Tag Archive for: septic arthritis

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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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.

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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.
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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.
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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
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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.
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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.

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Pelvic Pyomyositis in Children: Current Concepts Review

Volume 8 | Issue 1 | January-April 2022 | Page: 02-07 | Archan Desai, Ashish Ranade, Mohan V. Belthur, Sandeep Patwardhan, Gauri A. Oka
DOI-10.13107/ijpo.2022.v08i01.127

Authors: Archan Desai [1], Ashish Ranade [1, 2], Mohan V. Belthur [3], Sandeep Patwardhan [4], Gauri A. Oka [1]

[1] Department of Orthopaedics, Bharati Hospital and Research Centre, Pune, Maharashtra, India.
[2] Department of Orthopaedics, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India.
[3] Department of Child Health & Orthopaedics, University of Arizona College of Medicine-Phoenix, USA.
[4] Department of Orthopaedics, Sancheti Hospital, Pune, Maharashtra, India.

Address of Correspondence
Dr. Ashish Ranade,
Consultant Paediatric Orthopaedic Surgeon, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India. Visiting Pediatric Orthopaedic Surgeon, Bharati Vidyapeeth Medical College Hospital, Pune, Maharashtra, India
E-mail: ranadea2@gmail.com

Abstract

Pyomyositis in children is an uncommon bacterial infection of skeletal muscles which has more frequently been described in tropical areas, but it is becoming increasingly recognized in temperate climates too. Any muscle group in the body can be involved, but it commonly affects the large muscle groups which are located around the pelvic girdle and lower extremities. Clinical presentation is very similar to septic arthritis of the hip and needs to be diagnosed early. MRI is the investigation of choice. Depending on the severity this condition, it can be treated conservatively with antibiotics in its early stage and with percutaneous or formal incision and drainage in later stages. Generally, if it is diagnosed early, good outcomes can be expected.
Keywords: Pelvic Pyomyositis, Septic arthritis, Infection, Magnetic resonance imaging

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How to Cite this Article:  Desai A, Ranade A, Belthur MV, Patwardhan S, Oka GA | Pelvic Pyomyositis in Children: Current Concepts Review | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 02-07.

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Bilateral Septic Hip Epiphyseal Detachment in Children: A Case Report and Review of the Literature

Volume 7 | Issue 2 | May-August 2021 | Page: 20-23 | Ferdinand Nyankoue Mebouinz, Serge Etoundi Bekoé, Rose Bengono, Bertine Manuela Ndjeunga, Cathy Bebey Engome, Fabrice Arroye Betou

Authors: Ferdinand Nyankoue Mebouinz [1], Serge Etoundi Bekoé [1], Rose Bengono [1], Bertine Manuela Ndjeunga [2], Cathy Bebey Engome [3], Fabrice Arroye Betou [4]

[1] Department of Orthopaedic Trauma Surgery, Aristide Le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal.
[2] Obstetrics Gynecology Clinic, Aristide Le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal.
[3] Albert Royer Children’s Hospital University teaching Hospital of Fann, Cheikh Anta Diop University, Dakar,Senegal.
[4] Department of Cardiovascular and Thoracic Surgery, University teaching Hospital of Fann, Cheikh Anta Diop University, Dakar, Senegal.

Address of Correspondence
Dr Ferdinand Nyankoue Mebouinz,
Estrada do Forte do Alto Duque, 1449-005, Lisbon.
E-mail: ferdinandmebouinz@gmail.com

Abstract

Background: Diagnosed and treated fairly early, children’s septic arthritis of the hip has few or no complications. Septic epiphyseal detachment of the hip in children is a rare complication due to delayed treatment. Unilateral forms have been reported, but bilateral involvement has never been described in the literature.
Case presentation: We report the case of an 8-year-old girl who presented with hip pain associated fever and diminished lower limb movements, approximately 4 months after the onset of symptoms. The diagnosis of bilateral septic epiphyseal detachment of the hips was made and computerized tomography (CT) scan revealed osteonecrosis of both femoral heads. The necrotic epiphyses required removal in order to control the infection.
Conclusion: This report highlights the importance of early diagnosis of septic arthritis of the hip in the neonatal period. Any delay in presentation, diagnosis or management can result in irrecoverable sequelae for the developing hip and seriously impact long-term function.
Keywords: Septic arthritis, Bilateral, Epiphysis detachment, Hip, Ablation.

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How to Cite this Article:  Mebouinz FN, Bekoé SE, Bengono R, Ndjeunga BM, Engome CB, Betou FA | Bilateral Septic Hip Epiphyseal Detachment in Children: A Case Report and Review of the Literature |
International Journal of Paediatric Orthopaedics | May-August 2021; 7(2): 20-23.

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Early Surgical Intervention in Children with a Suspected Diagnosis of Acute Septic Arthritis or Osteomyelitis: Is it Justified?

Volume 4 | Issue 2 | July-December 2018 | Page: 03-10 | Petnikota Harish

DOI- 10.13107/ijpo.2018.v04i02.011

Authors: Petnikota Harish

Vasudev Children’s Orthopaedics Centre, Bellary, Karnataka, India

Address of Correspondence
Dr. Petnikota Harish,
‘Vasudev’, Opp. Shanti Sishu Vihar School, Talur Road, Bellary – 583 103, Karnataka, India.
E-mail: harishportho@gmail.com

Abstract

Context: Early surgical intervention is the key for good outcome in children with acute haematogenous osteomyelitis (AHO) or septic arthritis. Often there is an impasse to observe or intervene early when the diagnosis is inconclusive due to blunted clinical findings and equivocal investigations. Aim: This study is aimed at justifying early surgical intervention in these doubtful/suspected cases. Settings and
Design: This study was a retrospective review of AHO/septic arthritis treated by the author between August 2010 and January 2015. A new scoring system, haematogenous osteomyelitis and septic arthritis (HOMSA) score was developed to aid in classifying and decision-making. With a maximum score of 8, a score >6 in the absence of infection elsewhere or a score <6 with radiological evidence makes the diagnosis of AHO/septic arthritis definite. A score 6 without radiological evidence makes the diagnosis suspected/doubtful. Outcome was measured by a new discrete criterion for the upper and lower limbs.
Materials and Methods: The protocol was early surgical intervention in both the groups. In septic arthritis, open arthrotomy along with joint lavage and debridement was performed. In AHO, bone decompression with abscess drainage was performed. Initial parenteral administration of antibiotics was followed by oral antibiotic administration. Necessary adjuvant treatment was given.
Results: Thirty-four children with 40 sites of infection were identified. Among them, 50% were neonates. Only 4/40 children were treated conservatively. Following surgery, outcome was excellent-to-good in 92.8% of the children with doubtful/suspected diagnosis and 96.6% with definite infection. One child in each group who were treated surgically, and two children in the group with definite infection treated non-operatively had fair-to-poor outcomes. Conclusion: Early surgical intervention is justified even in children with a doubtful/suspected diagnosis of AHO or Septic Arthritis. The new scoring system, HOMSA Score, is a better tool to diagnose Acute septic arthritis or osteomyelitis, even with limited resources.
Keywords: Acute haematogenous osteomyelitis, Early surgery, Infants and children, Neonates, New outcome, Measure, New scoring system, Septic arthritis

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How to Cite this Article:  Harish P Early Surgical Intervention | in Children with a Suspected Diagnosis of Acute Septic Arthritis or Osteomyelitis: Is it Justified? | July-December 2018; 4(2): 03-10.

 

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