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

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==Background==
 
==Background==
*hematogenous spread or local inf.
+
*Age - 6 mo to 8 yrs
* [[Staph]], [[S. Pneumo]], [[group A strep]]
+
*Hematogenous spread or local infection
* in neonates also [[Group B strep]] and [[gram negatives]]
+
*[[Staph]], [[S. Pneumo]], [[group A strep]]
 +
*Neonates: also [[Group B strep]] and [[gram negatives]]
  
 
==Clinical Features==
 
==Clinical Features==
*Age - 6 mo to 8 yrs
 
 
*Pain, Pseudoparalysis
 
*Pain, Pseudoparalysis
* May present with referred knee or thigh pain
+
*May present with referred knee or thigh pain
* Usually hold joint in flexion, external rotation and slight abduction
+
*Usually hold joint in flexion, external rotation and slight abduction
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
 
{{Pediatric hip DDX}}
 
{{Pediatric hip DDX}}
  
==Diagnosis==
+
==Evaluation==
 
===Workup===
 
===Workup===
*Labs - ESR > 20 after 1-2 d, WBC >
+
*Labs - ESR >20, WBC >12
* Bld Cxs (40-50% grow out)
+
*Blood cultures (40-50% grow out)
* Xrays  
+
*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
+
*Consider:
**may be useful to look for abscess, UTZ for effusion
+
**Ultrasound to evaluate for effusion
 +
**CT to evaluate for abscess
  
===Kocher Criteria===
+
{{Kocher criteria}}
*ESR > 40
 
*WBC > 12
 
*Refusal or inability to weight bear on affected joint
 
*Fever
 
  
 +
==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]]
  
*1/4 criteria met --> 3% have septic joint
+
==Disposition==
*2/4 --> 40%
+
*Admit
*3/4 --> 93%
 
*4/4 --> 99%
 
 
 
==Treatment==
 
* 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]]
 
  
 
==External Links==
 
==External Links==
Line 45: Line 39:
  
 
==See Also==
 
==See Also==
*[[Hip Pain]]
 
 
*[[Hip Pain (Peds)]]
 
*[[Hip Pain (Peds)]]
 
*[[Septic Arthritis (Peds)]]
 
*[[Septic Arthritis (Peds)]]
*[[Septic Arthritis (General)]]
+
*[[Limp (peds)]]
 +
 
 +
==References==
 +
<references/>
  
[[Category:Peds]]
+
[[Category:Pediatrics]]
[[Category:Ortho]]
+
[[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