Difference between revisions of "Septic arthritis of the hip (peds)"
(Created page with "==Background== - hematogenous spread or local inf. - wt. bearing joints most common - knee (40-50%) - hip (20- 25%) - staph, S. Pneumo, group A strep - in neonates also Gr...") |
(→Diagnosis) |
||
| Line 17: | Line 17: | ||
| − | ==Diagnosis== | + | == Diagnosis == |
| − | |||
Age - 6 mo to 8 yrs | Age - 6 mo to 8 yrs | ||
| Line 28: | Line 27: | ||
Xrays - possible effusion | Xrays - possible effusion | ||
| − | + | ||
- may present w/ referred knee or thigh pain | - may present w/ referred knee or thigh pain | ||
| Line 36: | Line 35: | ||
- get Bld Cxs (40-50% grow out) | - get Bld Cxs (40-50% grow out) | ||
| − | + | ||
- Xrays useful to exclude other cause of joint pain (AP & Frog leg) | - Xrays useful to exclude other cause of joint pain (AP & Frog leg) | ||
| Line 42: | Line 41: | ||
- CT may be useful to look for abscess, UTZ for effusion. | - CT may be useful to look for abscess, UTZ for effusion. | ||
| − | + | ||
| + | |||
| + | '''Kocher Criteria''' | ||
| + | |||
| + | 1. ESR > 40 | ||
| + | |||
| + | 2. WBC > 12 | ||
| + | |||
| + | 3. Refusal or inability to weight bear on affected joint | ||
| + | |||
| + | 4. Fever | ||
| + | |||
| + | 1/4 criteria met --> 3% have septic joint | ||
| + | |||
| + | 2/4 --> 40% | ||
| + | |||
| + | 3/4 --> 93% | ||
| + | |||
| + | 4/4 --> 99% | ||
==Treatment== | ==Treatment== | ||
Revision as of 22:37, 20 June 2011
Contents
Background
- hematogenous spread or local inf.
- wt. bearing joints most common
- knee (40-50%)
- hip (20- 25%)
- staph, S. Pneumo, group A strep
- in neonates also Groub B strep % gram neg.
Diagnosis
Age - 6 mo to 8 yrs
Pres - Pain, Pseudoparalysis
Labs - ESR > 20 after 1-2 d, WBC >
Xrays - possible effusion
- may present w/ referred knee or thigh pain
- 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
1. ESR > 40
2. WBC > 12
3. Refusal or inability to weight bear on affected joint
4. Fever
1/4 criteria met --> 3% have septic joint
2/4 --> 40%
3/4 --> 93%
4/4 --> 99%
Treatment
- drainage
- 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
Peds: Hip Pain
- SEPTIC JOINT***
- usu acute, same mech as OM, usu similar org w/ s. aureus most common (think gc if older).
- Rx= aspirate sufficient for all xcept hip, must go to OR/IR w/ hip b/c incr pressure can cause avn of hip! o/w tap okay, usu OR if reaccumulates. send for (in order) 1) cx 2) count 3) gs.
- CBC >15 in 50%, ESR >60mm/hr in >90% of cases, CRP >20mg/L in 94%, Bcx 50%, fluid usu >50,000 WBC
(in gc arthritis: +blood cx: ~0%, +fluid cx/gs: 25-50%, urethral/rectal/throat swab may incr cx yield)
- xr for septic hip usu w/ joint space wide of >1-2 mm vs other side
- Rx= neonate ox & gent, 2mo-5yr cefotax & ox, 5y-12y ox (vanco?), >12 ox & ctx