Download Bone or joint infections

Survey
yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project

Document related concepts

Kawasaki disease wikipedia, lookup

Acute pancreatitis wikipedia, lookup

Hospital-acquired infection wikipedia, lookup

Osteochondritis dissecans wikipedia, lookup

Multiple sclerosis signs and symptoms wikipedia, lookup

Ankylosing spondylitis wikipedia, lookup

Rheumatoid arthritis wikipedia, lookup

Rheumatic fever wikipedia, lookup

Arthritis wikipedia, lookup

Transcript
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 [1]
 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 [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
1.
May present with: [1]
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 [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
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 [1]
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.