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
* 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
  
==DDX==
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==Differential Diagnosis==
[[Hip Pain (Peds)]]
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{{Pediatric hip DDX}}
  
==Diagnosis==
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==Evaluation==
*Age - 6 mo to 8 yrs
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===Workup===
*Pres - Pain, Pseudoparalysis
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*Labs - ESR >20, WBC >12
*Labs - ESR > 20 after 1-2 d, WBC >
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*Blood cultures (40-50% grow out)
*Xrays - possible effusion
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*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
  
* may present w/ referred knee or thigh pain
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{{Kocher criteria}}
* 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===
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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==
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==External Links==
# drainage
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*[http://www.mdcalc.com/kocher-criteria-septic-arthritis/ MDCalc - Kocher Criteria for Septic Arthritis]
# 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]]
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*[[Hip Pain (Peds)]]
 
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*[[Septic Arthritis (Peds)]]
[[Septic Arthritis (Peds)]]
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*[[Limp (peds)]]
  
[[Septic Arthritis (General)]]
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==References==
 +
<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