Septic arthritis of the hip (peds): Difference between revisions
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==Background== | ==Background== | ||
*hematogenous spread or local inf. | *hematogenous spread or local inf. | ||
* | * [[Staph]], [[S. Pneumo]], [[group A strep]] | ||
* in neonates also [[Group B strep]] and [[gram negatives]] | |||
* in neonates also | |||
==Differential Diagnosis== | ==Differential Diagnosis== |
Revision as of 04:09, 7 June 2015
Background
- hematogenous spread or local inf.
- Staph, S. Pneumo, group A strep
- in neonates also Group B strep and gram negatives
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
Workup
- Labs - ESR > 20 after 1-2 d, WBC >
- Bld Cxs (40-50% grow out)
- Xrays
- useful to exclude other cause of joint pain (AP & Frog leg)
- possible effusion
- CT
- may be useful to look for abscess, UTZ for effusion
Diagnosis
- Age - 6 mo to 8 yrs
- Pres - Pain, Pseudoparalysis
- may present w/ referred knee or thigh pain
- usually hold jt in flexion, ext rotat & slt abduction.
Kocher Criteria
- ESR > 40
- WBC > 12
- Refusal or inability to weight bear on affected joint
- Fever
- 1/4 criteria met --> 3% have septic joint
- 2/4 --> 40%
- 3/4 --> 93%
- 4/4 --> 99%
Treatment
- OR 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