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[Coxitis in children]
1Ortopedisk avdeling, Buskerud sentralsykehus, Drammen.
Insights
Delayed diagnosis of suppurative arthritis, especially in newborns, can lead to severe complications like femoral head necrosis. Early detection and treatment are crucial for better outcomes in septic coxitis.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Medical Diagnostics
Background:
- Suppurative arthritis (septic coxitis) requires prompt diagnosis and treatment to prevent joint destruction.
- This study reviews therapeutic procedures and presents two cases of Staphylococcus aureus septic arthritis.
Observation:
- A newborn with delayed diagnosis presented with femoral head necrosis and luxation, exhibiting subtle symptoms possibly due to immunodeficiency.
- A 14-year-old boy had typical septic coxitis, treated successfully with early arthrotomy and antibiotics.
Findings:
- Penicillinase-producing Staphylococcus aureus was identified in both cases.
- Delayed diagnosis, associated osteomyelitis, and the presence of penicillinase-producing Staphylococcus aureus negatively impact prognosis.
- Ultrasonography and bone scintigraphy are vital for therapeutic strategy in suspected cases.
Implications:
- Prompt diagnosis and surgical intervention (arthrotomy) are critical for favorable outcomes in pediatric septic arthritis.
- Understanding the subtle clinical presentation in infants is essential for timely intervention.
- Advanced imaging modalities aid in treatment planning and prognosis assessment.
Abstract:
The article includes a historical review of therapeutic procedures. Two patients with suppurative arthritis are described, one newborn child with delayed diagnosis resulting in necrosis of the femoral head and luxation. This child was in very good health all the time with no signs reflecting the severity of the infection; a fact which explains the failure to diagnose the condition. Immunodeficiency during the first year of life is probably responsible for the subdued clinical findings. Another patient, a 14 year-old boy, had a typical septic coxitis, which was treated early with arthrotomy and antibiotics with good result. Penicillinase-producing staphylococcus aureus was the causative organism in both patients. Osteomyelitis in the metaphysis was also present in the first patient. The most important factors affecting prognosis seem to be delayed diagnosis and arthrotomy. Associated osteomyelitis and penicillinase-producing staphylococcus aureus are also factors having an adverse influence on prognosis. The diagnostic aspects of transient synovitis and the pathogenetic correlation between this and Perthes' disease are discussed. In this field, ultrasonography and bone scintigraphy are essential for planning the strategy of therapy. The high risk of femoral head destruction is obvious.