Septic arthritis: just like osteomyelitis in a child, a septic joint is usually hematogenous in origin and frequently follows a URI. The m.c are staph and strep. It is characterized by severe pain, leukocytosis and elevated ESR. The affected limb is externally rotated (this allows for maximal pus accumulation
US guided aspiration of the synovial fluid should be performed immediately. The x-ray is often normal.
- Empiric antibiotics based on the gram stain results and child’s age should be administered immediately.
- infants a combo of nafcillin and a 3rd generation cephalosporin
- children over 5 years nafcillin alone is reasonable.
- This is a true surgical emergency and needs immediate drainage. A delay of even 4 - 6 hours can lead to avascular necrosis of the femoral head.