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Hip Septic Arthritis - Pediatric
Posted: Jan 6 2014 #(C1746)
A

Pediatric Hip Pain in 8 month old

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HPI

An 8 month old male presents with a 4-day history of decreased movement of the left hip, intermittent fever measured up to 101.5 F, and general fussiness.

PMH

Unremarkable for PMH or PSH. Full-term, spontaneous vaginal delivery without complications.

PE

Physical exam reveals an irritable and crying infant. There is decreased active movement of the left hip during exam. The left hip is maintained in flexed and abducted position. Painful range of motion of hip; difficult to isolate any specific focal area of tenderness. He is afebrile. Labs: CRP = 5.8 mg/dl ESR = 115 mm/Hr WBC's = 12K

Poll
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In addition to plain radiographs of the hip, would you obtain any additional imaging to guide treatment?
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P: 130394
Would you use a classification system to guide management?
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P: 130395
If you choose the Original Kocher criteria, how many points would you give this patient?
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P: 130396
Would you obtain a Hip aspiration on this patient?
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P: 130401
If you choose to obtain a Hip aspiration, would you perform the procedure yourself?
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P: 130398
If you choose to obtain a Hip aspiration, would you use a synovial WBC cut-off to guide surgical management?
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P: 130400
If Hip aspiration reveals a synovial WBC count of 25K, how you manage this patient at this time?
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P: 130397
If you choose Nonoperative management, how would you monitor for improvement?
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P: 130399
PROCEDURE #1 DOP: 12/25/2013

Aspiration of hip and proximal femur, both negative. Arthrogram performed to confirm intra-articular needle placement.

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