Updated: 6/13/2021

SI Joint Infection - Pediatric

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  • summary
    • SI Joint Infections are rare infections in the pediatric population most commonly associated with progressive low back and buttock pain. 
    • Diagnosis is generally made with MRI studies. 
    • Treatment is nonoperative with antibiotics targeted towards the specific organism in the majority of cases. Surgical debridement is indicated in the presence of abscess or lack of response to antibiotics. 
  • Epidemiology
    • Incidence
      • rare and only accounts for 1-2% of cases of septic arthritis
    • Demographics
      • more common in children over the age of 10 than adults
    • Risk factors in adults
      • intravenous drug abuse
      • immune suppression
      • pregnancy
      • trauma
      • infective endocarditis
      • sepsis
      • TB
  • Etiology
    • Pathophysiology
      • microbiology
        • staphylococcus aureus
          • is the causative organism in most of these infections
        • mycobacterium tuberculosis
          • skeletal tuberculosis accounts for 3–5 % of all tuberculosis, of which approximately 10 % occurs at the SIJ
        • Salmonella
          • seen in the setting of Sickle Cell Disease
  • Presentation
    • Symptoms
      • progressive low back and buttock pain
      • unable to bear weight on affected side secondary to pain
      • fever
    • Physical exam
      • pain worsened by
        • compression of the iliac wings
        • palpation of the right sacroiliac (SI) joint
      • motion
        • normal hip range of motion
      • provocative tests
        • Faber test
          • positive flexion, abduction and external rotation (FABER) test of the hip joint that dramatically aggravates the pain
  • Imaging
    • Radiographs
      • indication
        • painful SI joints
      • views
        • AP and lateral pelvis
      • optional views
        • inlet/outlet views
      • findings
        • joint destruction
        • partial or complete fusion
        • periarticular osteopenia
        • widening and cavitation
    • MRI
      • is the most sensitive diagnostic study for SIJ infection
      • findings in the acute phase
        • intra-articular fluid or gas
        • subchondral bone marrow edema
        • articular and periarticular post-gadolinium enhancement and soft tissue edema
      • findings in chronic phase
        • periarticular bone marrow reconversion
        • replacement of articular cartilage by pannus
        • bone erosion
        • subchondral sclerosis
        • joint space widening or narrowing and ankylosis
      • outcomes
        • more sensitive than CT scan
  • Studies
    • Serum labs
      • elevated WBC
      • elevated ESR (>50)
      • elevated CRP (>70)
    • Blood cultures
      • may be positive and should be obtained prior to starting antibiotics
  • Treatment
    • Nonoperative
      • antibiotics targeted towards the specific organism
        • indications
          • first line of treatment
        • technique
          • target staph aureus in children if no organism is identified from blood cultures
    • Operative
      • surgical debridement only - rarely needed in children
        • indications
          • acute cases with abscess present
          • failed antibiotic treatment
          • the presence of sequestered bone
      • debridement and SI joint arthrodesis
        • indications
          • chronic cases
          • sequestered bone with joint narrowing/destruction
          • recurrent infection
        • outcomes
          • longer operative times
          • more complications
  • Complications
    • chronic pain
    • recurrent infection
    • delayed wound healing
    • hardware complications
    • sepsis
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