Pseudoarthrosis of the Femur Secondary to Tuberculosis: A Rare and First Report

Tuberculosis poses a major health problem worldwide, and more so in developing countries. Tuberculosis will exist for as long as there are facets of malnutrition, poor sanitation, overcrowding, and immunocompromised populations. We report a rare case of pseudoarthrosis of the femur secondary to tuberculosis. A five-year-old female child presented with swelling, discharging sinuses, and abnormal mobility in the right lower one-third of the thigh secondary to trauma seven months ago. Incision, drainage, and debridement were done, and the obtained pus showed no growth. The sample turned out to be acid-fast bacilli-positive. The patient was on anti-tubercular drugs for six months and had a protective plaster cast for about six weeks, following which knee mobilization was started. During knee mobilization, the patient underwent a forced manipulation of the lower end of the femur, and the radiograph revealed a pathological fracture for which one-and-a-half hip-spica was applied. Further radiographs revealed an un-united fracture after three months despite hip spica application, and a pseudoarthrosis of the right distal femur developed, for which non-vascularized fibular strut grafting for pseudoarthrosis of the distal third of the femur was performed and stabilized with two 2.5 mm-long K-wires supplemented with hip spica for six months. The patient was followed up regularly, and subsequent radiographs showed fibular uptake and resolution of pseudoarthrosis of the femur at the eighth-month follow-up. The patient showed complete resolution of pseudoarthrosis and an excellent functional outcome by the end of the two-year follow-up.