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

(Background)
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==Background==
 
==Background==
 
*hematogenous spread or local inf.
 
*hematogenous spread or local inf.
* wt. bearing joints most common
+
* [[Staph]], [[S. Pneumo]], [[group A strep]]
* knee (40-50%)
+
* in neonates also [[Group B strep]] and [[gram negatives]]
* hip (20- 25%)
 
* staph, S. Pneumo, group A strep
 
* in neonates also Groub B strep % gram neg.
 
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==

Revision as of 04:09, 7 June 2015

Background

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