Also it was not developed in infants or adults, so it may not apply to these populations. It has been used for other joints such as the knee, however it was not developed for the knee and may not be valid. What pearls, pitfalls and/or tips do you have for users of the Kocher Criteria? Are there cases when it has been applied, interpreted, or used inappropriately? The prediction rule was developed for the hip in children. The goal of the prediction rule was to make the diagnosis in a more accurate, reliable, and timely manner. However, the differentiation is essential since septic arthritis is a surgical emergency with the potential for a poor outcome such as septic necrosis of the hip, whereas transient synovitis is treated with observation and has a generally benign outcome. This could often be a vexing diagnosis as the patients often presented similarly with atraumatic hip pain, limp, and fever. It was inspired from my clinical experience as a resident and fellow trying to differentiate between septic arthritis and transient synovitis of the hip in children in the emergency department. Diarthroses are joints that allow for free movement of the joint, as in synovial joints.Why did you develop the Kocher Criteria? Was there a clinical experience that inspired you to create this tool for clinicians? The prediction rule was actually my thesis project for my MPH in Clinical Epidemiology from the Harvard School of Public Health.Amphiarthroses are joints that allow slight movement, including syndesmoses and symphyses.This includes sutures, gomphoses, and synchondroses. Synarthroses are a joints that are immovable.The functional classification divides joints into three categories: synarthroses, amphiarthroses, and diarthroses: Classification of Joints on the Basis of Function Knees, elbows, and shoulders are examples of synovial joints. Synovial joints are capable of the greatest movement of the three structural joint types however, the more mobile a joint, the weaker the joint. Articular capsules may also possess ligaments that hold the bones together. The ends of the bones are covered with articular cartilage, a hyaline cartilage, and the entire joint is surrounded by an articular capsule composed of connective tissue that allows movement of the joint while resisting dislocation. Synovial fluid lubricates the joint, reducing friction between the bones and allowing for greater movement. This space is referred to as the synovial (or joint) cavity and is filled with synovial fluid. Synovial joints are the only joints that have a space between the adjoining bones (Figure 3). Either type of cartilaginous joint allows for very little movement. Symphyses are found at the joints between vertebrae. In symphyses, hyaline cartilage covers the end of the bone but the connection between bones occurs through fibrocartilage. Synchondroses are found in the epiphyseal plates of growing bones in children. In a synchondrosis, the bones are joined by hyaline cartilage. There are two types of cartilaginous joints: synchondroses and symphyses. Figure 3. Synovial joints are the only joints that have a space or “synovial cavity” in the joint.Ĭartilaginous joints are joints in which the bones are connected by cartilage.
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