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

(See Also)
Line 6: Line 6:
 
* staph, S. Pneumo, group A strep
 
* staph, S. Pneumo, group A strep
 
* in neonates also Groub B strep % gram neg.
 
* in neonates also Groub B strep % gram neg.
 +
 +
==DDX==
 +
[[Hip Pain (Peds)]]
  
 
==Diagnosis==
 
==Diagnosis==
Age - 6 mo to 8 yrs
+
*Age - 6 mo to 8 yrs
 
+
*Pres - Pain, Pseudoparalysis
Pres - Pain, Pseudoparalysis
+
*Labs - ESR > 20 after 1-2 d, WBC >
 
+
*Xrays - possible effusion
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
+
* 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.
  
4. Fever
+
===Kocher Criteria===
 +
#ESR > 40
 +
#WBC > 12
 +
#Refusal or inability to weight bear on affected joint
 +
#Fever
  
 
*1/4 criteria met --> 3% have septic joint
 
*1/4 criteria met --> 3% have septic joint

Revision as of 06:28, 25 February 2012

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.

DDX

Hip Pain (Peds)

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

  1. drainage
  2. Oxacillin, Nafcillin or Clinda in pen all
  3. cover H. inf as needed w/ 3rd gen ceph.
  4. IV abx for 10-14 days before po

See Also

Hip Pain

Septic Arthritis (Peds)

Septic Arthritis (General)