Chief of pediatric orthopedics at UCLA Medical Center, Dr. Anthony Scaduto, explains how septic arthritis infects the knee, ankle or hip joint.
Read the full transcript »
Understanding Septic Arthritis in Children Dr. Travis Stork: Nancy in Seattle Washington writes to us, “Hi Doctors. My two year old son has been limping for the past three days. I was wondering if this could be something serious or if I should just wait it out. I would love to hear your advice.” Here to explain the potential dangers behind a child’s limp is Dr. Anthony Scaduto who’s the Chief of Pediatric Orthopedics at UCLA so welcome to the show. And we all know that a limping toddler can be difficult because they can’t explain to you. What’s going on? Dr. Jim Sears: Yeah kids can’t talk, they can’t tell you where it hurts but apparently lots of parents don’t know this but an unexplained limp is actually potentially very serious. It’s actually one of the few true pediatric emergencies that kind of ranks up there with a stiff neck and a high fever. Dr. Travis Stork: So Doctor Scaduto, say I have a child who’s limping, can’t explain to me what’s going on, when do we have to worry? Dr. Anthony Scaduto: So many conditions that cause limping that aren’t serious but one of the most serious is when there’s a septic arthritis which is an infection of the joint neither the knee, the ankle or the hip. Dr. Travis Stork: So it’s something that all of see. How would be go about diagnosing septic arthritis in a young child? Dr. Anthony Scaduto: Well, there’s a number of things that happen. What involves is that the child has an infection, a tooth abscess, a cut on the skin and that involves a bacteria getting into the blood stream then gets into the foot or around the joint, in this case the hip joint and this would lead to pain and limping in the child. Dr. Travis Stork: But a child can't always say, “Hey it hurts right here.” Dr. Jim Sears: They maybe saying it’s their knee or their foot and that can really mislead positions. One problem with the septic arthritis untreated that bacteria starts to eat away of the hip joint, right? It can be permanently disabling. Dr. Anthony Scaduto: Permanent destruction. Right. That’s exactly that. Dr. Travis Stork: So there is some lab test that can help us at least start thinking about septic arthritis, if there elevated inflammatory marker in such. But why don’t you walk us through. Dr. Anthony Scaduto: If we examine the child they limp, they don’t bare weight when we move the hip joint it seems irritable then we’ll get some blood test. A white blood cell count will be elevated and then we would do additional test and maybe to draw off some fluid from the joints send that to the laboratory for a test. And if they're really suspicious, then they require surgery. Dr. Jim Sears: Okay. So suppose we do those test and they come out normal and maybe we suspect a toddler fracture because a lot of babies that are toddlers don’t fracture a bone without really falling from a car accident thing like that simply just tripping on their own feet. They can fracture their bones pretty easily, huh? Dr. Anthony Scaduto: Right. Right. And one of the other things that we have to consider and in a kid that’s limping, some fracture are very obvious. This one’s obvious here. Dr. Jim Sears: Right, that’s a no brainer. Dr. Anthony Scaduto: Everyone would be able to pick that up but sometimes— Dr. Travis Stork: It fractured Tibia that everyone's looking out there— Dr. Jim Sears: See the bone just cracked—out there— Dr. Anthony Scaduto: And that would heal with a cast. But sometimes we have fractures that are little less obvious. And so, in this would be an example of one where — initially we look at the X-ray we don’t see any obvious crack— Dr. Jim Sears: Yeah. That looks pretty normal. Dr. Anthony Scaduto: And then we do apply cast we’ve got cast there — and this cast — after the cast is removed, we see actually new bone that is developed along the edge of the tibia there in this case. And that confirms that there was a fracture. Dr. Travis Stork: That first fracture it was pretty o