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

(Text replacement - "UTZ" to "ultrasound")
 
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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]]
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==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
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==Evaluation==
 
==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, ultrasound for effusion
+
**Ultrasound to evaluate for effusion
 
+
**CT to evaluate for abscess
===Evaluation===
 
====Kocher Criteria====
 
#ESR > 40
 
#WBC > 12
 
#Refusal or inability to weight bear on affected joint
 
#Fever
 
  
*1/4 criteria met --> 3% have septic joint
+
{{Kocher criteria}}
*2/4 --> 40%
 
*3/4 --> 93%
 
*4/4 --> 99%
 
  
 
==Management==
 
==Management==
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==Disposition==
 
==Disposition==
*Admission
+
*Admit
  
 
==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)]]
+
*[[Limp (peds)]]
 +
 
 +
==References==
 +
<references/>
  
 
[[Category:Pediatrics]]
 
[[Category:Pediatrics]]
 
[[Category:Orthopedics]]
 
[[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