Diferencia entre revisiones de «Septic arthritis of the hip (peds)»
m (Rossdonaldson1 moved page Septic Arthritis (Hip) to Septic arthritis of the hip (peds)) |
Sin resumen de edición |
||
| Línea 11: | Línea 11: | ||
==Workup== | ==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 | |||
==Diagnosis== | ==Diagnosis== | ||
| Línea 26: | Línea 26: | ||
===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 | *1/4 criteria met --> 3% have septic joint | ||
| Línea 37: | Línea 37: | ||
==Treatment== | ==Treatment== | ||
* OR drainage | |||
* 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== | ||
Revisión del 04:05 7 jun 2015
Background
- hematogenous spread or local inf.
- wt. bearing joints most common
- knee (40-50%)
- hip (20- 25%)
- staph, S. Pneumo, group A strep
- in neonates also Groub B strep % gram neg.
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:
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
Diagnosis
- Age - 6 mo to 8 yrs
- Pres - Pain, Pseudoparalysis
- may present w/ referred knee or thigh pain
- usually hold jt in flexion, ext rotat & slt abduction.
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
- Oxacillin, Nafcillin or Clinda in pen all
- cover H. inf as needed w/ 3rd gen ceph.
- IV abx for 10-14 days before po