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

(Background)
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* [[Staph]], [[S. Pneumo]], [[group A strep]]
 
* [[Staph]], [[S. Pneumo]], [[group A strep]]
 
* in neonates also [[Group B strep]] and [[gram negatives]]
 
* in neonates also [[Group B strep]] and [[gram negatives]]
 +
 +
==Clinical Features==
 +
*Age - 6 mo to 8 yrs
 +
*Pain, Pseudoparalysis
 +
* May present with referred knee or thigh pain
 +
* Usually hold joint in flexion, external rotation and slight abduction
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
 
{{Pediatric hip DDX}}
 
{{Pediatric hip DDX}}
  
==Workup==
+
==Diagnosis==
 +
===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)
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* CT  
 
* CT  
 
**may be useful to look for abscess, UTZ for effusion
 
**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===
 
===Kocher Criteria===
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*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
+
* IV [[antibioticis]] x 10-14 days (before po)
* cover H. inf as needed w/ 3rd gen ceph.
+
**[[Oxacillin]], [[Nafcillin]] or [[Clindamycin]] in penicillin allergic
* IV abx for 10-14 days before po
+
** Cover [[H. inf]] as needed with 3rd generation [[cephalosporin]]
  
 
==External Links==
 
==External Links==

Revision as of 04:13, 7 June 2015

Background

Clinical Features

  • Age - 6 mo to 8 yrs
  • 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

Diagnosis

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

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

External Links

See Also