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Acute septic arthritis in infancy and childhood. 10 years' experience
Insights
Septic arthritis management in children varies by joint and symptom duration. Selective arthrotomy, rather than routine, is recommended, with joint aspiration often sufficient for non-hip infections and early hip infections.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
Background:
- Septic arthritis is a serious joint infection in children.
- Optimal management strategies, particularly the role of arthrotomy versus aspiration, remain debated.
Purpose of the Study:
- To review the management and outcomes of pediatric septic arthritis.
- To evaluate the effectiveness of selective versus mandatory arthrotomy.
Main Methods:
- Retrospective review of 61 children treated for septic arthritis between 1972 and 1981.
- Diagnosis confirmed by bacteriology or radiographic changes.
- Management included joint aspiration and, in select cases, arthrotomy.
Main Results:
- Most patients underwent joint aspiration; routine arthrotomy was not performed.
- Septic arthritis of the hip in infants necessitated arthrotomy.
- Older children with hip infections and symptom duration < 4 days responded well to aspiration.
- Delayed hip infections (>4 days) often required arthrotomy.
- Non-hip joint infections were successfully managed with aspiration.
Conclusions:
- Arthrotomy for pediatric septic arthritis should be selective, not mandatory.
- Aspiration is effective for most non-hip joint infections and early hip infections in older children.
- Hip involvement in infants consistently requires arthrotomy.
Abstract:
We have reviewed 61 children treated for septic arthritis from 1972 to 1981. The diagnosis in all cases was confirmed by bacteriology or by radiographic changes. Routine arthrotomy was not performed, but most patients had a joint aspiration. The management and outcome are described. We suggest that arthrotomy should be selective rather than mandatory. Septic arthritis of the hip in infants requires arthrotomy, but in the older child an infected hip can be treated by aspiration if the duration of symptoms is less than four days; arthrotomy may be needed if there has been more delay. Infected joints other than the hip can be satisfactorily managed by aspiration.