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

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==Workup==
 
==Workup==
#Labs - ESR > 20 after 1-2 d, WBC >
+
*Labs - ESR > 20 after 1-2 d, WBC >
# Bld Cxs (40-50% grow out)
+
* Bld Cxs (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  
+
* CT  
##may be useful to look for abscess, UTZ for effusion
+
**may be useful to look for abscess, UTZ for effusion
  
 
==Diagnosis==
 
==Diagnosis==
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===Kocher Criteria===
 
===Kocher Criteria===
#ESR > 40
+
*ESR > 40
#WBC > 12
+
*WBC > 12
#Refusal or inability to weight bear on affected joint
+
*Refusal or inability to weight bear on affected joint
#Fever
+
*Fever
  
 
*1/4 criteria met --> 3% have septic joint
 
*1/4 criteria met --> 3% have septic joint
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==Treatment==
 
==Treatment==
# OR drainage
+
* OR drainage
# Oxacillin, Nafcillin or Clinda in pen all
+
* Oxacillin, Nafcillin or Clinda in pen all
# cover H. inf as needed w/ 3rd gen ceph.
+
* cover H. inf as needed w/ 3rd gen ceph.
# IV abx for 10-14 days before po
+
* IV abx for 10-14 days before po
  
 
==External Links==
 
==External Links==

Revision as of 04:05, 7 June 2015

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.

Differential Diagnosis

Pediatric hip pain

Workup

  • Labs - ESR > 20 after 1-2 d, WBC >
  • Bld Cxs (40-50% grow out)
  • Xrays
    • useful to exclude other cause of joint pain (AP & Frog leg)
    • possible effusion
  • CT
    • may be useful to look for abscess, UTZ for effusion

Diagnosis

  • Age - 6 mo to 8 yrs
  • Pres - Pain, Pseudoparalysis
  • may present w/ referred knee or thigh pain
  • usually hold jt in flexion, ext rotat & slt abduction.

Kocher Criteria

  • ESR > 40
  • WBC > 12
  • Refusal or inability to weight bear on affected joint
  • Fever
  • 1/4 criteria met --> 3% have septic joint
  • 2/4 --> 40%
  • 3/4 --> 93%
  • 4/4 --> 99%

Treatment

  • OR 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

External Links

See Also