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Septic arthritis – hip — RACP Paediatrics MCQ

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HardIDSeptic arthritis – hipRACP Paediatrics

A 2-year-old presents with acute onset left hip pain, refusal to weight-bear, and high fever. The hip is held in flexion, abduction, and external rotation. Ultrasound shows a large hip joint effusion. Aspirate reveals turbid fluid with WCC >50,000 (predominantly neutrophils). What is the most appropriate management?

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Correct answer: D — IV flucloxacillin + surgical washout

Septic arthritis of the hip is a surgical emergency. Joint aspirate with WCC >50,000 and neutrophil predominance confirms the diagnosis. Management requires both IV flucloxacillin (S. aureus cover) and urgent surgical washout/arthrotomy to prevent joint destruction.

Reference: Australian Therapeutic Guidelines – 2024 – Antibiotic; RCH Melbourne – 2023 – Septic Arthritis CPG