EMed

Osteomyelitis - Paediatric

Background

  • Haematogenous seeding of bacteria to metaphysis
  • 1 in 5000 children
  • M > F, max incidence 6yo
  • Most long bones limbs (50% distal femur / tibia)

Risks

  • Diabetes/ immune compromise
  • Chronic disease e.g. Still's, renal disease, haemoglobinopathy (sickle)
  • Recent varicella infection

Pathology

  • Local trauma (Hx in 30%) → ↑local blood flow → bacterial seeding
  • Staph aureus (high abscess rate), Gp B Strep (neonates), H. influenza (check vaccine Hx), salmonella, TB

History

  • Limb pain ± fevers
  • Limb
  • Check vaccination and antibiotic (masks) use

Exam

  • ↓WB / limp / arm fxn
  • Local bony tenderness &↓ROM local joints
  • ± local inflammation (rare)
  • Fever unusual (± other source e.g. URTI)

Investigations

  • Blood cultures in all suspected
  • ± ↑ESR & ↑CRP
  • X-ray signs late
    (new periosteal bone @ 1/52, lytic lesion @ 2/52)
  • Dx MRI (bone oedema)
  • Bone scan less sensitive than MRI in chldren
  • Consider HbS (sickle)

Management

  • Analgesia
  • Ensure blood cultures before antibiotics
  • Admit ortho. for Ix / Mx (± drain)
  • Consider DVT prophylaxis

Please discuss all query osteomyelitis / septic arthritis with a senior doctor (not another SHO).

Content by Dr Íomhar O' Sullivan Last review Dr ÍOS 21/11/21.