Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills

Abstract

Acute osteoarticular infections (AOI) should be treated as top emergencies. The first few days following the inception of infection are ultra-critical to long-term prognosis. A comprehensive road map for management of childhood AOI is still lacking despite recent advances in microbiology and imaging (magnetic resonance imaging). The many faces of childhood AOI warrant a multidiscipline approach to management. Laboratory and imaging findings of are still debatable and should not overshadow or delay a management plan based on the experienced physician’s clinical judgment. Ample evidence-based practice supports the use of a few days of intravenous antibiotic administration followed by oral therapy until correlative clinical and basic laboratory (acute phase reactants) results improve. The growing body of evidence on ‘high-risk’ children/neonates of AOI warrants continual clinical extra-vigilance in identifying these patient subsets. Open drainage and debridement remain the mainstay of treatment of septic hips, whereas for other joints the use of alternative surgical techniques should be individualized or on case-by-case basis. Because the consequences of misdiagnosis of AOI are usually grave and permanent, proactive treatment/overtreatment is justified in the event of unconfirmed but suspicious diagnosis. Cite this article: EFORT Open Rev 2021;6:584-592. DOI: 10.1302/2058-5241.6.200155

A scoping review of mycetoma profile in Egypt: revisiting the global endemicity map

“…Unlike bacterial osteomyelitis and septic arthritis, mycetoma infections are generally related to certain occupations, such as farming and herd raising, that may entail working barefooted. 48 , 49 This calls for wide proactive measures aimed at raising the awareness of vulnerable populations regarding the use of protective clothes and footwear, among others. This is of particular importance not only for mycetoma, but also for other mycotic diseases, because the Middle East and North Africa in general, and Egypt specifically, are postulated to have a considerable burden of serious fungal infections.…”

Bone transport in the management of post-osteomyelitis femoral defects in children: A case series with a minimum of 10-year follow-up in Uganda

“…The difficulties in management are augmented in low-income countries in which adequate facilities and surgical skills are few in number and difficult to access both logistically and economically. 4 , 21 We opted for BT as it may address all of the clinical requirements of complex cases. The improvements in clinical and radiological features within our series show excellent BT results in the long term, achieving sound bone reconstruction, resolution of infection, and functional improvement of joints that initially appeared unsalvageable.…”

“… 1 , 2 In low-income countries, such bone defects typically develop as a sequela of mismanaged or undertreated acute bone infections. 3 , 4 The systemic upset resulting from osteoarticular infections such as fevers, pain, and myalgia may be falsely attributed to malaria or infection at alternate sites. Moreover, local practitioners or child caretakers may ineffectively self-manage with over-the-counter antibiotics.…”

Acute haematogenous osteomyelitis in the paediatric population: a current concepts review

“…The femur (23-29%), tibia (19-26%) and humerus (5-13%) are most commonly affected, but 10-25% can involve the short or non-tubular bones, and 5% are polyostotic. [2][3][4]7,11,16,18,[38][39][40][41] Preceding trauma is reported in 30-60% of cases. 4,12,15 Concomitant septic arthritis is present in 30% of cases, but this could be as high as 75% in cases involving neonates.…”