Tag Archive for: Osteomyelitis

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.


References

1. Trapani S. Musculoskeletal infections in childhood: Recognize early to quickly and properly treat. Glob Pediatr. 2024 Mar 1; 7:100108. doi: 10.1016/j.gpeds.2023.100108
2. Hunter, Sarah & Chan, Heidi & Crawford, et al: (2023). Appropriate Antibiotic Duration in Pediatric Bone and Joint Infection: A Systematic Review. Journal of the Pediatric Orthopaedic Society of North America. 5. doi: 10.55275/JPOSNA-2023-736.
3. Hannon M, Lyons T. Pediatric musculoskeletal infections. Curr Opin Pediatr. 2023 Jun 1;35(3):309–15.
4. Radcliffe G. (iii) Osteomyelitis – a historical and basic sciences review. Orthop Trauma. 2015 Aug 1;29(4):243–52.
5. Klenerman L. A history of osteomyelitis from the Journal of Bone and Joint Surgery: 1948 TO 2006. J Bone Joint Surg Br. 2007 May;89(5):667-70. doi: 10.1302/0301-620X.89B5.19170. PMID: 17540756.
6. Nelaton A.: Elements de pathologie chirurgical1844.Germer BailliereParispp. 595-597
7. Schmitt SK. Osteomyelitis. Infect Dis Clin North Am. 2017 Jun;31(2):325-338. doi: 10.1016/j.idc.2017.01.010. PMID: 28483044.
8. Ahmad S, Barik S, Mishra D, et al: Epidemiology of paediatric pyogenic musculoskeletal infections in a developing country. Sudan J Paediatr. 2022;22(1):54-60. doi: 10.24911/SJP.106-1616783478. PMID: 35958066.
9. Jaña FC NETO, Ortega CS, Goiano EO. Epidemiological study of osteoarticular infections in children. Acta Ortop Bras. 2018 May-Jun;26(3):201-205. doi: 10.1590/1413-785220182603145650. PMID: 30038548.
10. Shah I, Dani S, Shetty NS, et al: Profile of osteoarticular tuberculosis in children. Indian J Tuberc. 2020 Jan;67(1):43-45. doi: 10.1016/j.ijtb.2019.08.014. Epub 2019 Aug 22. PMID: 32192616.
11. Jain AK, Jaggi KR, Bhayana H, et al: Drug-resistant Spinal Tuberculosis. Indian J Orthop. 2018 Mar-Apr;52(2):100-107. doi: 10.4103/ortho.IJOrtho_306_17. PMID: 29576636.
12. Mohamad M, Steiger C, Spyropoulou V, et al: Clinical, biological and bacteriological characteristics of osteoarticular infections in infants less than 12 months of age. Future Microbiol. 2021 Apr;16:389-397. doi: 10.2217/fmb-2020-0070. Epub 2021 Apr 13. PMID: 33847142.
13. Shenoy B, Singhal T, Yewale V, et al: Indian Academy of Pediatrics Consensus Statement on Diagnosis and Management of Bone and Joint Infections in Children. INDIAN Pediatr. 2024;61.
14. Agarwal A, Aggarwal AN. Bone and Joint Infections in Children: Septic Arthritis. Indian J Pediatr. 2016 Aug;83(8):825-33. doi: 10.1007/s12098-015-1816-1. Epub 2015 Jul 21. PMID: 26189923.
15. Saavedra-Lozano J, Falup-Pecurariu O, Faust SN, et al: Bone and Joint Infections. Pediatr Infect Dis J. 2017 Aug;36(8):788-799. doi: 10.1097/INF.0000000000001635. PMID: 28708801.
16. Le Saux N. Diagnosis and management of acute osteoarticular infections in children. Paediatr Child Health. 2018 Aug;23(5):336-343. doi: 10.1093/pch/pxy049. Epub 2018 Jul 18. PMID: 30653632; PMCID: PMC6054183.
17. Morrey BF, Peterson HA. Hematogenous pyogenic osteomyelitis in children. Orthop Clin North Am. 1975 Oct;6(4):935-51. PMID: 1178165.
18. Hatzenbuehler J, Pulling TJ. Diagnosis and management of osteomyelitis. Am Fam Physician. 2011 Nov 1;84(9):1027-33. PMID: 22046943.
19. Roderick MR, Shah R, Rogers V, et al: Chronic recurrent multifocal osteomyelitis (CRMO) – advancing the diagnosis. Pediatr Rheumatol Online J. 2016 Aug 30;14(1):47. doi: 10.1186/s12969-016-0109-1. PMID: 27576444.
20. Vij N, Ranade AS, Kang P, et al: Primary Bacterial Pyomyositis in Children: A Systematic Review. J Pediatr Orthop. 2021 Oct 1;41(9):e849-e854. doi: 10.1097/BPO.0000000000001944. PMID: 34411048.
21. Taksande A, Vilhekar K, Gupta S. Primary pyomyositis in a child. Int J Infect Dis. 2009 Jul;13(4):e149-51. doi: 10.1016/j.ijid.2008.08.013. Epub 2008 Nov 13. PMID: 19013093.
22. Mignemi ME, Benvenuti MA, An TJ, et al: A Novel Classification System Based on Dissemination of Musculoskeletal Infection is Predictive of Hospital Outcomes. J Pediatr Orthop. 2018 May/Jun;38(5):279-286. doi: 10.1097/BPO.0000000000000811. PMID: 27299780.
23. Hotchen AJ, McNally MA, Sendi P. The Classification of Long Bone Osteomyelitis: A Systemic Review of the Literature. J Bone Jt Infect. 2017 Sep 12;2(4):167-174. doi: 10.7150/jbji.21050. PMID: 29119075.
24. Mader JT, Shirtliff M, Calhoun JH. Staging and staging application in osteomyelitis. Clin Infect Dis. 1997 Dec;25(6):1303-9. doi: 10.1086/516149. PMID: 9431368.
25. Stevenson AJ, Jones HW, Chokotho LC, et al: The Beit CURE Classification of Childhood Chronic Haematogenous Osteomyelitis–a guide to treatment. J Orthop Surg Res. 2015 Sep 17;10:144. doi: 10.1186/s13018-015-0282-9. PMID: 26384208
26. McHenry MC, Alfidi RJ, Wilde AH, Hawk WA. Hematogenous osteomyelitis; a changing disease. Cleve Clin Q. 1975 Spring;42(1):125-53. doi: 10.3949/ccjm.42.1.125. PMID: 1095249.
27. Copley L.A.B., Herring J.A., (2014) Infections of the Musculoskeletal System. In J.A. Herring (Ed). Tachdjian’s Paediatric Orthopaedics (5th ed, Vol-2, pp:1024 -1076e10) Elseweir, Saunders
28. Ciampolini J, Harding KG. Pathophysiology of chronic bacterial osteomyelitis. Why do antibiotics fail so often? Postgrad Med J. 2000;76(898):479–83.
29. Moore-Lotridge, S.N., Schoenecker, J.G. (2022). Pathology of Musculoskeletal Infections. In: Belthur, M.V., Ranade, A.S., Herman, M.J., Fernandes, J.A. (eds) Pediatric Musculoskeletal Infections. Springer, Cham. https://doi.org/10.1007/978-3-030-95794-0_3
30. Scheman L.R., Janota M., & Lewin P. The production of experimental osteomyelitis: Preliminary report. JAMA, Nov 1 1941, 117:18, 1525-1529.
31. Hobo T: Zur Pathogenese der akuten hematogenen Osteomyelitis. Acta Sch Me Kioto 1921;4:1.
32. Trueta J. The three types of acute hematogenous osteomyelitis: A clinical and vascular study. J Bone Joint Surg. 1959, 41-B:4, 671-680.
33. Herring J.A., (2002) Bone and Joint Infections. Tachdjian’s Paediatric Orthopaedics (3rd ed, Vol-3, pp:1841 -1894) W.B. Saunders.
34. Ogden JA, Lister G: The pathology of Neonatal osteomyelitis. Pediatrics 1975;56-A:941
35. Whalen JL,Fitzgerald RH Jr, Morrissy RT: A histological study of acute hematogenous osteomyelitis following physeal injury in rabbits. J Bone Joint Surg 1988;70-A:1383
36. Morrissy RT, Haynes DW: Acute Hematogenous Osteomyelitis: A model with trauma as an etiology. J Pediatr Orthop 1989;9:447.
37. Manche E, Rombouts-Godin V, Rombouts JJ: {Acute Hematogenous Osteomyelitis due to ordinary germs in children with closed injuries: a study of 44 cases}.Acta Orthop Belg 1991;57:91
38. Hofstee MI, Muthukrishnan G, Atkins GJ, Riool M, Thompson K, Morgenstern M, Stoddart MJ, Richards RG, Zaat SAJ, Moriarty TF. Current Concepts of Osteomyelitis: From Pathologic Mechanisms to Advanced Research Methods. Am J Pathol. 2020 Jun;190(6):1151-1163. doi: 10.1016/j.ajpath.2020.02.007. Epub 2020 Mar 16. PMID: 32194053
39. Rosenfeld S, Bernstein DT, Daram S, Dawson J, Zhang W. Predicting the presence of adjacent infections in septic arthritis in children. J Pediatr Orthop. 2016;36(1):70–4.
40. R. Cunningham, A. Cockayne, H. Humphreys. Clinical and molecular aspects of the pathogenesis of Staphylococcus aureus bone and joint infections. J. Med Microbiol. – Vol. 44 (1996), 157-164
41. Flemming H.C., Wingender J., Szewzyk U., Steinberg P., Rice S.A., Kjelleberg S. Biofilms: an emergent form of bacterial life. Nat Rev Microbiol. 2016; 14: 563-575
42. Garzoni C., Kelley W.L. Staphylococcus aureus: new evidence for intracellular persistence. Trends Microbiol. 2009; 17: 59-65
43. Martinez-Aguilar G, Avalos-Mishaan A, Hulten K, et al: Community-acquired, methicillin-resistant and methicillin susceptible Staphylococcus aureus musculoskeletal infections in children, Pediatr Infect Dis J 23:701, 2004
44. Yang D., Wijenayaka A.R., Solomon L.B., Pederson S.M., Findlay D.M., Kidd S.P., Atkins G.J. Novel insights into Staphylococcus aureus deep bone infections: the involvement of osteocytes. mBio. 2018; 9: e00415-e00418
45. Kwiecinski J., Na M., Jarneborn A., Jacobsson G., Peetermans M., Verhamme P., Jin T. Tissue plasminogen activator coating on implant surfaces reduces Staphylococcus aureus biofilm formation. Appl Environ Microbiol. 2016; 82: 394-401
46. Cicuéndez M, Doadrio JC, Hernández A, Portolés MT, Izquierdo-Barba I, Vallet-Regí M. Multifunctional pH sensitive 3D scaffolds for treatment and prevention of bone infection. Acta Biomater. 2018 Jan;65:450-461. doi: 10.1016/j.actbio.2017.11.009. Epub 2017 Nov 8. PMID: 29127064.


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

(Article Text HTML)      (Full Text PDF)


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


References

1. Saavedra-Lozano J, Falup-Pecurariu O, Faust SN, Girschick H, Hartwig N, Kaplan S, et al. Bone and joint infections. Pediatr Infect Dis J. 2017;36:788–99.
2. Agarwal A, Aggarwal AN. Bone and joint infections in children: acute hematogenous osteomyelitis. Indian J Pediatr. 2016;83:817–24.
3. Calvo C, Núñez E, Camacho M, Clemente D, Fernández-Cooke E, Alcobendas R, et al. Epidemiology and management of acute, uncomplicated septic arthritis and osteomyelitis: Spanish multicenter study. Pediatr Infect Dis J. 2016;35:1288–93.
4. Dartnell J, Ramachandran M, Katchburian M. Haematogenous acute and subacute paediatric osteomyelitis: a systematic review of the literature. J Bone Joint Surg Br. 2012;94:584–95.
5. Samara E, Spyropoulou V, Tabard-Fougère A, Merlini L, Valaikaite R, Dhouib A, et al. Kingella Kingae and osteoarticular infections. Pediatrics. 2019;144:e20191509.
6. Kang SN, Sanghera T, Mangwani J, Paterson JMH, Ramachandran M. The management of septic arthritis in children: systematic review of the English language literature. J Bone Joint Surg Br. 2009;91:1127–33.
7. Gigante A, Coppa V, Marinelli M, Giampaolini N, Falcioni D, Specchia N. Acute osteomyelitis and septic arthritis in children: a systematic review of systematic reviews. Eur Rev Med Pharmacol Sci. 2019 ;23(2 Suppl):145–58.
8. Comegna L, Guidone PI, Prezioso G, Franchini S, Petrosino MI, Di Filippo P, et al. Pyomyositis is not only a tropical pathology: a case series. J Med Case Reports. 2016;10:372.
9. Momodu II, Savaliya V. Septic Arthritis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 May 1]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK538176/
10. Stephen RF, Benson MKD, Nade S. Misconceptions about childhood acute osteomyelitis. J Child Orthop. 2012;6:353–6.
11. Morrissy RT, Haynes DW. Acute hematogenous osteomyelitis: a model with trauma as an etiology. J Pediatr Orthop. 1989;9:447–56.
12. Rosenfeld S, Bernstein DT, Daram S, Dawson J, Zhang W. Predicting the presence of adjacent infections in septic arthritis in children. J Pediatr Orthop. 2016;36:70–4.
13. Benvenuti M, An T, Amaro E, Lovejoy S, Mencio G, Martus J, et al. Double-edged sword: musculoskeletal infection provoked acute phase response in children. Orthop Clin North Am. 2017;48:181–97.
14. Li Y, Zhou Q, Liu Y, Chen W, Li J, Yuan Z, et al. Delayed treatment of septic arthritis in the neonate: A review of 52 cases. Medicine (Baltimore). 2016;95:e5682.
15. Deshpande SS, Taral N, Modi N, Singrakhia M. Changing epidemiology of neonatal septic arthritis. J Orthop Surg Hong Kong. 2004;12:10–3.
16. Narang A, Mukhopadhyay K, Kumar P, Bhakoo ON. Bone and joint infection in neonates. Indian J Pediatr. 1998;65:461–4.
17. Moore-Lotridge SN, Gibson BH, Duvernay MT, Martus JE, Thomsen IP, Schoenecker JG. Pediatric musculoskeletal infection: an update through the four pillars of clinical care and immunothrombotic similarities with COVID-19. J Pediatr Orthop Soc N Am [Internet]. 2020 [cited 2024 May 1];2(2). Available from: https://www.jposna.org/index.php/jposna/article/view/124
18. Mitchell PD, Abraham A, Carpenter C, Henman PD, Mavrotas J, McCaul J, et al. Consensus guidelines on the management of musculoskeletal infection affecting children in the UK. Bone Jt J. 2023;105-B:815–20.
19. Moore-Lotridge SN, Daryoush JR, Wollenman CC, Gibian JT, Johnson SR, Thomsen IP, et al. CRP predicts the need to escalate care after initial debridement for musculoskeletal infection. J Pediatr Orthop. 2024;44:188–96.
20. Benvenuti MA, An TJ, Mignemi ME, Martus JE, Mencio GA, Lovejoy SA, et al. A clinical prediction algorithm to stratify pediatric musculoskeletal infection by severity. J Pediatr Orthop. 2019;39:153–7.
21. Sox HC, Liang MH. The erythrocyte sedimentation rate. Guidelines for rational use. Ann Intern Med. 1986;104:515–23.
22. Böttiger LE, Svedberg CA. Normal erythrocyte sedimentation rate and age. Br Med J. 1967;2(5544):85–7.
23. Wirtz DC, Heller KD, Miltner O, Zilkens KW, Wolff JM. Interleukin-6: a potential inflammatory marker after total joint replacement. Int Orthop. 2000;24:194–6.
24. Whicher J, Bienvenu J, Monneret G. Procalcitonin as an acute phase marker. Ann Clin Biochem. 2001;38:483–93.
25. Oppert M, Reinicke A, Müller C, Barckow D, Frei U, Eckardt KU. Elevations in procalcitonin but not C-reactive protein are associated with pneumonia after cardiopulmonary resuscitation. Resuscitation. 2002;53:167–70.
26. Li H, Luo YF, Blackwell TS, Xie CM. Meta-analysis and systematic review of procalcitonin-guided therapy in respiratory tract infections. Antimicrob Agents Chemother. 2011;55:5900.
27. Lowsby R, Gomes C, Jarman I, Lisboa P, Nee PA, Vardhan M, et al. Neutrophil to lymphocyte count ratio as an early indicator of blood stream infection in the emergency department. Emerg Med J. 2015;32:531–4.
28. Gafter-Gvili A, Mansur N, Bivas A, Zemer-Wassercug N, Bishara J, Leibovici L, et al. Thrombocytopenia in Staphylococcus aureus bacteremia: risk factors and prognostic importance. Mayo Clin Proc. 2011;86:389–96.
29. Malpani R, Haynes MS, Clark MG, Galivanche AR, Bovonratwet P, Grauer JN. Abnormally high, as well as low, preoperative platelet counts correlate with adverse outcomes and readmissions after elective total knee arthroplasty. J Arthroplasty. 2019;34:1670–6.
30. Higgins E, Suh GA, Tande AJ. Enhancing diagnostics in orthopedic infections. J Clin Microbiol. 2022;60:e0219621.
31. Li SF, Cassidy C, Chang C, Gharib S, Torres J. Diagnostic utility of laboratory tests in septic arthritis. Emerg Med J. 2007;24:75–7.
32. Kelly EG, Cashman JP. Leucocyte esterase in the rapid diagnosis of paediatric septic arthritis. Med Hypotheses. 2013;80:191–3.
33. Deshpande PG, Wagle SU, Mehta SD, Bharucha BA, Irani SF. Neonatal osteomyelitis and septic arthritis. Indian Pediatr. 1990;27:453–7.
34. Kothari NA, Pelchovitz DJ, Meyer JS. Imaging of musculoskeletal infections. Radiol Clin North Am. 2001;39:653–71.
35. Volberg FM, Sumner TE, Abramson JS, Winchester PH. Unreliability of radiographic diagnosis of septic hip in children. Pediatrics. 1984;74:118–20.
36. Chau CLF, Griffith JF. Musculoskeletal infections: ultrasound appearances. Clin Radiol. 2005;60:149–59.
37. Shenoy B, Singhal T, Yewale V, Choudhury J, Kumar A P, Agashe MV, et al. Indian Academy of Pediatrics consensus statement on diagnosis and management of bone and joint infections in children. Indian Pediatr. 2024;61:209–18.
38. Castellazzi L, Mantero M, Esposito S. Update on the management of pediatric acute osteomyelitis and septic arthritis. Int J Mol Sci. 2016;17:855.
39. Bhaskar AR, Johari AN. Musculoskeletal infections in the neonate. In: Belthur MV, Ranade AS, Herman MJ, Fernandes JA (eds), Pediatric Musculoskeletal Infections. Springer, Cham. 2022.
40. Swarup I, Meza BC, Weltsch D, Jina AA, Lawrence JT, Baldwin KD. Septic arthritis of the knee in children: a critical analysis review. JBJS Rev. 2020;8:e0069.
41. Peters W, Irving J, Letts M. Long-term effects of neonatal bone and joint infection on adjacent growth plates. J Pediatr Orthop. 1992;12:806–10.
42. Kaye JJ, Winchester PH, Freiberger RH. Neonatal septic “dislocation” of the hip: true dislocation or pathological epiphyseal separation? Radiology. 1975 ;114:671–4.
43. Zhang Z, Li H, Li H, et al. Clinical experience of debridement combined with resorbable bone graft substitute mixed with antibiotic in the treatment for infants with osteomyelitis. J Orthop Surg Res. 2018;13:218.


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

(Article Text HTML)      (Full Text PDF)


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.
[2] Department of Orthopaedics, Central Institute of Orthopaedics, VMMC and Safdarjung Hospital, New Delhi
[3] University of North Dakota, USA

Address of Correspondence

Dr. Prateek Behera
Department of Orthopaedics, AIIMS Bhopal, Madhya Pradesh.
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


References

1. Davis CP Definition of Sequela.
https://www.rxlist.com/sequela/definition.htm. Accessed 10 May 2024
2. Dodwell, E. R. (2013). Osteomyelitis and septic arthritis in children:
current concepts. Current opinion in pediatrics, 25(1), 58-63.
3. Belthur M V, Esparza M, Fernandes JA, Chaudhary MM (2022) Post
Infective Deformities: Strategies for Limb Reconstruction. In: Belthur M V,
Ranade AS, Herman MJ, Fernandes JA (eds) Pediatric Musculoskeletal
Infections: Principles Practice. Springer International Publishing, Cham, pp
411–493.
4. Krzysztofiak A, Roversi M, Musolino A, et al (2022) Clinical report and
predictors of sequelae of 319 cases of pediatric bacterial osteomyelitis. Sci
Rep 12:1–10. https://doi.org/10.1038/s41598-022-19208-2
5. Shenoy B, Singhal T, Yewale V, et al (2024) Indian Academy of Pediatrics
Consensus Statement on Diagnosis and Management of Bone and Joint
Infections in Children. Indian Pediatr 61:209–218.
6. Penny JN, Spiegel DA (2014) Chronic osteomyelitis in children. Glob
Orthop Caring Musculoskelet Cond Inj Austere Settings 20:315–324.
https://doi.org/10.1007/978-1-4614-1578-7_31
7. Ilharreborde B (2015) Sequelae of pediatric osteoarticular infection.
O r t h o p T r a u m a t o l S u r g R e s 1 0 1 : S 1 2 9 – S 1 3 7 .
https://doi.org/10.1016/j.otsr.2014.07.029
8. Manz N, Krieg AH, Buettcher M, et al (2020) Long-Term Outcomes of
Acute Osteoarticular Infections in Children. Front Pediatr 8:1–9.
https://doi.org/10.3389/fped.2020.587740
9. Montgomery NI, Epps HR (2017) Pediatric Septic Arthritis. Orthop Clin
North Am 48:209–216. https://doi.org/10.1016/j.ocl.2016.12.008
10. Brown DW, Sheffer BW (2019) Pediatric Septic Arthritis: An Update.
Orthop Clin North Am 50:461–470.
https://doi.org/10.1016/j.ocl.2019.05.003
11. Dashti AS, Karimi A (2013). Skeletal involvement of Brucella melitensis
in children: a systematic review. Iranian journal of medical sciences.
Dec;38(4):286.
12. Barakat A, Schilling WH, Sharma S, et al (2019) Chronic osteomyelitis: a
review on current concepts and trends in treatment. Orthop Trauma
33:181–187. https://doi.org/10.1016/j.mporth.2019.03.005
13. Foong B, Wong KPL, Jeyanthi CJ, et al (2021) Osteomyelitis in
Immunocompromised children and neonates, a case series. BMC Pediatr
21:1–7. https://doi.org/10.1186/s12887-021-03031-1
14. Panteli M, Giannoudis P V. (2016) Chronic osteomyelitis: What the
surgeon needs to know. EFORT Open Rev 1:128–135.
https://doi.org/10.1302/2058-5241.1.000017
15. Pinto D, Aroojis A (2022) Chronic Hematogenous Osteomyelitis. In:
Belthur M V, Ranade AS, Herman MJ, Fernandes JA (eds) Pediatric
Musculoskeletal Infections: Principles Practice. Springer International
Publishing, Cham, pp 321–338.
16. Padman M, Rosenfeld SB, Belthur M V (2022) Pathological Fractures
with Osteomyelitis. In: Belthur M V, Ranade AS, Herman MJ, Fernandes JA
(eds) Pediatric Musculoskeletal Infections: Principles Practice. Springer
International Publishing, Cham, pp 383–409.
17. Nunn T, Patwardhan S, Hosny GA (2022) Post Infective Bone Gap
Management of the Lower Extremity. In: Belthur M V, Ranade AS, Herman
MJ, Fernandes JA (eds) Pediatric Musculoskeletal Infections: Principles
Practice. Springer International Publishing, Cham, pp 543–559.
18. Choi I-H, Cho H-C (2022) Sequelae of Septic Arthritis of the Hip and
Late Reconstruction. In: Belthur M V, Ranade AS, Herman MJ, Fernandes JA
(eds) Pediatric Musculoskeletal Infections: Principles {\&} Practice.
Springer International Publishing, Cham, pp 495–510.
19. Eastwood DM, Gheldere A De (2011) Physeal injuries in children.
Surgery 29:146–152. https://doi.org/10.1016/j.mpsur.2011.01.003


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

(Article Text HTML)      (Full Text PDF)


Septic Arthritis Management: Current Guidelines

Volume 8 | Issue 1 | January-April 2022 | Page: 08-13 | Gaurav Gupta, Easwar T. Ramani, Gaurav Garg, Maulin Shah
DOI-10.13107/ijpo.2022.v08i01.128


Authors: Gaurav Gupta MS Ortho. [1, 2], Easwar T. Ramani MS Ortho. [3, 4 ], Gaurav Garg MS Ortho. [5], Maulin Shah MS Ortho. [6]

[1] Department of Paediatric Orthopaedics, Asian Hospital, Faridabad, UP, India.
[2] Department of Orthopaedics, Child Ortho Clinic, Faridabad & Delhi, India.
[3] Department of Paediatric Orthopaedics, Baby Memorial Hospital, Kozhikode, Kerala, India.
[4] Department of Paediatric Orthopaedics and Spine Surgery, Palakkad District Cooperative & Research Centre, Palakkad, Kerala, India.
[5] Department of Paediatric Orthopaedics, Excelcare Hospital, Jaipur, India.
[6] Department of Paediatric Orthopaedics, Orthokid Clinic, Ahmedabad, Gujarat, India.

Address of Correspondence
Dr. Maulin Shah,
Consultant Paediatric Orthopaedic Surgeon, Orthokid Clinic, Ahmedabad, Gujarat, India.
E-mail: maulinmshah@gmail.com


Abstract

Septic arthritis is an orthopaedic emergency that is more commonly seen in infants and young children. Release of proteolytic enzymes leads to permanent destruction of intra-articular cartilage and subchondral bone as early as 72 hours after onset. Hip and knee are the most commonly involved joints. Staphylococcus aureus is the most common causative organism across all paediatric age groups. Recently, there is a significant increase in incidence of Klebsiella and Pseudomonas, especially in neonates. Sensitivity patterns of causative organisms are also changing with increasing resistance to empirical antibiotics, requiring the use of higher antibiotics.
The detection of septic arthritis in neonates is challenging. The physician has to rely on indirect signs and maintain a high index of suspicion. C-reactive protein (CRP) along with difficulty in weight bearing have a better predictive value in diagnosis. Ultrasonography (USG) is a useful tool for quick screening of a joint and to detect effusion. Many recent studies have suggested percutaneous drainage/aspiration as an equally effective modality to manage septic joints, thus avoiding the morbidity of open arthrotomy and the risks of general anaesthesia. Lack of response to minimally invasive methods warrant an open approach. Antero-lateral arthrotomy is preferred over the posterior approach to avoid iatrogenic damage to the blood supply of the femoral head. Arthroscopic lavage of the septic joint is also becoming popular. The choice of empiric antibiotic treatment should be based on age, vaccination status and underlying co-morbidities. There is growing evidence in literature for short-course intravenous (IV) therapy. Delayed diagnosis, sickle cell disease, and infection caused by certain strains of methicillin-resistant staphylococcus aureus (MRSA) are predispose to orthopaedic sequelae.
Keywords:  Septic Arthritis, Arthrotomy, Osteomyelitis.


References

1. Momodu II, Savaliya V. Septic Arthritis.In:StatPearls[Internet.Treasure Island(FL):StatPearlsPublishing;2022 https://www.ncbi.nlm.nih.gov/books/NBK538176/
2. Anil Agarwal, Aditya N. Aggarwal. Bone and Joint Infections in Children: Septic Arthritis. Indian J Pediatr 2015 July 21. DOI 10.1007/s12098-015-1816-1.
3. T. Sreenivas, A. R. Nataraj, Anand Kumar, Jagdish Menon. Neonatal septic arthritis in a tertiary care hospital: a descriptive study. Eur J Orthop Surg Traumatol 2016 May 6. DOI 10.1007/s00590-016-1776-9.
4. Gireesh Sankaran, Balaji Zacharia1, Antony Roy1, Sulaikha Puthan Purayil. Current clinical and bacteriological profile of septic arthritis in young infants: a prospective study from a tertiary referral centre. European Journal of Orthopaedic Surgery & Traumatology 2018 February 9. https://doi.org/10.1007/s00590-018-2142-x.
5. Rai A, Chakladar D, Bhowmik S, Mondal T, Nandy A, Maji B, et al. Neonatal septic arthritis: Indian perspective. Eur J Rheumatol 2020; 7(Suppl 1): S72-S77.
6. Agarwal A, Aggarwal AN. Septic arthritis in children. In: Agarwal A, Aggarwal AN, editors. Pediatric osteoarticular infections. Delhi: Jaypee; 2014. p. 60–74.
7. Giovanni Autore, Luca Bernardi, Susanna Esposito. Update on Acute Bone and Joint Infections in Paediatrics: A Narrative Review on the Most Recent Evidence-Based Recommendations and Appropriate Anti Infective Therapy. Antibiotics 2020, 9, 486; doi:10.3390/antibiotics9080486.
8. Sultan J, Hughes PJ. Septic arthritis or transient synovitis of the hip in children: the value of clinical prediction algorithms. J Bone Joint Surg Br. 2010;92(9):1289–1293.
9. Ju KL, Zurakowski D, Kocher MS. Differentiating between methicillin-resistant and methicillin-sensitive Staphylococcus aureus osteomyelitis in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am. 2011;93(18):1693–1701
10. Yagupsky P, Dubnov-Raz G, Gené A, Ephros M, Israeli-Spanish Kin-gella kingae Research Group Differentiating Kingella kingae septic arthritis of the hip from transient synovitis in young children. J Pediatr. 2014;165(5):985–989.
11. Kocher MS, Mandiga R, Zurakowski D, Barnewolt C, Kasser JR. Validation of a clinical prediction rule for the differentiation between septic arthritis and transient synovitis of the hip in children. J Bone Joint Surg Am. 2004 Aug;86(8):1629-35. doi: 10.2106/00004623-200408000-00005. PMID: 15292409.
12. Pääkkönen M. Septic arthritis in children: diagnosis and treatment. Pediatric Health Med Ther. 2017;8:65-68. Published 2017 May 18. 10.2147/PHMT.S115429.
13. Singhal R, Perry DC, Khan FN, Cohen D, Stevenson HL, James LA, Sampath JS, Bruce CE. The use of CRP within a clinical prediction algorithm for the differentiation of septic arthritis and transient synovitis in children. J Bone Joint Surg Br. 2011 Nov;93(11):1556-61. doi: 10.1302/0301-620X.93B11.26857. PMID: 22058311.
14. Krogstad P. Osteomyelitis and septic arthritis. In: Feigin RD, Cherry JD, editors. Textbook of Pediatric Infectious Diseases. 6th ed. Philadelphia, PA: Saunders; 2009. pp. 725–748.
15. G. Fabry, E. Miere. Septic arthritis hip in children : poor results after late and inadequate treatment. JPO -A , 3: 461-466, 1983.
16. W A Herndon, S Knauer, J A Sullivan, R H Gross. Management of septic arthritis in children. J Pediatr Ortho, Sep-Oct 1986;6(5):576-8. doi: 10.1097/01241398-198609000-00009.
17. Uri Givon 1, Boaz Liberman, Amos Schindler, Alexander Blankstein, Abraham Ganel. Treatment of septic arthritis of the hip joint by repeated ultrasound-guided aspirations. J Pediatr Orthop May-Jun 2004;24(3):266-70. doi: 10.1097/00004694-200405000-00006.
18. Daniel M Weigl 1, Tali Becker, Eyal Mercado, Elhanan Bar-On. Percutaneous aspiration and irrigation technique for the treatment of pediatric septic hip: effectiveness and predictive parameters. J Pediatr Orthop B 2016 Nov;25(6):514-9. doi: 10.1097/BPB.0000000000000345.
19. Ahmad Essa 1, Michael Asa’af, Haim Shtarker. Preliminary results: continuous double luminal catheter drainage for the management of septic hip arthritis in children. J Pediatr Orthop B,2022 Jan 1;31(1):e11-e16. doi: 10.1097/BPB.0000000000000866.
20. Kristin S Livingston 1, Leslie A Kalish 2, Donald S Bae 3, Young-Jo Kim 3, Benjamin J Shore. Wash, Rinse, Repeat: Which Patients Undergo Serial Joint Irrigation in Pediatric Septic Hip Arthritis? J Pediatr Orthop. 2019 Aug;39(7):e494-e499. doi: 10.1097/BPO.0000000000001323.
21. Gaurav Gupta 1, Qaisur Rabbi, Vikas Bohra, Maulin M Shah. Protrusio acetabulae as a sequel to septic arthritis of the hip with obturator internus pyomyositis. J Pediatr Orthop B,2021 Nov 1;30(6):572-578. doi: 10.1097/BPB.0000000000000823.
22. Garg R, Ho J, Gourineni PV. Simplified arthroscopic lavage of pediatric septic hip: case series. J Pediatr Orthop B. 2020 May;29(3):304-308. doi: 10.1097/BPB.0000000000000717.
23. Thompson RM, Gourineni P. Arthroscopic Treatment of Septic Arthritis in Very Young Children. J Pediatr Orthop. 2017 Jan;37(1):e53-e57. doi: 10.1097/BPO.0000000000000659
24. Eric W Edmonds 1 2, Christina Lin 1, Christine L Farnsworth 2, James D Bomar 2, Vidyadhar V Upasani 1 2 . A Medial Portal for Hip Arthroscopy in Children With Septic Arthritis: A Safety Study. J Pediatr Orthop Nov/Dec 2018;38(10):527-531. doi: 10.1097/BPO.0000000000000861.
25. Scott Rosenfeld 1, Derek T Bernstein, Shiva Daram, John Dawson, Wei Zhang. Predicting the Presence of Adjacent Infections in Septic Arthritis in Children. J Pediatr Orthop 2016 Jan;36(1):70-4. doi: 10.1097/BPO.0000000000000389.
26. Corey O Montgomery 1, Eric Siegel, Robert D Blasier, Larry J Suva. Concurrent septic arthritis and osteomyelitis in children. J Pediatr Orthop , 2013 Jun;33(4):464-7. doi: 10.1097/BPO.0b013e318278484f.
27. Jedidiah E Schlung 1, Tracey P Bastrom 2, Joanna H Roocroft 2, Peter O Newton 2, Scott J Mubarak 1 2, Vidyadhar V Upasani. Femoral Neck Aspiration Aids in the Diagnosis of Osteomyelitis In Children With Septic Hip. J Pediatr Orthop ,Nov/Dec 2018;38(10):532-536. doi: 10.1097/BPO.0000000000000868.
28.Clinical Practice Guideline by PIDS and IDSA • JPIDS 2021
29. Ohl CA. Infectious arthritis of native joints. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa.: Churchill Livingstone; 2010:1443-1456.
30. Liu C, Bayer A, Cosgrove SE, et al; Infectious Diseases Society of America. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011;52(3):e18–e55
31. No authors listed. British Society for Antimicrobial Chemotherapy.http://www.bsac.org.uk/pyxis/Bone%20and%20joint/Septic%20arthritis/Septic%20arthritis.htm(date last accessed 28 February 2009).
32. Vinod MB, Matussek J, Curtis N, Graham HK, Carapetis JR. Duration of antibiotics in children with osteomyelitis and septic arthritis. J Paediatr Child Health 2002;38:363-7
33. Peltola H, Paakkonen M, Kallio P, Kallio MJ; OM-SA Study Group. Clindamycin vs. first-generation cephalosporins for acute osteoarticular infections of childhood – a prospective quasi-randomized controlled trial. Clin Microbiol Infect. 2012;18(6):582–589.
34. Peltola H, Paakkonen M, Kallio P, Kallio MJ; Osteomyelitis-Septic Arthritis (OM-SA) Study Group. Prospective, randomized trial of 10 days versus 30 days of antimicrobial treatment, including a short-term course of parenteral therapy, for childhood septic arthritis. Clin Infect Dis. 2009;48(9):1201–1210


How to Cite this Article:  Gupta G, Ramani ET, Garg G, Shah M | Septic Arthritis Management: Current Guidelines | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 08-13.

(Article Text HTML)      (Full Text PDF)


Primary Subacute Osteomyelitis of Talus: An Unusual Presentation of a Limping Child

Volume 3 | Issue 1 | Jan-Jun 2017 | Page 24-25 | Rajib Naskar, Balgovind S. Raja, Dhanish V. Mehendiratta, Pravin Jadhav, Harshad G. Argekar


Authors : Rajib Naskar [1], Balgovind S. Raja [2], Dhanish V. Mehendiratta [1], Pravin Jadhav [1], Harshad G. Argekar [1].

[1] Department of Orthopaedics, LTMC &Sion Hospital, Sion, Mumbai, Maharashtra, India,
[2] Department of Orthopaedics, K B Bhabha Municipal Hospital, Bandra, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Rajib Naskar,
Suite no.115, College building, Sion hospital, Dr. Ambedkar Road Mumbai 400022
Email: dr.rajibnaskar@gmail.com


Abstract

A 9-year-old female presented with symptoms of limp and pain in the right ankle region along with swelling. Prominent systemic features of osteomyelitis were lacking. The delay in diagnosis from limping to diagnosis confirmation and hospital admission was 6 days. The final diagnosiswas made after adetailed radiological investigation and open sampling and curettage. It was the treated conservatively, and after 6 weeks of treatment, radiological improvement was noted. We conclude that, in a limping child with ankle pain, subacute osteomyelitis of talus should be kept in mind as a differential and it can be successfully treated in outpatient basis with conservative management.
Keywords: Osteomyelitis, Talus, Children, Ankle pain.


References 

1. Lew DP, Waldvogel FA. Osteomyelitis. Lancet 2004;364(9431):369-379.
2. Krogstad P. Osteomyelitis. In: Feigin RD, Cherry JD, Demmler-Harrison GD, Kaplan SL, editors. Textbook of Pediatric Infectious Diseases. 6th ed. Philadelphia, PA, USA: Saunders Elsevier; 2009. p. 725-742


How to Cite this Article: Naskar R, Raja B S, Mehendiratta D V, Jadhav P, Argekar H G. Primary Subacute Osteomyelitis of Talus: An Unusual Presentation of a Limping Child. International Journal of Paediatric Orthopaedics Jan-Jun 2017;3(1):24-25.

(Abstract)      (Full Text HTML)      (Download PDF)