A 3-year-old child presents with fever, a hot swollen hip, and the leg held in flexion, abduction, and external rotation. Ultrasound shows a large joint effusion. ESR is 100 mm/hr. The single most important next step in management is:

• A Start IV antibiotics and observe for 48 hours
• B MRI of the hip to confirm diagnosis
• C Joint immobilisation in a hip spica and oral antibiotics
• D Emergency aspiration and surgical drainage of the hip joint ✓

Explanation

Septic arthritis of the hip in a child is a surgical emergency requiring immediate joint aspiration under anaesthesia and open (or arthroscopic) drainage. Delay allows pus under pressure to strip the epiphyseal blood supply, causing avascular necrosis of the femoral head and permanent disability. The classic position of the hip in septic arthritis (flexion, abduction, external rotation) maximises joint capacity to reduce pain. Antibiotics alone are insufficient.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.