Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills - PubMed (original) (raw)

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

Tamer El-Sobky et al. EFORT Open Rev. 2021.

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.

Keywords: acute pyogenic osteomyelitis; childhood suppurative arthritis; non-technical skills; paediatric musculoskeletal infection; referral / consultation.

© 2021 The author(s).

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Conflict of interest statement

ICMJE Conflict of interest statement: The authors declare no conflict of interest relevant to this work.

Figures

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Serious clinical scenarios precipitating complications.

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Management algorithm for septic arthritis in children.

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Management algorithm for acute haematogenous osteomyelitis in children.

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Management algorithm for antibiotic therapy in acute osteoarticular infections in children.

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References

    1. Mitha A, Boutry N, Nectoux E, et al. ; Hospital Network for Evaluating the Management of Infectious Diseases in Children. Community-acquired bone and joint infections in children: a 1-year prospective epidemiological study. Arch Dis Child 2015;100:126–129. - PubMed
    1. Brischetto A, Leung G, Marshall CS, Bowen AC. A retrospective case-series of children with bone and joint infection from northern Australia. Medicine (Baltimore) 2016;95:e2885. - PMC - PubMed
    1. Kim J, Lee MU, Kim TH. Nationwide epidemiologic study for pediatric osteomyelitis and septic arthritis in South Korea: a cross-sectional study of national health insurance review and assessment service. Medicine (Baltimore) 2019;98:e15355. - PMC - PubMed
    1. Okubo Y, Nochioka K, Testa M. Nationwide survey of pediatric acute osteomyelitis in the USA. J Pediatr Orthop B 2017;26:501–506. - PubMed
    1. Tretiakov M, Cautela FS, Walker SE, et al. . Septic arthritis of the hip and knee treated surgically in pediatric patients: analysis of the Kids’ Inpatient Database. J Orthop 2019;16:97–100. - PMC - PubMed

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