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

(DDX)
(Treatment)
Line 38: Line 38:
  
 
==Treatment==
 
==Treatment==
# 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.

Revision as of 06:32, 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

Workup

  1. Labs - ESR > 20 after 1-2 d, WBC >
  2. Bld Cxs (40-50% grow out)
  3. Xrays
    1. useful to exclude other cause of joint pain (AP & Frog leg)
    2. possible effusion
  4. CT
    1. 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

  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. OR 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)