Septic arthritis of the hip (peds): Difference between revisions
Line 23: | Line 23: | ||
**may be useful to look for abscess, UTZ for effusion | **may be useful to look for abscess, UTZ for effusion | ||
===Kocher Criteria=== | ===Evaluation=== | ||
====Kocher Criteria==== | |||
#ESR > 40 | #ESR > 40 | ||
#WBC > 12 | #WBC > 12 | ||
#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 |
Revision as of 12:56, 26 August 2015
Background
- Hematogenous spread or local infection
- Staph, S. Pneumo, group A strep
- 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
Pediatric hip pain
- Acute rheumatic fever
- Developmental dysplasia of hip
- Femur fracture
- Juvenile idiopathic arthritis
- Legg-Calve-Perthes disease
- Septic arthritis of the hip (peds)
- Lyme disease arthritis
- Slipped capital femoral epiphysis
- Transient (toxic) synovitis
- Osteosarcoma
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
- 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
- OR drainage
- IV antibiotics x 10-14 days (before po)
- Oxacillin, Nafcillin or Clindamycin in penicillin allergic
- Cover Haemophilus influenzae as needed with 3rd generation cephalosporin
Disposition
- Admission