Paediatric orthopaedic infections

Bone and joint infections in children are uncommon, but potentially devastating. The use of effective antibiotic chemotherapy has minimized associated mortality, but prompt recognition and treatment is necessary to preserve normal growth and function of the affected bone or joint. Diagnostic challenges include inability of patients to report symptoms, non-specificity of clinical signs and low sensitivity of diagnostic tests while treatment challenges include choosing appropriate empiric antibiotics, accounting for patient and epidemiological risk factors, and ensuring adequate compliance with long antibiotic courses in children. Successful management requires regular review of clinical progress and assessment for development of complications requiring surgical intervention. This article will cover the commonest infections seen clinically. Septic arthritis and osteomyelitis are discussed separately though concurrent infection can occur, particularly in children under 2 years of age, and recognition of this can alter the duration of treatment required.