Good Morning and Welcome Applicants!

December 2, 2010

Septic ArthritisOsteomyelitis

Septic Arthritis• Most common organism?

• Staph Aureus• Presentation?

• Acute• Monoarthritis• Erythema• Warmth• Swelling• Intense pain on movement• Fever – 70%

Septic Arthritis• Definitive Diagnostic Test?

• Joint fluid anaylsis and culture• Other labs or studies?

• CBC• ESR/CRP• US• CT/MRI

Septic Arthritis• Emergency?

• Outcome depends of timing of diagnosis, initiation of antibiotics, adequacy of drainage, virulence and host factors

Osteomyelitis• Presentation

• Fever• Localized pain• Erythema• Swelling• Pinpoint tenderness• Decreased ROM

Osteomyelitis• Diagnosis?

• Bone scan• MRI• Bone Culture

• Other labs?• WBC• ESR/CRP• Blood culture – 60%• Bone culture – 80%• Plain films

Transient or Toxic Synovitis

• Emergency?• Benign, self-limited

• Causes?• Acute or post infection• Trauma

• 30% of all nontraumatic limps

Transient Synovitis• Presentation?

• Limp• Painful hip• Afebrile or low-grade• Otherwise appears well• Mild restriction of ROM

Transient Synovitis• Diagnosis?

• Exclude septic arthritis and osteo• Four predictors associated with septic

arthritis• History of fever• Inability to bear weight• ESR >40• WBC >12

Transient Synovitis• Treatment?

• Rest• Anti-inflammatory

• Most children do very well