Paediatrics - Queensland Health - Queensland Government

Bone and joint problems
3. Clinical assessment
• Obtain complete patient history including:
-- past episodes
-- does the patient have pain? ask them to rate?
-- when does it hurt? at rest? on movement?
-- has there been any recent trauma?
-- has the patient any skin infections currently or recently?
-- history of acute rheumatic fever
-- current medications taken
• Perform standard clinical observations
• Perform physical examination including:
-- note patient on presentation - do they walk in? limp? hop? lean on another
person? hold their arm to chest?
-- inspect joints - is there any swelling, redness?
-- allowing for pain levels check the range of movement in affected joint
-- palpate the joint - is the joint warm to touch? is there tenderness?
4. Management
• Consult MO who will arrange:
-- evacuation / hospitalisation
-- referral to Orthopaedic Specialist
-- FBC, ESR, blood cultures
-- may order x-ray
-- IV antibiotics
• Rest and immobilise limb [1]
• Treat pain and fever with paracetamol
See Simple analgesia back cover
5. Follow up
All children with suspected osteomyelitis or septic arthritis should be managed in
hospital
6. Referral / consultation
Consult MO on all occasions of suspected osteomyelitis and septic arthritis
Refer to Orthopaedic Specialist if osteomyelitis / septic arthritis is suspected or
confirmed [1]
References
1. The Royal Children’s Hospital Melbourne. Osteomyelitis and Septic Arthritis. 2008 [cited 2011 January]; 8th edition:
Available from: www.rch.org.au/clinicalguide/cpg.cfm?doc_id=5234.
2. National Heart Foundation, RF / RHD Guideline Development Working Group, and Cardiac Society of Australia and
New Zealand, Diagnosis and management of acute rheumatic fever and rheumatic heart disease in Australia: An
evidence based review. 2006, National Heart Foundation Australia.
Primary Clinical Care Manual 2011 Controlled copy V 1.0 631