The Clinical Aspects of Septic Arthritis in Children

Koo, Milim; Kim, Dongsoo

Abstract

PURPOSE
Acute septic arthritis in infancy and childhood is uncommon. Delay of diagnosis and inappropriate treatment of septic arthritis results in permanent physical sequelae. We studied the initial treatment, clinical manifestations, involved sites, and etiologic organisms of septic arthritis.
METHODS
We reviewed 74 patients who were diagnosed septic arthritis in Departments of Pediatrics and Orthopedic Surgery, Yonsei University College of Medicine from July 1986 to Sep. 1995.
RESULTS
1) Seventy-four children in the treatment group comprised of 48 males and 26 females. The age distribution is : 21 cases of neonates (28%), 19 cases of infants (26%), and 34 cases of children under 15 years. 2) The frequently involved sites were : 34 cases of hip joint (45%), 28 cases of knee joint (37%), 8 cases of shoulder joint (10%), 4 cases of elbow joint (5%), and 2 cases of ankle joint (3%). In two cases, two joints were involved simultaneously. 3) On imaging studies, 37.8% (28/74) of all cases had abnormal X-ray findings initially. Bone scan were done in 43 cases (58.1%). Half of these cases (22/43) had abnormal, increased uptake in involved joint during the third hospital day through seventh. 4) There were some predisposing factors. : respiratory tract infection (63.5%), trauma (6.8%), sepsis (8.1%), congenital hip dislocation (1/74). However, there were no specific problems in 15 cases. 5) Major complaints of patients were : limitation of motion, fever, local swelling, pain, tenderness, erythema, irritability, and heating sensation, etc. 6) Sixty-three cases had bacterial growth, either from blood or wound. Wounds cultures were positive in 23 cases. : S. aureus (13/23), Streptococcus (6/23). The combination of incision & drainage, irrigation, intravenous antibiotics and traction were therapeutic modalities. Antibiotics used were cephalosporins and vancomycin.
CONCLUSIONS
Early diagnosis and treatment are essential to prevent the permanent sequelae of septic arthritis. In cases presenting with limitation of motion, fever, or pain with or without abnormal radiologic findings, septic arthritis should be ruled out.