
The average patient's age at time of infection was 2.9 years. Five children were infants. The time to arthrotomy from initial symptoms was mean 21.6 days. Multifocal involvement was seen in 2 patients. Concurrent arthritis and osteomyelitis was present in 8 (53%) and pathological subluxation or dislocation in 9 hips (60%). Methicillin-sensitive Staphylococcus aureus was isolated in 7 and Methicillin-resistant Staphylococcus aureus in 4 patients. The Choi IV findings were established on average 3.8 months post arthrotomy.
Conclusions:
Delay in treatment, post septic dislocation and concurrent femoral osteomyelitis were factors associated with Choi IV septic sequelae. The pathology occurred irrespective of age.
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