Sequelae of Paediatric Musculoskeletal Infections

Volume 9 | Issue 3 | September-December 2023 | Page: 22-27 | Prateek Behera, Vikas Gupta, Shubhangi Gupta

DOI- https://doi.org/10.13107/ijpo.2023.v09.i03.159

Authors: Prateek Behera MS Ortho [1], Vikas Gupta MS Ortho [2], Shubhangi Gupta MS Ortho [3]

[1] Department of Orthopaedics, AIIMS Bhopal, Madhya Pradesh, India.
[2] Department of Orthopaedics, Central Institute of Orthopaedics, VMMC and Safdarjung Hospital, New Delhi, India.
[3] University of North Dakota, USA.

Address of Correspondence

Dr. Prateek Behera
Department of Orthopaedics, AIIMS Bhopal, Madhya Pradesh, India.
E-mail: pbehera15@outlook.com

Abstract

Musculoskeletal infections (MskI) are one of the leading causes of morbidity in children. In neonates and infants, they can result in deaths, too, if timely
treatment is not initiated. Of the several factors contributing to the development of sequelae, late presentation, delay in diagnosis, and failure in initiation of appropriate treatment are considered important. Chronic osteomyelitis is often a continuation of untreated or incompletely treated osteomyelitis. The management of chronic osteomyelitis rests on the pillars of extensive surgical debridement and appropriate antibiotic therapy. The diseased bones might get fractured and need to be supported till union, which invariably happens inappropriately treated patients. In young children, osteomyelitis and septic arthritis tend to be frequently present concomitantly, and the infection can result in the destruction of the epiphysis, too. These children with damaged epiphysis have poor outcomes despite best of the efforts to restore function. Physis can also be involved in MskI, resulting in formation of physeal bar that can result in growth arrest. This bar can result in a shortened limb, angular deformity, or both. Management of these conditions includes physeal bar excision wherever suitable or correction of angular deformity by osteotomies. Length can be gained concomitantly using ring external fixators.
Keywords: Musculoskeletal infections, Osteomyelitis, Sequelae, Growth arrest, Physeal bar

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How to Cite this Article:  Behera P, Gupta V, Gupta S | Sequelae of Paediatric Musculoskeletal Infections | International Journal of Paediatric Orthopaedics | September-December 2023; 9(3): 22-27.| https://doi.org/10.13107/ijpo.2023.v09.i03.159

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Musculoskeletal Tuberculosis in Children

Volume 9 | Issue 3 | September-December 2023 | Page: 28-34 | Santoshini Nemuri, Mandar Agashe

DOI- https://doi.org/10.13107/ijpo.2023.v09.i03.160

Authors: Santoshini Nemuri MS Ortho [1], Mandar Agashe MS Ortho [1]

[1] Department of Orthopaedics, Agashe Paediatric SuperSpeciality Clinic, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Mandar Agashe
Chief consultant, Department of Orthopaedics, Agashe Paediatric SuperSpeciality Clinic, Mumbai, Maharashtra, India.
E-mail: mandarortho@gmail.com

Abstract

Paediatric musculoskeletal tuberculosis is very important to understand as it shares similar clinical, radiological and hematologocal findings with other infectious and non-infectitious conditions . It has become a major health hazard because of its association with immunocompromised states like HIV, Diabetes mellitus and chronic renal and liver diseases. Diagnosis is delayed in paediatric musculoskeletal tuberculosis because of lack of awareness of disease , non-specific clinical and laboratory findings. TB culture is considered as the gold standard in diagnosing tuberculosis and also, detecting drug sensitivity. Because of its potential for multi-drug resistance, there is a dilemma regarding drug of choice and duration of treatment. Surgery is reserved for obtaining samples to establish diagnosis, debridement and sequestrectomy in recalcitrant infections and correction of deformities to restore joint function. This review article briefs about classical clinical presentation, atypical and multifocal musculoskeletal tuberculosis, radiological and laboratory investigations and management of paediatric musculoskeletal tuberculosis.
Musculoskeletal tuberculosis should be kept as a differential diagnosis when managing a case of musculoskeletal infection in children because of its non- specific presentation. Imaging such as MRI and advanced microbiological analysis aids in arriving correct diagnosis. Multidrug chemotherapy is mainstay of treatment. Radical curettage and, antituberculous chemotherapy followed by a period of immobilisation and rehabilitation will give excellent results
Keywords: Paediatric musculoskeletal tuberculosis, multifocal tuberculosis, Tubercular osteomyelitis

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How to Cite this Article:  Nemuri S, Agashe M | Musculoskeletal Tuberculosis in Children | International Journal of Paediatric Orthopaedics | September-December 2023; 9(3): 28-34.| https://doi.org/10.13107/ijpo.2023.v09.i03.160

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Introduction to Paediatric Musculoskeletal Infections -A Review Article

Volume 9 | Issue 3 | September-December 2023 | Page: 02-08 | Suresh Chand, Bhushan Sagade, Udit Agarwal, Nishant Jagdale, Smit Rajput

DOI- https://doi.org/10.13107/ijpo.2023.v09.i03.156

Authors: Suresh Chand MS Ortho [1], Bhushan Sagade MS Ortho [2], Udit Agarwal MS Ortho [1], Nishant Jagdale DNB Ortho [2], Smit Rajput MD [3]

[1] Department of Paediatric Orthopaedics, King George’s Medical University, Lucknow, India.
[2] Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, India.
[3] Department of Internal Medicine, East Carolina University and ECU Health Medical Center, Greenville, North Carolina, USA.

Address of Correspondence

Dr. Nishant Jagdale,
Fellow in Paediatric Orthopaedics, Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, India.
E-mail: nishant93ortho@gmail.com

Abstract

Paediatric Musculoskeletal Infections include osteomyelitis, septic arthritis, pyomyositis, surgical site infections, tuberculosis, and fungal infections with some infrequent manifestations like purpura fulminans, necrotizing fasciitis, soft tissue abscess and septic bursitis. Osteomyelitis and septic arthritis are two common Musculoskeletal Infections. Vertebral tuberculosis is the most common form of skeletal tuberculosis. Staphylococcus aureus is the most frequent cause of Paediatric Musculoskeletal Infections, followed by streptococci. They can be classified on the basis of pathogen, anatomical site, spread, severity etc. Pathogenic organisms may reach a bone or soft tissue location by either of the three means: (a) direct inoculation from penetrating trauma or surgery, (b) contiguous spread from an adjacent soft tissue infection, (c) hematogenous spread from a distant focus of infection with hematogenous spread being the most common cause. It is a complex interplay between the host and the pathogen which plays major role in these infections. Peculiar anatomy of the metaphysis with classical hairpin loop system of the end arterioles and venous sinusoids aids in pathogen entry into the host. After successful invasion of the host, bacteria escapes the host immunity through various mechanisms, complement component pathway being the most common way. Also the various toxins and proteins secreted by bacteria plays an important role in adhesion, invasion, escape form immunity and spread of the infection. This review article helps in understanding this complex interplay between host and pathogen which ultimately results in infection

Keywords: Paediatric Musculoskeletal infections, Osteomyelitis, Pyomyositis, Septic Arthritis.

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How to Cite this Article:  Chand S, Sagade B, Agarwa U, Jagdale N, Rajput S | Introduction to Paediatric Musculoskeletal Infections- A Review Article | International Journal of Paediatric Orthopaedics | September- December 2023; 9(3): 02-08.| https://doi.org/10.13107/ijpo.2023.v09.i03.156

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Paediatric Musculoskeletal Infection– A Review

Volume 9 | Issue 3 | September-December 2023 | Page: 09-15 | Ashish Upadhyay, Varun Garg, Anil Agarwal, Kishmita Sachdeva, Ankitha KS, Jainam Salot

DOI- https://doi.org/10.13107/ijpo.2023.v09.i03.157

Authors: Ashish Upadhyay MS Ortho [1], Varun Garg MS Ortho [1], Anil Agarwal MS Ortho [1], Kishmita Sachdeva MS Ortho [1], Ankitha KS MS Ortho [1], Jainam Salot MS Ortho [1]

[1] Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.

Address of Correspondence

Dr. Anil Agarwal,
Department of Orthopedics, Chacha Nehru Bal Chikitsalya, New Delhi, India
E-mail: anilrachna@gmail.com

Abstract

Acute paediatric musculoskeletal infections (MSKI) include septic arthritis, acute osteomyelitis and pyomyositis. Prompt treatment is necessary to prevent long term disabilities in children. Explore medical topics like blood flow, natural remedies, and pill effects. Discover how pharmaceutical companies innovate treatments, impacting health. Learn about blood pressure influences and timing medication efficacy. In this review, we discuss the etiopathogenesis, clinical features and management of MSKI. We also discuss about the role of new markers of inflammation and MRI in MSKI. The clinical presentation is variable, depending upon the age group, and difficult to distinguish from other pathologies. Diagnosis is therefore based on not only clinical presentation but also laboratory and radiological investigations. The mainstay of treatment includes antibiotic therapy, and surgical decompression.

Keywords: Septic arthritis, Musculoskeletal infections, Osteomyelitis, Pyomyositis

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How to Cite this Article:  Upadhyay A, Garg V, Agarwal A, Sachdeva K, Ankitha KS, Salot J. | Paediatric Musculoskeletal Infection– A Review | International Journal of Paediatric Orthopaedics | September-December 2023; 9(3): 09-15. | https://doi.org/10.13107/ijpo.2023.v09.i03.157

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Mimics of Paediatric Musculoskeletal Infections and their Management

Volume 9 | Issue 3 | September-December 2023 | Page: 16-21 | Vivek Singh, Cury Sharma, Aditya K S, Danish Vayoli, Sitanshu Barik 

DOI- https://doi.org/10.13107/ijpo.2023.v09.i03.158

Authors: Vivek Singh MS Ortho [1], Cury Sharma MS Ortho [1], Aditya K S MS Ortho [1], Danish Vayoli MS Ortho [1], Sitanshu Barik MS Ortho [2]

[1] Department of Orthopedics, Paediatric Orthopaedic Unit, AIIMS, Rishikesh, Uttarakhand, India,
[2]  Department of Orthopedics, Paediatric Orthopaedic Unit, AIIMS, Nagpur, Maharashtra, India.

Address of Correspondence

Dr. Vivek Singh,
Additional Professor, In-charge Paediatric Orthopaedics, Shoulder & Hand Surgery Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
E-mail: singhvr27@gmail.com

Abstract

Musculoskeletal infections in pediatric and adolescent populations pose challenges due to heightened pathogen virulence and emerging antimicrobial resistance. Prompt diagnosis is hindered by conditions mimicking these infections, necessitating multidisciplinary approaches. Recent advancements in diagnostics facilitate accurate differentiation. Common mimickers include cellulitis, neoplasms, hematological disorders, inflammatory conditions and stress fractures. Overlapping symptoms demand thorough history-taking and clinical assessment. Laboratory investigations, including CRP and procalcitonin, aid diagnosis, alongside imaging modalities like MRI. Management involves collaborative efforts, emphasizing early recognition, antibiotic therapy, and surgical intervention as needed. Adherence to guidelines and vigilant monitoring optimize outcomes and mitigate risks. This article describes the common mimickers of MSK infection in children and the approach to reaching a correct diagnosis by thorough history taking, clinical examination, relevant laboratory investigations, and appropriate radiological investigations.

Keywords: Infection mimickers, Pediatric infections, MSKI,  Blood markers, Multidisciplinary approach

References

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9. Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am 1999; 81: 1662–1670.
10. Henninger B, Glodny B, Rudisch A, Trieb T, Loizides A, Putzer D, Judmaier W, Schocke MF. Ewing sarcoma versus osteomyelitis: differential diagnosis with magnetic resonance imaging. Skeletal Radiol. 2013 Aug;42(8):1097-104.
11. Sykes MC, Ahluwalia AK, Hay D, Dalrymple J, Firth GB. Acute musculoskeletal infection in children: assessment and management. Br J Hosp Med (Lond). 2023 Jun 2;84(6):1-6.
12. Castellazzi L, Mantero M, Esposito S. Update on the Management of Pediatric Acute Osteomyelitis and Septic Arthritis. Int J Mol Sci. 2016 Jun 1;17(6):855. doi: 10.3390/ijms17060855. PMID: 27258258; PMCID: PMC4926389.
13. Harik NS, Smeltzer MS. Management of acute hematogenous osteomyelitis in children. Expert Rev Anti Infect Ther. 2010 Feb;8(2):175-81. doi: 10.1586/eri.09.130. PMID: 20109047; PMCID: PMC2836799.
14. Afghani B., Kong V., Wu F.L. What would pediatric infectious disease consultants recommend for management of culture-negative acute hematogenous osteomyelitis? J. Pediatr. Orthop. 2007;27:805–809.
15. Pääkkönen M, Peltola H. Management of a child with suspected acute septic arthritis. Arch Dis Child. 2012 Mar;97(3):287-92. doi: 10.1136/archdischild-2011-300462. Epub 2011 Sep 27. PMID: 21953417.
16. Gornitzky AL, Kim AE, O’Donnell JM, Swarup I. Diagnosis and Management of Osteomyelitis in Children: A Critical Analysis Review. JBJS Rev. 2020 Jun;8(6):e1900202. doi: 10.2106/JBJS.RVW.19.00202. PMID: 33006465.

How to Cite this Article:  Singh V, Sharma C, Aditya KS, Vayoli D, Barik S. | Mimics of Paediatric Musculoskeletal Infections and their Management | International Journal of Paediatric Orthopaedics | September-December 2023; 9(3): 16-21. | https://doi.org/10.13107/ijpo.2023.v09.i03.158

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Editorial

Volume 9 | Issue 3 | September-December 2023 | Page: 01 | Jayanth S. Sampath

DOI- https://doi.org/10.13107/ijpo.2023.v09.i03.155

Authors: Jayanth S. Sampath FRCSEd (Tr & Orth) [1]

[1] Department of Orthopaedics, Rainbow Children’s Hospital, Bangalore, Karnataka, India.

Address of Correspondence

Dr. Jayanth S. Sampath,
Rainbow Children’s Hospital, Bangalore, Karnataka, India.
E-mail: editor.posi.ijpo@gmail.com

Editorial

At the outset, I must apologize on behalf of the Editorial Committee of IJPO for the recent loss of continuity in the release of journal issues. The National Medical Commission stopped recognising Index Copernicus towards publication credit for academic clinicians in medical colleges. Consequently, there was a steep reduction in the number of articles submitted to the journal from institutions based in India, one of our main sources of submissions. There was some delay from our reviewers in speedy completion of the review process.
To address these issues, the IJPO Editorial Team with the help of the Executive Council of Paediatric Society of India (POSI) have put in place several measures to improve the number of submissions and for the timely review of submissions. We will increase our presence on social media to expand our reach to young orthopaedic surgeons all over the world. We would like to invite our readers, particularly members of POSI and paediatric orthopaedic academic societies around the world, to join our panel of reviewers. This will provide members a direct insight into the review process and contribute to the dissemination of knowledge within the profession. This is a noble and worthwhile cause and we request your support.
We are also looking towards expanding our editorial board. The current team has been in place for over 6 years. It is time to introduce new talent and ideas, in the long-term interests of the journal.
This issue offers readers a comprehensive overview of the current thinking on the management of musculoskeletal infection in childhood. A series of five articles introduces readers to the basic pathophysiology of infections in the bone, progressing to acute osteomyelitis, mimics and sequelae of infection, and concluding with a review on tuberculosis. I am sure that this symposium will benefit orthopaedic postgraduates and practising surgeons.
We invite your suggestions and comments for any improvements to the journal. Kindly write to us editor@ijpo.com
Before I finish, it is my pleasure to acknowledge the contributions of Mr Saurabh Pullawar from Indian Orthopaedic Research Group who manages the page proofs, communications and the IJPO website single-handedly. The cover page artwork is by Dr Easwar T Ramani, POSI Webmaster and part-time artist. An explanatory note is available below this message.
Sincerely
Dr Jayanth S Sampath
Editor, International Journal of Paediatric Orthopaedics

 


The Two Hands
The two facets of care in septic arthritis, one delivering the surgical knockout punch and the other offering quiet support to the patient to help tide over the sequelae. Conceptualized as the two hands of the Pediatric Orthopedic Surgeon in this artwork.

How to Cite this Article:  Sampat JS | Editorial | International Journal of Paediatric Orthopaedics | September-December 2023; 9(3): 01.| https://doi.org/10.13107/ijpo.2023.v09.i03.155

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