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

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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
*[[Hip pain (peds)|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
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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
*Consider:
*Consider:
**Ultrasound to evaluate for effusion
**[[musculoskeletal ultrasound|Ultrasound]] to evaluate for effusion
**CT to evaluate for abscess
**CT to evaluate for [[abscess]]


{{Kocher criteria}}
{{Kocher criteria}}
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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]]
[[Category:ID]]

Latest revision as of 20:34, 6 October 2019

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:

Kocher Criteria for septic arthritis of the hip

  • ESR > 40 mm/hr
  • WBC > 12,000/microliter
  • Refusal or inability to weight bear on affected joint
  • Fever 38.5° C or greater
Number of Kocher Criteria Chance of Septic Joint
1 3%
2 40%
3 93%
4 99%

Management

Disposition

  • Admit

External Links

See Also

References