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File 68 Bone and Joint Problems
 Bone or joint infections (child)
(Osteomyelitis and septic arthritis)
 Referral to orthopaedic specialist if suspected osteomyelitis / septic arthritis [1]
 An important consideration if a skin infection is taking a long time to resolve, or
occurs over a joint
 Osteomyelitis and septic arthritis can affect any joint or bone, but most commonly
involve the lower limbs [1]
 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) [2]
Related topics:
 Bacterial skin infections, page 279
 Acute rheumatic fever (ARF), page 539
May present with: [1]
 Subacute onset of limp / non-weight
bearing / refusal to use limb
 Localized pain and pain on
 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
Immediate management:
 Consult MO
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
 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 [1]
 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
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 [1]
The Royal Childrens Hospital. Osteomyelitis and Septic Arthritis. Clinical Practice
Guidelines 2008 [cited 27/7/09]; Available from:
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.