Septic arthritis of the hip (peds): Difference between revisions
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* [[Staph]], [[S. Pneumo]], [[group A strep]] | * [[Staph]], [[S. Pneumo]], [[group A strep]] | ||
* in neonates also [[Group B strep]] and [[gram negatives]] | * in neonates also [[Group B strep]] and [[gram negatives]] | ||
==Clinical Features== | |||
*Age - 6 mo to 8 yrs | |||
*Pain, Pseudoparalysis | |||
* May present with referred knee or thigh pain | |||
* Usually hold joint in flexion, external rotation and slight abduction | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Pediatric hip DDX}} | {{Pediatric hip DDX}} | ||
==Workup== | ==Diagnosis== | ||
===Workup=== | |||
*Labs - ESR > 20 after 1-2 d, WBC > | *Labs - ESR > 20 after 1-2 d, WBC > | ||
* Bld Cxs (40-50% grow out) | * Bld Cxs (40-50% grow out) | ||
| Line 15: | Line 22: | ||
* CT | * CT | ||
**may be useful to look for abscess, UTZ for effusion | **may be useful to look for abscess, UTZ for effusion | ||
===Kocher Criteria=== | ===Kocher Criteria=== | ||
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*Refusal or inability to weight bear on affected joint | *Refusal or inability to weight bear on affected joint | ||
*Fever | *Fever | ||
*1/4 criteria met --> 3% have septic joint | *1/4 criteria met --> 3% have septic joint | ||
| Line 35: | Line 37: | ||
==Treatment== | ==Treatment== | ||
* OR drainage | * OR drainage | ||
* Oxacillin, Nafcillin or | * IV [[antibioticis]] x 10-14 days (before po) | ||
* | **[[Oxacillin]], [[Nafcillin]] or [[Clindamycin]] in penicillin allergic | ||
** Cover [[H. inf]] as needed with 3rd generation [[cephalosporin]] | |||
==External Links== | ==External Links== | ||
Revision as of 04:13, 7 June 2015
Background
- hematogenous spread or local inf.
- Staph, S. Pneumo, group A strep
- in neonates also Group B strep and gram negatives
Clinical Features
- Age - 6 mo to 8 yrs
- Pain, Pseudoparalysis
- May present with referred knee or thigh pain
- Usually hold joint in flexion, external rotation and slight abduction
Differential Diagnosis
Pediatric limp
Hip Related
- 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
Other Causes of Limping
- Developmental dysplasia
- Fracture
- Toddler's fracture
- Tillaux fracture, adolescent
- Neoplasm:
- Leukemia
- Ewings
- Osteogenic sarcoma
- Metastatic neuroblastoma
- Osteomyelitis
- Myositis
- Other:
Diagnosis
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
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
- IV antibioticis x 10-14 days (before po)
- Oxacillin, Nafcillin or Clindamycin in penicillin allergic
- Cover H. inf as needed with 3rd generation cephalosporin