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Septic arthritis in children is an orthopedic Emergency..

WRITTEN AND PUBLISHED BY PTT. THOMAS ADJEI BIO ON

 SEPTIC ARTHRITIS IN CHILDREN 
 Septic arthritis of the knee. 
damaged femur head due to septic arthritis 


Septic arthritis in children is an orthopaedic emergency. As soon as a child is diagnosed of having septic arthritis, an abrupt orthopaedic intervention is required to prevent associated complications and joint damage.

Septic arthritis in children can wrongly be likened to an acute febrile illnesses. Symptoms may arise as though the child is having fever.

 Septic arthritis(SA)
Is an invasion of infection, usually bacterial infection into a synovial joint,usually the hip.
The child may have symptoms developing as that of febrile illness, the child would have relatively high body temperature >38 degrees Celcius, there is joint pain, Swelling and ESR test gives value more than 40mm/h for chronic situations and >200mg/l for CRP in acute situations.
 The child also requires positioning the hip in a position of comfort, usually in abduction, flexion and externally rotated, reduced ROM and difficulty bearing weight.
The position of the hip is resistant to attempt of repositioning, since doing so would aggravate patient's pain.
This particular position would add up to the child's symptoms to differentiate SA from other febrile illness, that may also result in high body temperature, and high values in ESR &CRP.

The commonest cause of SA can be haematogenous route( infection transferred via blood to the site), adjacent osteomyelitis can also be the cause( infection from already infected bone can be transferred to the site when osteomyelitis is left untreated), direct innoculation, less common, mostly from penetrating trauma, can also result, in children up to 2 years, with osteomyelitis, there's increased risk of developing SA, due to loose periosteum and thin cortex coupled with linkage between the epiphyseal and metaphyseal circulation.

During the course of the disease, the body tries to combat the bacterial, and this result in inflammation.
swelling of the joint increases intra-articular pressure, thereby preventing blood from reaching the cartilage and the femur head may die up completely if early intervention does not occur.
Also, the pressure may result in overstretch of the joint capsule which can result in subluxation/dislocation in the joint.


CLINICAL PRESENTATION

  • Many children with septic arthritis will present with severe joint(hip) pain
  • Many children would not bear weight on their limbs due to pain 
  • Fever
  • Limping, those who may try to walk
  • Adduction and internal rotation of the hip may indicate effusion
  • At the hip, hip flexion, abduction, external rotation is most obvious position the child may assume.



      MANAGEMENT OF SA
The medical management of SA is solely administration of antibiotics, but this is dependent on what bacterial is causing the condition. Hospitalization is mandatory.
staph areus(neonates <2months), H. influenza(2-5years children), and N. gonorrhea( in adolescent).

As soon as the antibacteria drug is administed, early mobilization is began.


PHYSIOTHERAPY MANAGEMENT

 The physiotherapy management of SA is aimed to restore the limb to normal functional position, reduce pain, promote ROM, and to maintain muscular strength, and achieve optimum muscle length.

1.Passive mobilization of the hip would reduce the flexion contracture of the hip. It will also improve range of motion of the hip

2.Stretching exercises can be included to stretch tight muscles in chronic situations. Casting can be done to maintain the stretch. The hip position is reversed to normal.

3. Strengthening exercises can be done to improve upon the strength of the quadriceps and hamstrings, whose strength might go down because of prolonged immobilization of the hip.
use quads bench or resistance exercises as soon as pain is reduced.

4. Active exercises would also help maintain muscle tone, and also prevent further complications.


septic arthritis can be treated, good prognosis depends on the earlier intervention is made. delayed intervention would lead to joint damage, leading to disability. Rush your baby to the hospital, when he/she has had episode of hip pain,swelling, coupled with severe fever, because it might be SEPTIC ARTHRITIS.

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 ARTICLE BY:
THOMAS ADJEI BIO
  

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