An 18-month-old girl is brought to you by her parents, who say she has had a fever of 104degF and has refused to walk since she awoke that morning. You obtain a hip x-ray, which shows a subtle widening of the left hip joint space. The most appropriate initial course of acting is

This patient most likely has septic ahritis of the hip. Signs and symptoms associated with septic ahritis of the hip often are subtle and may be limited to a limp or refusal to walk. X-ray frequently shows a widening of the joint space. Septic ahritis of the hip requires immediate surgical drainage, because the blood supply to the femoral head may be compromised, causing permanent destruction to the joint. Drainage may be performed by needle aspiration or surgical excision. Cram stain and culture of the synol fluid should be obtained and appropriate antibiotic therapy begun.