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

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==Background==
 
==Background==
*hematogenous spread or local inf.
+
*Age - 6 mo to 8 yrs
* wt. bearing joints most common
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*Hematogenous spread or local infection
* knee (40-50%)
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*[[Staph]], [[S. Pneumo]], [[group A strep]]
* hip (20- 25%)
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*Neonates: also [[Group B strep]] and [[gram negatives]]
* staph, S. Pneumo, group A strep
 
* in neonates also Groub B strep % gram neg.
 
  
==DDX==
+
==Clinical Features==
*[[Hip Pain]]
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*[[Hip pain (peds)|Pain]], pseudoparalysis
*[[Hip Pain (Peds)]]
+
*May present with referred knee or thigh pain
 +
*Usually hold joint in flexion, external rotation and slight abduction
  
==Workup==
+
==Differential Diagnosis==
#Labs - ESR > 20 after 1-2 d, WBC >
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{{Pediatric hip DDX}}
# 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==
+
==Evaluation==
*Age - 6 mo to 8 yrs
+
===Workup===
*Pres - Pain, Pseudoparalysis
+
*Labs - ESR >20, WBC >12
* may present w/ referred knee or thigh pain
+
*Blood cultures (40-50% grow out)
* usually hold jt in flexion, ext rotat & slt abduction.
+
*Xrays
 +
**useful to exclude other cause of joint pain (AP & Frog leg)
 +
**possible effusion
 +
*Consider:
 +
**[[musculoskeletal ultrasound|Ultrasound]] to evaluate for effusion
 +
**CT to evaluate for [[abscess]]
  
===Kocher Criteria===
+
{{Kocher criteria}}
#ESR > 40
 
#WBC > 12
 
#Refusal or inability to weight bear on affected joint
 
#Fever
 
  
*1/4 criteria met --> 3% have septic joint
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==Management==
*2/4 --> 40%
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*OR drainage
*3/4 --> 93%
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*IV [[antibiotics]] x 10-14 days (before po)
*4/4 --> 99%
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**[[Oxacillin]], [[Nafcillin]] or [[Clindamycin]] in penicillin allergic
 +
**Cover [[Haemophilus influenzae]] as needed with 3rd generation [[cephalosporin]]
  
==Treatment==
+
==Disposition==
# OR drainage
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*Admit
# 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==
 
==External Links==
Line 47: Line 39:
  
 
==See Also==
 
==See Also==
*[[Hip Pain]]
+
*[[Hip Pain (Peds)]]
 
*[[Septic Arthritis (Peds)]]
 
*[[Septic Arthritis (Peds)]]
*[[Septic Arthritis (General)]]
+
*[[Limp (peds)]]
 +
 
 +
==References==
 +
<references/>
  
[[Category:Peds]]
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[[Category:Pediatrics]]
[[Category:Ortho]]
+
[[Category:Orthopedics]]
 +
[[Category:ID]]

Latest revision as of 20:34, 6 October 2019

Background

Clinical Features

  • 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

Evaluation

Workup

  • Labs - ESR >20, WBC >12
  • Blood cultures (40-50% grow out)
  • Xrays
    • useful to exclude other cause of joint pain (AP & Frog leg)
    • possible effusion
  • Consider:

Kocher Criteria for septic arthritis of the hip

  • ESR > 40
  • WBC > 12
  • Refusal or inability to weight bear on affected joint
  • Fever
Number of Kocher Criteria Chance of Septic Joint
1 3%
2 40%
3 93%
4 99%

Management

Disposition

  • Admit

External Links

See Also

References