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

 
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==Background==
 
==Background==
*hematogenous spread or local inf.
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*Age - 6 mo to 8 yrs
* wt. bearing joints most common
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*Hematogenous spread or local infection
* knee (40-50%)
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*[[Staph]], [[S. Pneumo]], [[group A strep]]
* hip (20- 25%)
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*Neonates: also [[Group B strep]] and [[gram negatives]]
* staph, S. Pneumo, group A strep
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* in neonates also Groub B strep % gram neg.
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==Clinical Features==
 +
*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==
+
==Evaluation==
*Labs - ESR > 20 after 1-2 d, WBC >
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===Workup===
* Bld Cxs (40-50% grow out)
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*Labs - ESR >20, WBC >12
* Xrays  
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*Blood cultures (40-50% grow out)
 +
*Xrays  
 
**useful to exclude other cause of joint pain (AP & Frog leg)
 
**useful to exclude other cause of joint pain (AP & Frog leg)
 
**possible effusion
 
**possible effusion
* CT
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*Consider:
**may be useful to look for abscess, UTZ for effusion
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**Ultrasound to evaluate for effusion
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**CT to evaluate for abscess
  
==Diagnosis==
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{{Kocher criteria}}
*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===
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==Management==
*ESR > 40
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*OR drainage
*WBC > 12
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*IV [[antibiotics]] x 10-14 days (before po)
*Refusal or inability to weight bear on affected joint
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**[[Oxacillin]], [[Nafcillin]] or [[Clindamycin]] in penicillin allergic
*Fever
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**Cover [[Haemophilus influenzae]] as needed with 3rd generation [[cephalosporin]]
  
*1/4 criteria met --> 3% have septic joint
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==Disposition==
*2/4 --> 40%
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*Admit
*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
 
  
 
==External Links==
 
==External Links==
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==See Also==
 
==See Also==
*[[Hip Pain]]
 
 
*[[Hip Pain (Peds)]]
 
*[[Hip Pain (Peds)]]
 
*[[Septic Arthritis (Peds)]]
 
*[[Septic Arthritis (Peds)]]
*[[Septic Arthritis (General)]]
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*[[Limp (peds)]]
 +
 
 +
==References==
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<references/>
  
[[Category:Peds]]
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[[Category:Pediatrics]]
[[Category:Ortho]]
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[[Category:Orthopedics]]

Latest 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