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

(Text replacement - "Category:Peds" to "Category:Pediatrics")
(Text replacement - "* " to "*")
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*Age - 6 mo to 8 yrs
 
*Age - 6 mo to 8 yrs
 
*Pain, Pseudoparalysis
 
*Pain, Pseudoparalysis
* May present with referred knee or thigh pain
+
*May present with referred knee or thigh pain
* Usually hold joint in flexion, external rotation and slight abduction
+
*Usually hold joint in flexion, external rotation and slight abduction
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
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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
  
Line 36: Line 36:
  
 
==Treatment==
 
==Treatment==
* OR drainage
+
*OR drainage
* IV [[antibiotics]] x 10-14 days (before po)
+
*IV [[antibiotics]] x 10-14 days (before po)
 
**[[Oxacillin]], [[Nafcillin]] or [[Clindamycin]] in penicillin allergic
 
**[[Oxacillin]], [[Nafcillin]] or [[Clindamycin]] in penicillin allergic
** Cover [[Haemophilus influenzae]] as needed with 3rd generation [[cephalosporin]]
+
**Cover [[Haemophilus influenzae]] as needed with 3rd generation [[cephalosporin]]
  
 
==Disposition==
 
==Disposition==

Revision as of 08:20, 8 July 2016

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

Evaluation

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

Disposition

  • Admission

External Links

See Also