Paediatric bone and joint infection

Overview

This review covers bone and joint infections in children, mainly acute haematogenous osteomyelitis and septic arthritis. It is aimed at paediatric orthopaedic surgeons, paediatricians and emergency clinicians, who have to recognise these infections early to avoid lasting damage to the growing skeleton.

Microbiology and diagnosis

Staphylococcus aureus is the leading pathogen overall. The review draws attention to Kingella kingae as an important cause in young children, which molecular methods detect far more reliably than conventional culture. Diagnosis combines clinical assessment, inflammatory markers and imaging. Ultrasound is useful for detecting joint effusion, and MRI helps define bone involvement and complications. Blood cultures, joint fluid analysis and tissue sampling support targeted treatment.

Treatment

Empiric antibiotic therapy is started promptly and adjusted to local resistance patterns and to microbiological results. The review describes a trend towards an earlier switch to oral therapy and shorter overall courses in uncomplicated cases, guided by clinical response and falling inflammatory markers. Septic arthritis usually needs urgent joint drainage. Surgery for osteomyelitis is reserved for abscesses, sequestra or failure to respond to treatment.

Complications and follow-up

Possible complications include chronic osteomyelitis, growth disturbance, joint destruction and deformity. Severe disease can also be complicated by thrombosis or systemic sepsis. Structured follow-up is advised to detect growth problems early.

Implications for practice

Early recognition, a pathway that takes different pathogens into account, and close cooperation between paediatric and orthopaedic teams improve outcomes.