Management of post septic hip dislocations when the capital femoral epiphysis is present.

Delayed or missed diagnosis of septic arthritis of hip in children results in various sequelae. The group of post septic hip dislocations when the capital femoral epiphysis (CFE) is present has not been described in the commonly used classifications. This is a retrospective series of 21 hips in 18 children. The presence of the CFE was confirmed radiologically or at the time of intervention. The mean follow-up after intervention was 6.3 years. Interventions for dislocations included closed reduction ± adductor tenotomy, open reduction ± supplementary femoral procedures, and acetabular procedures. Results were evaluated clinically with Ponseti hip scoring and radiologically with the modified Severin grading. Closed reduction was successful in seven of 20 hips (35%) and open reduction in 13 of 14 hips. At follow-up, good clinical result was seen in nine of 18 cases (50%). The mean neck shaft angle was 129° in all hips and 124° after femoral varus osteotomy. There was one redislocation and three subluxations. The modified Severin classification was class 2 in five hips (good), class 3 in 12 hips (fair), class 4 in three hips (poor), and class 6 in one hip (failure). Septic hip dislocation with CFE present is a distinct entity. MRI is helpful for planning treatment. A significant number of patients need open reduction with other procedures. Femoral varus osteotomy may contribute to coxa vara. In the short term, intervention results in a stable, functional, and mobile hip.

Hip dislocation revealing hip tuberculosis. A case report.

Hip dislocation is an uncommon presentation of hip tuberculosis. We report a case in an 18-year-old woman with active hip tuberculosis. An attempt to reduce the dislocation 7 weeks into antituberculous therapy was followed by necrosis of the femoral head. Although severe forms of hip tuberculosis are common in endemic areas, dislocation is exceedingly rare. Capsule laxity and/or synovial hypertrophy probably contribute more to the occurrence of dislocation than does the accumulation of pus.

Unusual radiological manifestations of Lemierre's syndrome: a case report.

Lemierre's syndrome is an uncommon clinical entity characterized by oropharyngeal infection followed by septic thrombophlebitis of the jugular vein with embolization to the lungs and other organs. The organism is a gram-negative anaerobic bacterium, Fusobacterium necrophorum. We report a case of Lemierre's syndrome in an 8-year-old child who presented with septic arthritis of the left hip joint. Roentgenograms and computed tomography demonstrated gas in the joint and adjacent soft tissues, along with a dislocated hip. Sonography of the neck coupled with the colour Doppler technique did not reveal any abnormality in the jugular veins. A blood culture grew Fusobacterium necrophorum, confirming the diagnosis of Lemierre's syndrome.