Diferencia entre revisiones de «Septic arthritis of the hip (peds)»

(Text replacement - "Category:Peds" to "Category:Pediatrics")
 
(No se muestran 10 ediciones intermedias de 4 usuarios)
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==Background==
==Background==
{{Hip anatomy background images}}
*Age - 6 mo to 8 yrs
*Hematogenous spread or local infection
*Hematogenous spread or local infection
*[[Staph]], [[S. Pneumo]], [[group A strep]]
*[[Staph]], [[S. Pneumo]], [[group A strep]]
Línea 5: Línea 7:


==Clinical Features==
==Clinical Features==
*Age - 6 mo to 8 yrs
*[[Hip pain (peds)|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==
{{Pediatric hip DDX}}
{{Pediatric hip DDX}}


==Diagnosis==
==Evaluation==
===Workup===
===Workup===
*Labs - ESR > 20 after 1-2 d, WBC >
*Labs - ESR >20, WBC >12
* Bld Cxs (40-50% grow out)
*Blood cultures (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
*Consider:
**may be useful to look for abscess, UTZ for effusion
**[[musculoskeletal ultrasound|Ultrasound]] to evaluate for effusion
 
**CT to evaluate for [[abscess]]
===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
{{Kocher criteria}}
*2/4 --> 40%
*3/4 --> 93%
*4/4 --> 99%


==Treatment==
==Management==
* 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==
*Admission
*Admit


==External Links==
==External Links==
Línea 48: Línea 40:


==See Also==
==See Also==
*[[Hip Pain]]
*[[Hip Pain (Peds)]]
*[[Hip Pain (Peds)]]
*[[Septic Arthritis (Peds)]]
*[[Septic Arthritis (Peds)]]
*[[Septic Arthritis (General)]]
*[[Limp (peds)]]
 
==References==
<references/>


[[Category:Pediatrics]]
[[Category:Pediatrics]]
[[Category:Orthopedics]]
[[Category:Orthopedics]]
[[Category:ID]]

Revisión actual - 20:25 26 feb 2025

Background

Hip anatomy.
Extracapsular ligaments (anterior right hip).
Extracapsular ligaments (posterior right hip).

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

Other Causes of Limping

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 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

Disposition

  • Admit

External Links

See Also

References

Obtenido de «https://www.wikem.org/w/index.php?title=Septic_arthritis_of_the_hip_(peds)&oldid=375804»