Infected nonunion fracture neck of femur with severe hip joint destruction in a child

Background: Pediatric femoral neck fractures are infrequent injuries associated with significant morbidity, particularly when complicated by infection and nonunion. Chronic osteomyelitis and septic arthritis in the skeletally immature hip can result in catastrophic outcomes, including physeal destruction, femoral head resorption, and significant limb length discrepancy.

Objective: This report details the clinical presentation and surgical management of a 10-year-old male with an infected nonunion and Choi Type V sequelae following internal fixation of a femoral neck fracture.

Key Points: The patient presented with a 4 cm limb shortening, persistent sinus drainage, and restricted hip motion. Radiographic and magnetic resonance imaging confirmed chronic osteomyelitis with complete resorption of the femoral head and neck. Laboratory analysis identified a multidrug-resistant Pseudomonas infection and hypoalbuminemia. Treatment involved radical surgical debridement, targeted intravenous antibiotic therapy, and nutritional optimization. To address the mechanical instability and proximal femoral migration, a valgus osteotomy was performed. While orthobiologic adjuncts were considered to facilitate osteogenesis, parental refusal necessitated a purely mechanical and pharmacological approach. Postoperative follow-up demonstrated successful infection suppression and improved joint mobility. The residual limb length discrepancy was managed conservatively with a shoe lift, with future epiphysiodesis or limb lengthening planned as the patient approaches skeletal maturity.

Conclusion: Management of infected pediatric femoral neck nonunions requires aggressive debridement and staged reconstruction. Valgus osteotomy serves as an effective salvage procedure to restore hip stability and improve functional outcomes in cases of severe femoral head loss where advanced regenerative therapies are not utilized.