Orthopaedic infections in children 2
SEPTIC ARTHRITIS
- In children septic arthritis can occur at any age but 50% of cases occur in children under 5years and 30% of cases occur in children under 2years
- Hip most commonly affected in infants, and knee in older children
- 10% of cases will have more than 1 joint affected
Route of spread
- Haematogenous
- Spread from metaphyseal osteomyelitis where the metaphysis is intra-articular
- Spread from contiguous soft tissue infection
- Direct inoculation
Causative organism
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Under 2 years
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2-16 years
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16-30 years
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over 30 years
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S.aureus
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S.aureus
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S.aureus
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S.aureus
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E.coli
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Strep. Pyogenes
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Strep. pyogenes
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Streptococci (A,B,C,G,pneumon)
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Group B Strep
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Streptococci (C,G)
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N.gonorrhoea
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Haemophilus
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Haemophilus
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Since the introduction of the HiB vaccine the incidence of haemophilus infections has dropped dramatically (Personal correspondence from Stepping Hill Hospital microbiology department)
Investigations
- FBC, ESR, CRP
- USS for detection of hip effusion
- XR may show subluxation or dislocation
Diagnostic aspiration
Send sample for
- Gram stain and microscopy
- Septic arthritis strongly suspected if the WCC is >50,000mm-3 with 90% PMN, even if the cultures are negative
- Culture
Differential diagnosis
Child
- Irritable hip (transient synovitis)
- Acute rheumatic fever
- Henoch-Schonlein purpura
Adult
- Gout
- Pseudogout
- Acute RA/OA
- Acute
- monarthropy
Treatment
- IV antibiotics broad spectrum aimed at best guess first then adjusted according to microbiology results
- Length of treatment (minimum)
- IV 2 weeks
- Oral child 2-4 weeks
- Adult 4-6 weeks
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Lower Limb
