A 7 years old child present with flexed and abducted hip, passive movement are not allowed. Hemogram is normal with moderately raised ESR. Next line of management: (AIPG 2011)
|A||Admit and watch|
|D||Aspiration under USG guidance|
Aspiration under USG guidance
Once a joint is suspected of being infected, aspiration of synovial fluid with a large bore needle should be done under USG guidance before antibiotic therapy is started
a. Acute septic arthritis in an infant is difficult to diagnose because fever, swelling and other symptom of inflammatory disease may be lacking.
b. The only finding may be infection at another site, i.e. umbilical catheter, irritability, asymmetry of limb position etc.
c. Once a joint is suspected of being infected, aspiration of synovial fluid with a large bore needle should be done under USG guidance before antibiotic therapy is started.
d. In septic arthritis, the cell count usually is greater than 80,000, with more than 75 percent of the cells being neutrophils. Gram stains identify the types of organisms (gram-positive or gram-negative) in about a third of bone and joint aspirates.
e. A white blood cell count greater than 10 per high-power field is considered indicative of infection, whereas a count less than 5 per high-power field all but excludes infection.
Synovial fluid analysis
a. Disease Leukocytes Neutrophils (%)
b. Normal <200 <25
c. Traumatic <5000 <25
d. Toxic synovitis 5000-15,000 <25
e. Acute rheumatic fever 10,000-15,000 50
f. Juvenile rheumatoid
g. Arthritis 15,000-80,000 75
h. Septic arthritis >80,000 >75