Osteomyelitis and Septic Arthritis of the Upper Extremity in Pediatric Patients

Abstract

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.

Keywords: Infection; Osteomyelitis; Pediatrics; Septic Arthritis; Upper Extremity.

Fig. 1.

8-year-old male with > 1 week of worsending left shoulder pain and limited range of motion after recent sinus infection. Note the ill-defined lucencies in the metaphysis

Fig. 2

a clinical photo of a child with two areas of draining sinus due to underlying chronic osteomyelitis. b AP xray of the forearm demonstrating a large sequestrum in the ulna with surrounding involucrum. The radiocapitellar joint is dislocated and the ulnohumeral joint shows degenerative changes, consistent with an untreated septic arthritis

Fig. 3

MRI of a shoulder showing joint effusion in setting of a septic joint

Fig. 4

An approximately 2-year-old child with chronic osteomyelitis of the radius. Note the sequestrum in the intramedullary canal with the surrounding involucrum

Fig. 5

Child with delayed presentation chronic osteomyelitis with large segmental bone defect from either extruded or surgically excised sequestrum of the diaphysis, without involucrum