Paediatric Orthopaedics - Infection of Bones & Joints

Question 1

What is Osteomyelitis?

Answer 1

Infection of metaphysis of long bones

• distal femur
• proximal tibia

Question 2

What is the common route of spread giving rise to Osteomyelitis?

Answer 2

Haematogenous/direct spread

Question 3

What are the causative organisms of Osteomyelitis?

Answer 3

Staph aureus
Streptococcus
Haemophilus influenzae
TB

Question 4

How does Osteomyelitis present?

Answer 4

Painful, immobile limb
Swollen skin over affected site
Infants
Back pain
Limp/groin pain

Question 5

What investigations are appropriate in suspected Osteomyelitis?

Answer 5

Blood cultures
WCC, ESR, CRP
X-rays (normal til 7-10 days, new bone formation)
USS (periosteal elevation)
MRI (identification of infection in bone)

Question 6

How is Osteomyelitis managed?

Answer 6

Parenteral antibiotics
Aspiration/surgical depression
Splinting

Question 7

What are the potential complications of Osteomyelitis?

Answer 7

Bone necrosis

Chronic infection

Question 8

What is septic arthritis?

Answer 8

Infection of joint space

Question 9

What causes septic arthritis?

Answer 9

Haematogenous spread/puncture wound/infected skin lesions

Question 10

What is the most common causative agent of septic arthritis?

Answer 10

Staph aureus

Question 11

How does septic arthritis present?

Answer 11

Erythematous, acutely tender joint
Reduced range of movement
Acutely unwell, febrile child
Joint effusion
Limp/pain referred to knee

Question 12

What investigations are appropriate in suspected septic arthritis?

Answer 12

WCC/CRP/ESR
USS (?effusion)
X-ray
MRI/radioisotope