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Garg V, Singh V, Kalia RB, Regmi A, Yasam R, Sinha SK. Role of Magnetic Resonance Imaging in Concomitant Periarticular Infections in Septic Arthritis of Large Joints in Children: A Systematic Review. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2024; 14:83-89. [PMID: 38486643 PMCID: PMC10936883 DOI: 10.4103/jwas.jwas_83_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/12/2023] [Indexed: 03/17/2024]
Abstract
Background Septic arthritis associated with adjacent infections, presents a diagnostic challenge as the clinical presentation is similar to that of isolated septic arthritis, additional diagnostic tools are needed to detect these infections. The purpose of this study was to examine the effectiveness of magnetic resonance imaging (MRI) for diagnosis of concomitant infection in children with septic arthritis of large joints and its effect on patient outcome and treatment. Materials and Methods Electronic literature research of PubMed, Cochrane and Scopus, was conducted in January 2022 using a combination of MeSH, search terms and keywords. The data extracted included the study details, demographic data, the proportion of patients having a concomitant periarticular infection, clinical presentation, blood parameters and culture findings and outcomes. Results This review included seven studies with 499 patients. The mean age was 7.08 ± 2.38 years in the study. There was a male predominance, with 174 being males (62.36%). The most common joint involved was the hip joint (44.47%). 42.48% had concomitant periarticular infections detected by MRI. Osteomyelitis was the most common infection seen in 209 patients (41.84%). The mean duration of antibiotics given and hospital stay was significantly more in periarticular infections (P > 0.05). 32.5% of the patients with septic arthritis underwent a second surgical procedure whereas 61.11% of patients with periarticular infections underwent second procedure in this review (P > 0.05). Conclusions The use of MRI to diagnose these complicated infections appears to be beneficial. Multi-centric randomised control trials are needed to investigate the efficacy of MRI and its impact on patient care and outcome.
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Affiliation(s)
- Varun Garg
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Vivek Singh
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Roop Bhusan Kalia
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Anil Regmi
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Ramapriya Yasam
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Sourabh Kumar Sinha
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
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Cochard B, Habre C, Pralong-Guanziroli N, Gavira N, Di Laura Frattura G, Di Marco G, Steiger CN, De Coulon G, Dayer R, Ceroni D. Transphyseal Hematogenous Osteomyelitis: An Epidemiological, Bacteriological, and Radiological Retrospective Cohort Analysis. Microorganisms 2023; 11:microorganisms11040894. [PMID: 37110317 PMCID: PMC10146640 DOI: 10.3390/microorganisms11040894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
Transphyseal hematogenous osteomyelitis (THO) is a serious condition that can affect the growing physis, yet it is insufficiently recognized in children. The aim of this study was to explore the prevalence and epidemiology of pediatric THO, and to discuss the underlying pathophysiology. All consecutive cases of acute and subacute osteomyelitis admitted to our institution over 17 years were retrospectively studied. Medical records were examined for patient characteristics, bacteriological etiology, and medical and surgical management. Magnetic resonance imaging was reviewed for all patients to identify those with transphyseal spread of infection. For positive cases, the surface area of the transphyseal lesion was estimated relative to the total physeal cross-sectional area. Fifty-four (25.7%) of the 210 patients admitted for acute or subacute osteomyelitis were diagnosed with THO. The study population’s ages ranged from 1 month to 14 years old (median age 5.8 years, interquartile range 1–167 months). Fourteen (25.9%) patients were younger than 18 months old; the remaining 40 (74.1%) had a mean age of 8.5 years old. The most common sites of THO were the distal tibia (29.1%), the proximal tibia (16.4%), and the distal fibula (14.5%). Transphyseal lesions were due to acute infection in 41 cases and to subacute osteomyelitis in 14 cases. The two most frequently identified pathogens were Staphylococcus aureus (49.1%) and Kingella kingae (20.0%). An average transphyseal lesion represented 8.9% of the total physeal surface, and lesions comprised more than 7% of the physeal cross-sectional area in 51% of cases. Our study revealed that pediatric THO was more frequent than commonly thought. Transphyseal lesions were frequently above this 7% cut-off, which is of paramount importance since subsequent growth is more likely to be disturbed when more than 7% of the physeal cross-sectional area is injured. THO also affected children older than 18 months, an age at which transphyseal arterial blood supply to the epiphysis is believed to have disconnected. This finding suggests another pathophysiological reason for the transphyseal diffusion of infection, a topic deserving further studies and greater understanding.
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Affiliation(s)
- Blaise Cochard
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland
- Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, CH-1211 Geneva, Switzerland
| | - Céline Habre
- Pediatric Radiology Unit, Geneva Children’s Hospital, Geneva University Hospitals, CH-1211 Geneva, Switzerland
| | | | - Nathaly Gavira
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland
| | - Giorgio Di Laura Frattura
- Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, CH-1211 Geneva, Switzerland
| | - Giacomo Di Marco
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland
| | - Christina N. Steiger
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland
| | - Geraldo De Coulon
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland
| | - Romain Dayer
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland
| | - Dimitri Ceroni
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland
- Correspondence:
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Shet NS, Iyer RS, Chan SS, Baldwin K, Chandra T, Chen J, Cooper ML, Creech CB, Gill AE, Levin TL, Moore MM, Nadel HR, Saidinejad M, Schooler GR, Squires JH, Swenson DW, Rigsby CK. ACR Appropriateness Criteria® Osteomyelitis or Septic Arthritis-Child (Excluding Axial Skeleton). J Am Coll Radiol 2022; 19:S121-S136. [PMID: 35550797 DOI: 10.1016/j.jacr.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 10/18/2022]
Abstract
Imaging plays an integral role in the evaluation of suspected musculoskeletal infections in children, not only in the accurate identification of infection such as osteomyelitis or septic arthritis, but also in guiding management. Various diagnostic modalities serve different purposes in the assessment of suspected pediatric musculoskeletal infections. The purpose of this document is to provide imaging guidance in the most frequently encountered clinical scenarios in which osteomyelitis and/or septic arthritis are suspected, outside of the axial skeleton. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion.
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Affiliation(s)
- Narendra S Shet
- Children's National Hospital, Washington, District of Columbia.
| | - Ramesh S Iyer
- Panel Chair, Seattle Children's Hospital, Seattle, Washington; and Chair, SPCC (CoPLL)
| | - Sherwin S Chan
- Panel Vice-Chair, Vice Chair of Radiology, Children's Mercy Hospital, Kansas City, Missouri
| | - Keith Baldwin
- Associate Professor, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; American Academy of Orthopaedic Surgeons
| | - Tushar Chandra
- Magnetic Resonance Medical Director, Chief of Research, Chief of Medical Education, Co-director of 3D and Advanced Imaging Lab, Nemours Children's Hospital, Orlando, Florida
| | - Jimmy Chen
- University of Florida College of Medicine Jacksonville, Jacksonville, Florida; American Academy of Pediatrics
| | - Matthew L Cooper
- Pediatric Radiology Division Chief, Radiology Medical Director, Riley Hospital for Children, Indianapolis, Indiana
| | - C Buddy Creech
- Vanderbilt University Medical Center, Nashville, Tennessee; Infectious Diseases Society of America; and President, Pediatric Infectious Diseases Society
| | - Anne E Gill
- Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia
| | - Terry L Levin
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York; Chair ACR Pediatric Practice Parameters
| | - Michael M Moore
- Co-director, Division of Radiology Innovation and Value Enhancement (DRIVE), Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Helen R Nadel
- Lucile Packard Children's Hospital at Stanford, Stanford, California; Member Committee on Practice Parameters-Pediatric ACR; and Alternate to Senate Stanford University School of Medicine
| | - Mohsen Saidinejad
- UCLA Medical Center, Los Angeles, California; American College of Emergency Physicians; and Director, Institute for Health Services and Outcomes Research-The Lundquist Institute for Biomedical Innovation at Harbor UCLA
| | | | - Judy H Squires
- Chief of Ultrasound; Associate Program Director for Diagnostic Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - David W Swenson
- Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cynthia K Rigsby
- Specialty Chair, Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Adam M, Ibrahim B, Khidir R, Elmahdi E, Ahmed S, Ahmed A. Usefulness of MRI findings in differentiating between septic arthritis and transient synovitis of hip joint in children: A systematic review and meta-analysis. Eur J Radiol Open 2022; 9:100439. [PMID: 36061257 PMCID: PMC9436746 DOI: 10.1016/j.ejro.2022.100439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose Septic arthritis (SA) of the hip joint is a serious infection which can lead to more irreversible complications. Differentiating Septic arthritis from Transient synovitis (which is the most common cause of painful hip in children) is difficult and very important to prevent serious complications which can occur with Septic arthritis. The aim of this study was to find out the MRI findings which can differentiate between these two conditions. Methods Systematic literature search was conducted according to the PRISMA guidelines on MEDLINE(PubMed), Google Scholar, ScienceDirect, and world Health Organization Virtual Health Library, up to April 2022. Studies that compared MRI findings between Septic Arthritis and Transient Synovitis of hip joint in children were included. The pooled sensitivity and specificity estimates of these findings were calculated using MetaDTA version 2.0. Results Six studies were included in qualitative analysis and five were included in quantitative analysis. Pooled sensitivity and specificity of synovial enhancement were 94.2 % (95 % CI, 45.2–99.7 %) and 60.6 % (95% CI, 6–97.4 %) respectively. Soft tissue changes had pooled sensitivity and specificity of 75 % (95% CI, 57.5–86.9 %) and 69.9 % (95 % CI, 46.5–86.2 %) respectively. Pooled sensitivity and specificity of femoral head changes were 41.5 % (95 % CI, 15.9–72.7 %) and 87.3 % (95 % CI, 75.5–93.8 %) respectively. Bone marrow changes had pooled sensitivity and specificity of 70 % (95 % CI, 26.8–93.7 %) and 99.9 % (95 % CI, 28.7–100 %) respectively. Conclusion MRI findings especially bone marrow changes were found to be useful in differentiating septic arthritis from transient synovitis among children presented with painful hip after exclusion of other causes.
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El-Sobky T, Mahmoud S. Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills. EFORT Open Rev 2021; 6:584-592. [PMID: 34377550 PMCID: PMC8335954 DOI: 10.1302/2058-5241.6.200155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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.
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Affiliation(s)
- Tamer El-Sobky
- Division of Paediatric Orthopaedics, Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Shady Mahmoud
- Division of Paediatric Orthopaedics, Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Filleron A, Laurens ME, Marin G, Marchandin H, Prodhomme O, Alkar F, Godreuil S, Nagot N, Cottalorda J, L'Kaissi M, Rodiere M, Vigue MG, Didelot MN, Michon AL, Delpont M, Louahem D, Jeziorski E. Short-course antibiotic treatment of bone and joint infections in children: a retrospective study at Montpellier University Hospital from 2009 to 2013. J Antimicrob Chemother 2020; 74:3579-3587. [PMID: 31504582 DOI: 10.1093/jac/dkz358] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Acute haematogenous bone and joint infections (AHBJI) represent a diagnostic and therapeutic emergency in children, with significant potential sequelae in the case of delayed treatment. Although historically the recommendations for treatment have been based on surgery and prolonged antibiotic therapy, recent studies have demonstrated that short-course antibiotic therapy is also effective. OBJECTIVES We evaluated a short-term antibiotic protocol for both osteomyelitis and septic arthritis in a 6 year retrospective study at the University Hospital of Montpellier. METHODS This protocol was based on an initial intravenous treatment with a re-evaluation after 48 h and an early switch to oral therapy in the case of a favourable clinical course for a minimum total duration of 15 days. Antibiotics were selected based on local microbiological epidemiology and systematically adapted to bacteriological results. RESULTS One hundred and seventy-six cases of AHBJI were included, comprising 56 patients with osteomyelitis, 95 with septic arthritis and 25 who had both of these. The aetiological agent was identified in 42% of the cases, with the main pathogens being Staphylococcus aureus (39%) and Kingella kingae (27%). The mean intravenous treatment duration was 4 days, while the total treatment duration was 15 days. There were no treatment failures, mild sequelae occurred in 1% of the cases and the secondary surgical revision rate was 7%. CONCLUSIONS The results of this study are comparable to those reported for evaluations of prolonged antibiotic therapy protocols, thus indicating that a common short-term antimicrobial therapy for the management of both osteomyelitis and septic arthritis (minimum of 15 days) is a viable option for treating AHBJI in children. Further prospective studies to confirm these findings are hence warranted.
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Affiliation(s)
- A Filleron
- Service de pédiatrie, CHU de Nîmes, Nîmes, France; INSERM U 1183, Université Montpellier-Nîmes, Nîmes, France
| | - M E Laurens
- Département de pédiatrie néonatale et de réanimation, CHU de Montpellier, Montpellier, France
| | - G Marin
- Department d'Information Medicale, CHU Montpellier, Montpellier, France
| | - H Marchandin
- HydroSciences Montpellier, University of Montpellier, CNRS, IRD, Montpellier, France; Laboratoire de microbiologie, CHU Nîmes, Nîmes, France
| | - O Prodhomme
- Département d'imagerie pédiatrique, CHU de Montpellier, Montpellier, France
| | - F Alkar
- Service de chirurgie orthopédique infantile, CHU Montpellier, Montpellier, France
| | - S Godreuil
- Service de bactériologie, CHU Montpellier, Montpellier, France.,Université de Montpellier UMR MIVEGEC, UMR IRD 224-CNRS Inserm, 1058, Montpellier, France
| | - N Nagot
- Department d'Information Medicale, CHU Montpellier, Montpellier, France.,Pathogenesis and Control of Chronic Infections, INSERM, Université de Montpellier, Montpellier, France
| | - J Cottalorda
- Service de chirurgie orthopédique infantile, CHU Montpellier, Montpellier, France
| | - M L'Kaissi
- Service de chirurgie infantile, CHU de la réunion, Saint-Denis, France
| | - M Rodiere
- Département urgences post-urgences, CHU Montpellier, Montpellier, France
| | - M G Vigue
- Département urgences post-urgences, CHU Montpellier, Montpellier, France
| | - M N Didelot
- Service de bactériologie, CHU Montpellier, Montpellier, France.,Pathogenesis and Control of Chronic Infections, INSERM, Université de Montpellier, Montpellier, France
| | - A L Michon
- Service de bactériologie, CHU Montpellier, Montpellier, France
| | - M Delpont
- Service de chirurgie orthopédique infantile, CHU Montpellier, Montpellier, France
| | - D Louahem
- Service de chirurgie orthopédique infantile, CHU Montpellier, Montpellier, France
| | - E Jeziorski
- Pathogenesis and Control of Chronic Infections, INSERM, Université de Montpellier, Montpellier, France.,Département urgences post-urgences, CHU Montpellier, Montpellier, France
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Abstract
Septic arthritis in children is a surgical emergency, and prompt diagnosis and treatment are mandatory. If diagnosed quickly and treated correctly, the outcomes can be good. With delay in diagnosis and without proper treatment, outcomes often are quite devastating, with growth disturbance and joint destruction.
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Bildgebung bei Infektionen großer Gelenke. ARTHROSKOPIE 2019. [DOI: 10.1007/s00142-018-0231-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
BACKGROUND The role of femoral aspiration (FA) in the treatment of septic arthritis of the hip is controversial. The purpose of this study was to determine if FA conducted concomitantly with irrigation and debridement (I&D) of the septic hip aids in microorganism and osteomyelitis identification and alters the treatment plan, or if the risks of the procedure outweigh its potential benefit. We also compare preoperative magnetic resonance imaging (MRI) with FA for diagnosis of osteomyelitis cooccurring with septic arthritis. METHODS Retrospective review was performed of all patients treated at a single institution between January 2003 and June 2014 for suspected septic hip arthritis. Eighty-three patients were identified with suspected or confirmed septic arthritis and 28 patients (33%) had cooccurring osteomyelitis. Demographic and clinical data were recorded for each patient. The sensitivity and specificity of FA and MRI for diagnosing osteomyelitis were determined. RESULTS Among the 83 patients with confirmed or suspected septic arthritis, 31 patients (37%) had a FA performed at the time of the hip I&D, resulting in positive cultures in 17 patients. All of these patients had other positive cultures (blood and/or joint fluid) that grew the same organism. 54 patients (65%) had a preoperative MRI. The MRI was falsely negative in 10 patients, 6 of whom had a positive FA resulting in appropriate management of osteomyelitis. Missed or delayed diagnosis of osteomyelitis resulted in significant morbidity in 3 patients (avascular necrosis and femoral neck fracture, extensive lower extremity osteomyelitis, and subtrochanteric fracture with malunion). No complications associated with FA were identified. FA and MRI were found to have sensitivity/specificity for osteomyelitis of 100%/100% and 38%/95%, respectively. CONCLUSIONS Although FA did not improve microorganism identification, it did aid in the diagnosis of cooccurring osteomyelitis when treating children with septic arthritis, especially in patients with false negative MRI findings for osteomyelitis. We recommend FA at the time of septic hip I&D as its benefits appear to far outweigh its risks. LEVEL OF EVIDENCE Level III-diagnostic study.
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