Septic arthritis of the hip (peds): Difference between revisions

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==Background==
==Background==
*hematogenous spread or local inf.
*Age - 6 mo to 8 yrs
* wt. bearing joints most common
*Hematogenous spread or local infection
* knee (40-50%)
*[[Staph]], [[S. Pneumo]], [[group A strep]]
* hip (20- 25%)
*Neonates: also [[Group B strep]] and [[gram negatives]]
* staph, S. Pneumo, group A strep
* in neonates also Groub B strep % gram neg.


==Diagnosis==
==Clinical Features==
Age - 6 mo to 8 yrs
*[[Hip pain (peds)|Pain]], pseudoparalysis
*May present with referred knee or thigh pain
*Usually hold joint in flexion, external rotation and slight abduction


Pres - Pain, Pseudoparalysis
==Differential Diagnosis==
{{Pediatric hip DDX}}


Labs - ESR > 20 after 1-2 d, WBC >
==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:
**[[musculoskeletal ultrasound|Ultrasound]] to evaluate for effusion
**CT to evaluate for [[abscess]]


Xrays - possible effusion
{{Kocher criteria}}


==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]]


- may present w/ referred knee or thigh pain
==Disposition==
*Admit


- usually hold jt in flexion, ext rotat & slt abduction.
==External Links==
 
*[http://www.mdcalc.com/kocher-criteria-septic-arthritis/ MDCalc - Kocher Criteria for Septic Arthritis]
- get Bld Cxs (40-50% grow out)
 
 
- Xrays useful to exclude other cause of joint pain (AP & Frog leg)
 
- CT may be useful to look for abscess, UTZ for effusion.
 
'''Kocher Criteria'''
1. ESR > 40
 
2. WBC > 12
 
3. Refusal or inability to weight bear on affected joint
 
4. Fever
 
*1/4 criteria met --> 3% have septic joint
*2/4 --> 40%
*3/4 --> 93%
*4/4 --> 99%
 
==Treatment==
# drainage
# Oxacillin, Nafcillin or Clinda in pen all
# cover H. inf as needed w/ 3rd gen ceph.
# IV abx for 10-14 days before po


==See Also==
==See Also==
Peds: Hip Pain
*[[Hip Pain (Peds)]]
 
*[[Septic Arthritis (Peds)]]
**Septic Joint***
*[[Limp (peds)]]
*usu acute, same mech as OM, usu similar org w/ s. aureus most common (think gc if older).
 
*Rx= aspirate sufficient for all xcept hip, must go to OR/IR w/ hip b/c incr pressure can cause avn of hip! o/w tap okay, usu OR if reaccumulates. send for (in order) 1) cx 2) count 3) gs.
 
*CBC >15 in 50%, ESR >60mm/hr in >90% of cases, CRP >20mg/L in 94%, Bcx 50%, fluid usu >50,000 WBC
 
(in gc arthritis: +blood cx: ~0%, +fluid cx/gs: 25-50%, urethral/rectal/throat swab may incr cx yield)
 
*xr for septic hip usu w/ joint space wide of >1-2 mm vs other side


*Rx= neonate ox & gent, 2mo-5yr cefotax & ox, 5y-12y ox (vanco?), >12 ox & ctx
==References==
<references/>


[[Category:Peds]]
[[Category:Pediatrics]]
[[Category:Ortho]]
[[Category:Orthopedics]]
[[Category:ID]]

Latest revision as of 20:34, 6 October 2019

Background

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

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:

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

Disposition

  • Admit

External Links

See Also

References