Septic arthritis of the hip (peds): Difference between revisions
No edit summary |
|||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Age - 6 mo to 8 yrs | |||
*Hematogenous spread or local infection | *Hematogenous spread or local infection | ||
*[[Staph]], [[S. Pneumo]], [[group A strep]] | *[[Staph]], [[S. Pneumo]], [[group A strep]] | ||
| Line 5: | Line 6: | ||
==Clinical Features== | ==Clinical Features== | ||
*Pain, Pseudoparalysis | *Pain, Pseudoparalysis | ||
*May present with referred knee or thigh pain | *May present with referred knee or thigh pain | ||
| Line 15: | Line 15: | ||
==Evaluation== | ==Evaluation== | ||
===Workup=== | ===Workup=== | ||
*Labs - ESR > 20 | *Labs - ESR >20, WBC >12 | ||
* | *Blood cultures (40-50% grow out) | ||
*Xrays | *Xrays | ||
**useful to exclude other cause of joint pain (AP & Frog leg) | **useful to exclude other cause of joint pain (AP & Frog leg) | ||
| Line 33: | Line 33: | ||
==Disposition== | ==Disposition== | ||
* | *Admit | ||
==External Links== | ==External Links== | ||
| Line 42: | Line 42: | ||
*[[Septic Arthritis (Peds)]] | *[[Septic Arthritis (Peds)]] | ||
*[[Limp (peds)]] | *[[Limp (peds)]] | ||
==References== | |||
<references/> | |||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
Revision as of 23:48, 21 May 2018
Background
- Age - 6 mo to 8 yrs
- Hematogenous spread or local infection
- Staph, S. Pneumo, group A strep
- Neonates: also Group B strep and gram negatives
Clinical Features
- Pain, Pseudoparalysis
- May present with referred knee or thigh pain
- Usually hold joint in flexion, external rotation and slight abduction
Differential Diagnosis
Pediatric hip pain
- Acute rheumatic fever
- Developmental dysplasia of hip
- Femur fracture
- Juvenile idiopathic arthritis
- Legg-Calve-Perthes disease
- Septic arthritis of the hip (peds)
- Lyme disease arthritis
- Slipped capital femoral epiphysis
- Transient (toxic) synovitis
- Osteosarcoma
Evaluation
Workup
- Labs - ESR >20, WBC >12
- Blood cultures (40-50% grow out)
- Xrays
- useful to exclude other cause of joint pain (AP & Frog leg)
- possible effusion
- Consider:
- Ultrasound to evaluate for effusion
- CT to evaluate for abscess
Kocher Criteria for septic arthritis of the hip
- ESR > 40 mm/hr
- WBC > 12,000/microliter
- Refusal or inability to weight bear on affected joint
- Fever 38.5° C or greater
| Number of Kocher Criteria | Chance of Septic Joint |
| 1 | 3% |
| 2 | 40% |
| 3 | 93% |
| 4 | 99% |
Management
- OR drainage
- IV antibiotics x 10-14 days (before po)
- Oxacillin, Nafcillin or Clindamycin in penicillin allergic
- Cover Haemophilus influenzae as needed with 3rd generation cephalosporin
Disposition
- Admit