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Choi IIIB sequelae of septic hip: Etiologically different entities clubbed together?
Anil Agarwal1, Varun Garg1, Kishmita Sachdeva1
1Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, 110031, India.
Background:
Choi IIIB sequela (pseudarthrosis of femoral neck) is an uncommon complication of septic hip. Only few cases are reported in literature and experience with the entity is limited. Variable pseudarthrosis behaviour and treatment outcomes are reported questioning the mechanical etiology for Choi III sequela.
Methods:
We briefly analysed the relevant literature and propose two different pathomechanism for the entity. Three illustrative cases in support of proposed etiology are presented.
Results:
There seems to be two distinct mechanisms of pseudarthrosis formation in Choi IIIB. The originally described mechanism is the articulating head getting dissociated from proximal femur due to a mechanical cause. The second proposed mechanism is the damage of physis and adjoining metaphysis by the septic inflammatory process (Choi II type sequela).
Conclusions:
It is important to understand the possible etiologies in Choi IIIB pseudarthrosis as the treatment planning and outcomes may vary. It will also help in prognostication.
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