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Osteomyelitis and Septic Arthritis

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The Pediatric Upper Extremity

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Abstract

Osteomyelitis and septic arthritis in the pediatric population are potentially life-threatening infections that will be encountered by practitioners who treat musculoskeletal disorders in children, and commonly occur in the upper extremity. The pathogens responsible for these increasingly severe infections have been changing in the past decades, most notably manifested as a rise in the rate of methicillin-resistant Staphlococcus aureus (MRSA) osteomyelitis and complex osteoarticular musculoskeletal infections. Similarly, the medical and surgical treatment of these infections has changed significantly over the prior decades, and controversy remains over the optimal treatment in certain clinical scenarios. As the complexity of these serious infections grows, an understanding of the current data regarding the topic is required for effective treatment.

In this chapter, we summarize the epidemiology, pathoanatomy, and treatment recommendations for pediatric osteomyelitis and septic arthritis involving the upper extremity. The specifics of non-surgical and surgical interventions are presented in a manner that will allow the treating practitioner to use this text as an efficient reference for treatment planning. We also present our preferred method of surgical treatment for these infections, when indicated, with illustrative case examples. Finally, we touch on relevant controversies and suggest future areas of investigation in an ever-evolving field.

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References

  • Arnold SR, et al. Changing patterns of acute hematogenous osteomyelitis and septic arthritis. J Pediatr Orthop. 2006;26(6):703–8.

    Article  PubMed  Google Scholar 

  • Atijosan O, et al. A national survey of musculoskeletal impairment in Rwanda: prevalence, causes and service implications. PLoS One. 2008;3(7):e2851.

    Article  PubMed Central  PubMed  Google Scholar 

  • Bardin T. Gonococcal arthritis. Best Pract Res Clin Rheumatol. 2003;17(2):201–8.

    Article  PubMed  Google Scholar 

  • Beckles VLL, Jones HW, Harrison WJ. Chronic haematogenous osteomyelitis in children: a retrospective review of 167 patients in Malawi. J Bone Joint Surg Br. 2010;92-B(8):1138–43.

    Article  Google Scholar 

  • Bickler SW, Sanno-Duanda B. Epidemiology of paediatric surgical admissions to a government referral hospital in the Gambia. Bull World Health Organ. 2000;78(11):1330–6.

    CAS  PubMed Central  PubMed  Google Scholar 

  • Blyth MJ, et al. The changing epidemiology of acute and subacute haematogenous osteomyelitis in children. J Bone Joint Surg Br. 2001;83(1):99–102.

    Article  CAS  PubMed  Google Scholar 

  • Ceroni D, et al. Kingella kingae osteoarticular infections in young children: clinical features and contribution of a new specific real-time PCR assay to the diagnosis. J Pediatr Orthop. 2010;30(3):301–4.

    Article  PubMed  Google Scholar 

  • Copley LAB. Pediatric musculoskeletal infection: trends and antibiotic recommendations. J Am Acad Orthop Surg. 2009;17(10):618–26.

    PubMed  Google Scholar 

  • Copley LAB, et al. The impact of evidence-based clinical practice guidelines applied by a multidisciplinary team for the care of children with osteomyelitis. J Bone Joint Surg Am. 2013;95(8):686–93.

    Article  PubMed  Google Scholar 

  • Craigen MA, Watters J, Hackett JS. The changing epidemiology of osteomyelitis in children. J Bone Joint Surg Br. 1992;74(4):541–5.

    CAS  PubMed  Google Scholar 

  • Daniel D, et al. Lavage of septic joints in rabbits: effects of chondrolysis. J Bone Joint Surg Am. 1976;58(3):393–5.

    CAS  PubMed  Google Scholar 

  • Dubnov-Raz G, et al. Invasive Kingella kingae infections in children: clinical and laboratory characteristics. Pediatrics. 2008;122(6):1305–9.

    Article  PubMed  Google Scholar 

  • Dubnov-Raz G, et al. Invasive pediatric Kingella kingae infections: a nationwide collaborative study. Pediatr Infect Dis J. 2010;29(7):639–43.

    Article  PubMed  Google Scholar 

  • Dunkle LM, Brock N. Long-term follow-up of ambulatory management of osteomyelitis. Clin Pediatr. 1982;21(11):650–5.

    Article  CAS  Google Scholar 

  • Gafur OA, et al. The impact of the current epidemiology of pediatric musculoskeletal infection on evaluation and treatment guidelines. J Pediatr Orthop. 2008;28(7):777–85.

    Article  PubMed  Google Scholar 

  • Gilmour WN. Acute haematogenous osteomyelitis. J Bone Joint Surg Br. 1962;64(4):450–3.

    Google Scholar 

  • Goergens ED, et al. Acute osteomyelitis and septic arthritis in children. J Paediatr Child Health. 2005;41(1–2):59–62.

    Article  CAS  PubMed  Google Scholar 

  • Green DP. Green’s operative hand surgery. 5th ed. Philadelphia: Elsevier/Churchill Livingstone; 2005.

    Google Scholar 

  • Howard AW, Viskontas D, Sabbagh C. Reduction in osteomyelitis and septic arthritis related to Haemophilus influenzae type B vaccination. J Pediatr Orthop. 1999;19(6):705–9.

    CAS  PubMed  Google Scholar 

  • Jones HW, et al. Chronic haematogenous osteomyelitis in children: an unsolved problem. J Bone Joint Surg Br. 2011;93-B(8):1005–10.

    Article  Google Scholar 

  • Khachatourians AG, et al. Laboratory monitoring in pediatric acute osteomyelitis and septic arthritis. Clin Orthop Relat Res. 2003;409:186–94.

    Article  PubMed  Google Scholar 

  • Lim-Dunham JE, Ben-Ami TE, Yousefzadeh DK. Septic arthritis of the elbow in children: the role of sonography. Pediatr Radiol. 1995;25(7):556–9.

    Article  CAS  PubMed  Google Scholar 

  • Mah ET, et al. Ultrasonic features of acute osteomyelitis in children. J Bone Joint Surg Br. 1994;76(6):969–74.

    CAS  PubMed  Google Scholar 

  • Mattar Júnior J, et al. Vascularized fibular graft for management of severe osteomyelitis of the upper extremity. Microsurgery. 1994;15(1):22–7.

    Article  PubMed  Google Scholar 

  • Mazur JM, et al. Usefulness of magnetic resonance imaging for the diagnosis of acute musculoskeletal infections in children. J Pediatr Orthop. 1995;15(2):144–7.

    Article  CAS  PubMed  Google Scholar 

  • McDonald JE, Copley LAB. Upper-extremity deep venous thrombosis associated with proximal humeral osteomyelitis in a child: a case report. J Bone Joint Surg Am. 2010;92(11):2121–4.

    Article  PubMed  Google Scholar 

  • Milewski MD, et al. Lyme arthritis in children presenting with joint effusions. J Bone Joint Surg Am. 2011;93(3):252–60.

    Article  PubMed  Google Scholar 

  • Pääkkönen M, Peltola H. Antibiotic treatment for acute haematogenous osteomyelitis of childhood: moving towards shorter courses and oral administration. Int J Antimicrob Agents. 2011;38(4):273–80.

    Article  PubMed  Google Scholar 

  • Pääkkönen M, Peltola H. Management of a child with suspected acute septic arthritis. Arch Dis Child. 2012;97(3):287–92.

    Article  PubMed  Google Scholar 

  • Pääkkönen M, et al. Sensitivity of erythrocyte sedimentation rate and C-reactive protein in childhood bone and joint infections. Clin Orthop Relat Res. 2009;468(3):861–6.

    Article  PubMed Central  PubMed  Google Scholar 

  • Peltola H, et al. Short- versus long-term Antimicrobial treatment for acute Hematogenous Osteomyelitis of childhood. Pediatr Infect Dis J. 2010;29(12):1123–8.

    Article  PubMed  Google Scholar 

  • Puius YA, Kalish RA. Lyme arthritis: pathogenesis, clinical presentation, and management. Infect Dis Clin North Am. 2008;22(2):289–300. vi–vii.

    Article  PubMed  Google Scholar 

  • Riebel TW, Nasir R, Nazarenko O. The value of sonography in the detection of osteomyelitis – springer. Pediatr Radiol. 1996;26(4):291–7.

    Article  CAS  PubMed  Google Scholar 

  • Roine I, et al. Serial serum C-reactive protein to monitor recovery from acute hematogenous osteomyelitis in children. Pediatr Infect Dis J. 1995;14(1):40.

    Article  CAS  PubMed  Google Scholar 

  • Sammer DM, Shin AY. Comparison of arthroscopic and open treatment of septic arthritis of the wrist. J Bone Joint Surg Am. 2009;91(6):1387–93.

    Article  PubMed  Google Scholar 

  • Smith RL, et al. The effect of antibiotics on the destruction of cartilage in experimental infectious arthritis. J Bone Joint Surg Am. 1987;69(7):1063–8.

    CAS  PubMed  Google Scholar 

  • Szer IS, Taylor E, Steere AC. The long-term course of Lyme arthritis in children. New Engl J Med. 1991;325(3):159–63.

    Article  CAS  PubMed  Google Scholar 

  • Trueta J. The three types of acute haematogenous osteomyelitis. J Bone Joint Surg. 1959;41:671–80.

    Google Scholar 

  • Vander Have KL, et al. Community-associated methicillin-resistant Staphylococcus aureus in acute musculoskeletal infection in children: a game changer. J Pediatr Orthop. 2009;29(8):927–31.

    Article  PubMed  Google Scholar 

  • Willis AA, et al. Lyme arthritis presenting as acute septic arthritis in children. J Pediatr Orthop. 2003;23(1):114–8.

    PubMed  Google Scholar 

  • Yagupsky P, Porsch E, St Geme JW. Kingella kingae: an emerging pathogen in young children. Pediatrics. 2011;127(3):557–65.

    Article  PubMed  Google Scholar 

  • Young TP, et al. Etiology of septic arthritis in children: an update for the new millennium. Am J Emerg Med. 2011;29(8):899–902.

    Article  PubMed  Google Scholar 

  • Zaoutis T, et al. Prolonged intravenous therapy versus early transition to oral antimicrobial therapy for acute osteomyelitis in children. Pediatrics. 2009;123(2):636–42.

    Article  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA

    Andrew R. Tyser

  2. Department of Orthopaedic Surgery, University of Utah School of Medicine, 590 Wakara Way, 84108, Salt Lake City, UT, USA

    Douglas T. Hutchinson

Authors
  1. Andrew R. Tyser
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  2. Douglas T. Hutchinson
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Corresponding author

Correspondence to Douglas T. Hutchinson .

Editor information

Editors and Affiliations

  1. Dept. of Orthopedics, University of Maryland School of Medicine, Baltimore, Maryland, USA

    Joshua M. Abzug

  2. Shriners Hospitals for Children, Philadelphia, Pennsylvania, USA

    Scott H. Kozin

  3. Shriners Hospitals for Children, Philadelphia, Pennsylvania, USA

    Dan A. Zlotolow

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Tyser, A.R., Hutchinson, D.T. (2015). Osteomyelitis and Septic Arthritis. In: Abzug, J., Kozin, S., Zlotolow, D. (eds) The Pediatric Upper Extremity. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8515-5_60

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  • DOI: https://doi.org/10.1007/978-1-4614-8515-5_60

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-8513-1

  • Online ISBN: 978-1-4614-8515-5

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