Slipped capital femoral epiphysis

In the April 1999 issue of the Journal (pages 145 to 148), Drs. Marx and Wright reported on an unusual case of slipped capital femoral epiphysis after septic arthritis of the hip in an adolescent boy. Although it is certainly most unusual to see these conditions simultaneously in an adolescent, I take exception to certain aspects of the treatment. The authors were presented with a child who had a late diagnosis of septic arthritis. I question their decision to close the wound, remove the suction drain after 2 days and treat with only a 6-day course of antibiotics intravenously. Although this treatment may be appropriate after prompt diagnosis and management of acute septic arthritis, I think it is unwise to manage delayed infections in this fashion. A more aggressive, yet conservative, approach of leaving the wound open over drains and then returning the patient to the operating room 24 to 48 hours later for a second look and repeat drainage followed by a 4- to 6-week course of antibiotics intravenously might have prevented the recurrent infection that this boy suffered 2 weeks after discharge. It is not clear whether the slipped capital femoral epiphysis was related to the original infection or to insufficient treatment of the infection.

Regardless of the slipped capital femoral epiphysis, which certainly makes for an interesting case report, I believe that most pediatric orthopedists would agree that treatment of a septic hip presenting relatively late should be different from the treatment of a septic hip that is promptly diagnosed. Indeed, I have observed that septic hips in adolescents tend to be associated with a worse prognosis and present in a more delayed fashion than those in younger children.