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File 68 Bone and Joint Problems Bone or joint infections (child) (Osteomyelitis and septic arthritis) Recommend Referral to orthopaedic specialist if suspected osteomyelitis / septic arthritis  An important consideration if a skin infection is taking a long time to resolve, or occurs over a joint Background Osteomyelitis and septic arthritis can affect any joint or bone, but most commonly involve the lower limbs  Polyarthritis or aseptic monoarthritis or polyarthralgia, usually migratory i.e. finishes in one joint and then begins in another is a major manifestation of acute rheumatic fever (ARF)  Related topics: Bacterial skin infections, page 279 Acute rheumatic fever (ARF), page 539 1. May present with:  Osteomyelitis Subacute onset of limp / non-weight bearing / refusal to use limb Localized pain and pain on movement Tenderness Soft tissue redness / swelling may not be present and may appear late + / - fever Septic arthritis Acute onset of limp / non-weight bearing / refusal to use limb Pain on movement and at rest Limited range / loss of movement Soft tissue redness / swelling often present Fever 2. Immediate management: Consult MO 3. Clinical assessment: Obtain complete patient history including past episodes does the patient have pain? ask them to rate? when does it hurt? at rest? on movement? has there been any recent trauma? has the patient any skin infections currently or recently? history of acute rheumatic fever current medications taken Perform standard clinical observations Perform physical examination including: note patient on presentation – do they walk in? limp? hop? lean on another person? hold their arm to chest? inspect joints – is there any swelling, redness? allowing for pain levels check the range of movement in affected joint palpate the joint - is the joint warm to touch? is there tenderness? File 68 Bone and Joint Problems 4. Management: Consult MO who will arrange evacuation / hospitalisation referral to orthopaedic specialist FBC, ESR, blood cultures may order x-ray IV antibiotics Rest and immobilise limb  Treat pain and fever with Paracetamol See simple Analgesia protocol (back cover) 5. Follow up: All children with suspected osteomyelitis or septic arthritis should be managed in hospital 6. Referral / Consultation: Consult MO on all occasions of suspected osteomyelitis and septic arthritis Refer to orthopaedic specialists if osteomyelitis / septic arthritis is suspected or confirmed  References 1. 2. The Royal Childrens Hospital. Osteomyelitis and Septic Arthritis. Clinical Practice Guidelines 2008 [cited 27/7/09]; Available from: http://www.rch.org.au/clinicalguide/cpg.cfm?doc_id=5234 National Heart Foundation, RF/RHD Guideline Development Working Group, and Cardiac Society of Australia and New Zealand, Diagnosis and management of acute rheumatic fever and rheumatic heart disease in Australia: An evidence based review. 2006, NHFA.