Septic arthritis of the hip (peds): Difference between revisions
Ostermayer (talk | contribs) (Text replacement - "Category:Peds" to "Category:Pediatrics") |
Neil.m.young (talk | contribs) (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 | ||
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==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
- 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 limp
Hip Related
- 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
Other Causes of Limping
- Developmental dysplasia
- Fracture
- Toddler's fracture
- Tillaux fracture, adolescent
- Neoplasm:
- Leukemia
- Ewings
- Osteogenic sarcoma
- Metastatic neuroblastoma
- Osteomyelitis
- Myositis
- Other:
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