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Osteomyelitis and Septic Arthritis of the Upper Extremity in Pediatric Patients
Nnaoma M Oji1, Coleen S Sabatini2,3
1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Insights
Pediatric upper extremity osteomyelitis and septic arthritis are often severe. Early diagnosis and individualized treatment, including urgent surgery for septic joints, are crucial for recovery.
Area of Science:
- Pediatric Orthopedics
- Pediatric Infectious Diseases
- Musculoskeletal Infections
Background:
- Pediatric osteomyelitis and septic arthritis occur in 10-24% of cases in the upper extremity (UE).
- UE infections present with diagnostic and management challenges, often leading to more severe outcomes compared to lower extremity (LE) infections.
- This review synthesizes recent literature on pediatric UE osteoarticular infections.
Purpose of the Study:
- To evaluate the literature from the past six years concerning pediatric osteomyelitis and septic arthritis of the UE.
- To provide a clinical management guide for healthcare professionals handling these complex pediatric conditions.
Main Methods:
- Comprehensive literature review of studies published within the last six years.
- Analysis of diagnostic criteria, causative organisms, and treatment strategies for UE osteoarticular infections.
- Synthesis of findings to inform clinical practice guidelines.
Main Results:
- The shoulder, elbow, and humerus are the most frequently affected sites.
- Staphylococcus aureus is the predominant pathogen, with Kingella kingae being an underrecognized cause in culture-negative cases.
- Urgent surgical irrigation and debridement followed by 2-4 weeks of antibiotics are recommended for septic joints. Antibiotics alone are standard for acute osteomyelitis without complications.
- Methicillin-resistant Staphylococcus aureus (MRSA) is linked to increased disease severity and surgical interventions.
Conclusions:
- Pediatric UE osteomyelitis and septic arthritis, though less common than LE, have a significant impact on children's health.
- An individualized, multidisciplinary approach combining antibiotic and surgical management is key to successful disease resolution.
- Further research is needed to evaluate aspiration as a primary treatment for UE septic joints.
Purpose Of Review:
For pediatric osteomyelitis and septic arthritis, 10-24% of cases occur in the upper extremity (UE). Due to delays in presentation and diagnosis, UE infections are often more complex and severe than infections of the lower extremity (LE). This review evaluates the literature from the past 6 years related to pediatric osteomyelitis and septic arthritis of the UE and provides a guide for professionals managing these conditions in children.
Recent Findings:
The shoulder and elbow are the most commonly affected joints, and the humerus is the most commonly affected bone. As with the LE, diagnosis of UE osteoarticular infections is based on clinical evidence, laboratory data, and diagnostic imaging. While Staphylococcus aureus is the primary bacteria identified in UE infections, there is an underappreciation of the burden from Kingella kingae as a causative organism in culture-negative patients where PCR is not performed. Septic joints should be treated with irrigation and debridement urgently, with subsequent antibiotic therapy for a minimum of 2-4 weeks. For acute osteomyelitis without abscess or concomitant septic joints, antibiotic therapy is standard of care. Methicillin-resistant Staphylococcus aureus is associated with more severe infection requiring more surgeries. Various strategies exist for managing segmental bone loss in chronic osteoarticular infections. Osteomyelitis and septic arthritis tend to occur less frequently in the UE than the LE but have a devastating impact on the health and quality of life of children around the world. Complete resolution of disease can be achieved through an individualized approach to antibiotic and operative management. Further study is needed to assess the efficacy of aspiration as a primary treatment strategy in UE joints.
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