Orthoteers homepage Advertise on Orthoteers
Orthoteers Junior Orthoteers Orthopaedic Biomechanics Orthopaedic World Literature Society Educational Resources Image Gallery About Orthoteers Orthoteers Members search

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

  1. Haematogenous
  2. Spread from metaphyseal osteomyelitis where the metaphysis is intra-articular
  3. Spread from contiguous soft tissue infection
  4. Direct inoculation

Causative organism

Under 2 years

2-16 years

16-30 years

over 30 years

S.aureus

S.aureus

S.aureus

S.aureus

E.coli

Strep. Pyogenes

Strep. pyogenes

Streptococci (A,B,C,G,pneumon)

Group B Strep

Streptococci (C,G)

N.gonorrhoea

Haemophilus

Haemophilus

 

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


This is a preview of the site content. To view the full text for this site, you need to log in.
If you are having problems logging in, please refer to the login help page.


© 2005-2007 Orthoteers.co.uk - last updated by Len Funk on 14 February 2005Medical Merketing and SEO by Blue Medical 
Biomet supporting orthoteersThe British Orthopedic Association supporting OrthoteersOrthoteers is a non-profit educational resource. Click here for more details
Lower Limb
Paediatric Spine
Arthritis in Children
Bibliography, Links & Recommended R...
Birth injuries
Cerebral palsy
Cerebral Palsy - Treatment
Childhood Upper extremity problems
Eastwood / Cole Method
Ellis-van Creveld Syndrome
Fracture Principles in Paediatrics
Gait abnormalities
Genetic disorders
Haematopoietic Disorders
Hereditary Sensory & Motor Neur...
Klippel-Feil syndrome
Metabolic disease
Metaphyseal Chondrodysplasia Case
Neuromuscular disorders
Orthopaedic embryology
Orthopaedic infections in children
Orthopaedic infections in children ...
Osteogenisis Imperfecta
Poliomyelitis
Skeletal dysplasias
Hide Menu