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

(Diagnosis)
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==Background==
 
==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
  
- hematogenous spread or local inf.
+
==Differential Diagnosis==
 +
{{Pediatric hip DDX}}
  
- wt. bearing joints most common
+
==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
  
- knee (40-50%)
+
{{Kocher criteria}}
  
- hip (20- 25%)
+
==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]]
  
- staph, S. Pneumo, group A strep
+
==Disposition==
 +
*Admit
  
- in neonates also Groub B strep % gram neg.
+
==External Links==
 
+
*[http://www.mdcalc.com/kocher-criteria-septic-arthritis/ MDCalc - Kocher Criteria for Septic Arthritis]
== ==
 
 
 
 
 
== Diagnosis ==
 
 
 
Age - 6 mo to 8 yrs
 
 
 
Pres - Pain, Pseudoparalysis
 
 
 
Labs - ESR > 20 after 1-2 d, WBC >
 
 
 
Xrays - possible effusion
 
 
 
 
 
 
 
- may present w/ referred knee or thigh pain
 
 
 
- usually hold jt in flexion, ext rotat & slt abduction.
 
 
 
- 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==
 +
*[[Hip Pain (Peds)]]
 +
*[[Septic Arthritis (Peds)]]
 +
*[[Limp (peds)]]
  
 +
==References==
 +
<references/>
  
Peds: Hip Pain
+
[[Category:Pediatrics]]
 
+
[[Category:Orthopedics]]
 
 
 
**SEPTIC JOINT***
 
 
 
*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
 
 
 
 
 
 
 
 
 
[[Category:Peds]]
 

Revision as of 23:48, 21 May 2018

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:
    • Ultrasound to evaluate for effusion
    • CT to evaluate for abscess

Kocher Criteria for septic arthritis of the hip

  • ESR > 40
  • WBC > 12
  • Refusal or inability to weight bear on affected joint
  • Fever
Number of Kocher Criteria Chance of Septic Joint
1 3%
2 40%
3 93%
4 99%

Management

Disposition

  • Admit

External Links

See Also

References