Septic Arthritis of Hip

 History of fever, malaise and reluctance to bear weight on his leg 

https://doctorlib.info/medical/clinical-practice-emergency-medicine/243.html

What will be your approach to diagnosis?

    Assess in line of Septic Arthritis and Osteomyelitis 

    

How to assess a child with hip pain and unwell ? 

 Child unwell - appetite / sleep / pain / weight bearing or not 

  Temperature 

   Resting posture of Hip (FABER )

    ROM of hip joint

    Also examine LL ,Spine , Chest and Abdomen

    Investigations 

            X-ray of Pelvis AP and ipsilateral hip latera view to r/o fracture and any structural abnormality

            USG - shows hip effusion , taping done and c/s 

            Blood c/s , WBC and ESR 

    Treatment 

            Arthrotomy and Pus drainage 

                    remove ellipse of capsule ,allow free drainage 

                    sample sent for c/s 

                    irrigation

        Hip Spica 

        Appropriate Antibiotics -initially broad spectrum antibiotics then adjusting based on c/s report and         clinical response.

        Serial Inlfammatory markers evaluation    

        Longer follow up for growth and development of acetabulum 

Predictive Markers for Hip sepsis

       temperature > 38.5 degree celcius 

        WBC > 12,000 cells/ mm3

        ESR > 40 

        Non-weight bearing