Bone and Joint Infections in Children

In infancy the hip joint infections are common and it is called as septic arthritis of infancy. The commonest organisms are the staphylococcus, streptococcus, and pneumococcus. In infancy, the commonest source of infection is umbilical sepsis. From here the organism spread by the bloodstream and gets deposited in any one joint or many joints called septic arthritis. The commonest joint that is involved is the hip joint (Ball and socket joint). When the hip joint is involved within a week or ten days after delivery, the baby will not take the feed well, there may not be a high temperature, and baby may not move the particular limb called as ”pseudoparalysis”. Early diagnosis is important otherwise the cartilaginous part of the head of the femur will get destroyed leading on to permanent disability, gross limping and shortening of the limb. High degree of suspicion by the surgeon by taking x—ray, MRI scan and if necessary Bone scan.

Early antibiotic therapy, letting out the pus by arthrotomy (opening the joint by surgery) and immobilization will save the joint. If not attended immediately, permanent structural changes will occur in the bones of the hip joint leading on to gross shortening of the affected limb and limitation of movements of the hip joint.

Osteomyelitis is inflammation of the bone caused by bacteria. These bacteria may come from tonsillitis, abscess in some part of the body, and respiratory infection and gets into the blood stream and settle down in the bone and that is why it is called as acute hematogenous Osteomyelitis. In children above 18months, there may be a history of mild trauma, followed by temperature. On many occasions, the pain in the leg or thigh is attributed to the trauma and the infection is missed in the bone. The commonest bones that are affected are the lower end of the femur (Thigh bone) and the upper end of the tibia (Leg bone). But it can occur in any bone in the body.

Bone and Joint Infections in Children Antibiotic

The bacteria gets settled in the metaphysis of a long bone and starts multiplying and form an abscess which is within the bone. This will cause severe pain, high temperature and child will be limping. This stage is invariably missed by parents and treating physician as post-traumatic blood collection in the affected area. Later on, the abscess inside the bone spreads to the periphery and center of bone and the abscess comes to the surface of the skin.

By this time enough damage is done to the blood supply of bone leading on to chronic Osteomyelitis which is a very difficult problem to deal with. Hence children with acute hematogenous Osteomyelitis must be diagnosed early with proper diagnosis.

X—ray appearance is normal in the acute stage. Hence it is often missed. The total white cell count will be increased, MRI Scan will show early changes and occasionally bone scan is useful. Once an early diagnosis is made massive, a dose of broad-spectrum antibiotic is given intravenously every 8 hours for 48 hours, and limb must be immobilized. If the pain and temperature do not subside within 48 hours, we will have to drill the bone and let out the pus and send the pus for culture and sensitivity before it goes in for chronic Osteomyelitis. If the culture grows, the organism and the sensitivity test shows which antibiotic is better that particular antibiotic therapy has to be given for 6 weeks. Early intervention of acute hematogenous Osteomyelitis is important to prevent chronicity which is a great nuisance.