Deep Dive MW R14

* Differential





* Traumatic causes: non-accidental trauma, fracture, dislocation, sprain, strain, tendonitis, osgood schlatter











* Non-traumatic causes: septic arthritis, transient synovitis, osteomyelitis, SCFE, LCP disease, rheumatologic disease, bony tumors

















* Work-up





* XRay











* Labs to evaluate for septic arthritis – CBC BMP ESR CRP

















* Kocher Criteria





* Non-weight bearing











* Fever >38.5C











* ESR >40











* WBC >12

















* Kocher Criteria Statistics





* 0 points: 0.2% (or 2% in prospective studies)











* 1 point: 3% (or 9% in prospective studies)











* 2 points: 40%











* 3 points:93%











* 4 points: 99%

















* Septic Arthritis DX





* >50,000 WBC





* Age 0-3mo : group B strep











* Age 3mo – 12 years: Staph Aureus











* Age 12-18 years: Gonorrhea











* Sickle Cell Disease: Salmonella