Diferencia entre revisiones de «Septic arthritis of the hip (peds)»
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==Background== | ==Background== | ||
{{Hip anatomy background images}} | |||
* | *Age - 6 mo to 8 yrs | ||
*Hematogenous spread or local infection | |||
* | *[[Staph]], [[S. Pneumo]], [[group A strep]] | ||
* | *Neonates: also [[Group B strep]] and [[gram negatives]] | ||
* | |||
== | ==Clinical Features== | ||
*[[Hip pain (peds)|Pain]], pseudoparalysis | |||
*May present with referred knee or thigh pain | |||
*Usually hold joint in flexion, external rotation and slight abduction | |||
==Differential Diagnosis== | |||
{{Pediatric hip DDX}} | |||
Labs - ESR > 20 | ==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: | |||
**[[musculoskeletal ultrasound|Ultrasound]] to evaluate for effusion | |||
**CT to evaluate for [[abscess]] | |||
{{Kocher criteria}} | |||
==Management== | |||
*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== | |||
*Admit | |||
==External Links== | |||
*[http://www.mdcalc.com/kocher-criteria-septic-arthritis/ MDCalc - Kocher Criteria for Septic Arthritis] | |||
==See Also== | ==See Also== | ||
[[Hip Pain]] | *[[Hip Pain (Peds)]] | ||
*[[Septic Arthritis (Peds)]] | |||
[[Septic Arthritis (Peds)]] | *[[Limp (peds)]] | ||
==References== | |||
<references/> | |||
[[Category: | [[Category:Pediatrics]] | ||
[[Category: | [[Category:Orthopedics]] | ||
[[Category:ID]] | |||
Revisión actual - 20:25 26 feb 2025
Background
- Age - 6 mo to 8 yrs
- Hematogenous spread or local infection
- Staph, S. Pneumo, group A strep
- Neonates: also Group B strep and gram negatives
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 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:
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:
- Ultrasound to evaluate for effusion
- CT to evaluate for abscess
Kocher Criteria for septic arthritis of the hip
- ESR > 40 mm/hr
- WBC > 12,000/microliter
- Refusal or inability to weight bear on affected joint
- Fever 38.5° C or greater
| Number of Kocher Criteria | Chance of Septic Joint |
| 1 | 3% |
| 2 | 40% |
| 3 | 93% |
| 4 | 99% |
Management
- 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
- Admit