Difference between revisions of "Septic arthritis of the hip (peds)"
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==Background== | ==Background== | ||
| + | *Age - 6 mo to 8 yrs | ||
*Hematogenous spread or local infection | *Hematogenous spread or local infection | ||
*[[Staph]], [[S. Pneumo]], [[group A strep]] | *[[Staph]], [[S. Pneumo]], [[group A strep]] | ||
| Line 5: | Line 6: | ||
==Clinical Features== | ==Clinical Features== | ||
| − | |||
*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}} | ||
| − | == | + | ==Evaluation== |
===Workup=== | ===Workup=== | ||
| − | *Labs - ESR > 20 | + | *Labs - ESR >20, WBC >12 |
| − | * | + | *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 | ||
| − | * | + | *Consider: |
| − | ** | + | **Ultrasound to evaluate for effusion |
| − | + | **CT to evaluate for abscess | |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | + | {{Kocher criteria}} | |
| − | |||
| − | |||
| − | |||
| − | == | + | ==Management== |
| − | * OR drainage | + | *OR drainage |
| − | * IV [[antibiotics]] x 10-14 days (before po) | + | *IV [[antibiotics]] x 10-14 days (before po) |
**[[Oxacillin]], [[Nafcillin]] or [[Clindamycin]] in penicillin allergic | **[[Oxacillin]], [[Nafcillin]] or [[Clindamycin]] in penicillin allergic | ||
| − | ** Cover [[Haemophilus influenzae]] as needed with 3rd generation [[cephalosporin]] | + | **Cover [[Haemophilus influenzae]] as needed with 3rd generation [[cephalosporin]] |
==Disposition== | ==Disposition== | ||
| − | * | + | *Admit |
==External Links== | ==External Links== | ||
| Line 48: | Line 39: | ||
==See Also== | ==See Also== | ||
| − | |||
*[[Hip Pain (Peds)]] | *[[Hip Pain (Peds)]] | ||
*[[Septic Arthritis (Peds)]] | *[[Septic Arthritis (Peds)]] | ||
| − | *[[ | + | *[[Limp (peds)]] |
| + | |||
| + | ==References== | ||
| + | <references/> | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
Revision as of 23:48, 21 May 2018
Contents
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
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
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
- 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
Disposition
- Admit