Septic arthritis is a serious disease in children.

 It may present with pseudoparalysis of a joint, limp, decreased range of motion, pain and fever.

 Diagnosis should be made promptly as cartilage destruction can begin within 8 hours.

Potential complications include avascular necrosis, ligamentous destruction, dislocation and lack of future growth.

H. influenza B was the most common organism prior to development of the vaccine.

Today Staphlococcus aureus is the most common.

 In neonates, gram negative organisms should also be considered.

The other most common organisms include Pseudomonas auruginosa, Pneumococcus and Neisseria meningitidis or gonorrhea.

MRSA should be covered as well due to its increasing incidence.

Septic arthritis is twice as common as osteomyelitis in children.

Hematogeneous spread to the joint is the most common cause either through synovial vessels or via osteomyelitis of the metaphysis.

Penetrating injury or spread via a contiguous cellulitis also occurs.

Most patient still require joint drainage, although occasionally antibiotic coverage may be sufficient.

Differential diagnosis depending upon location and presentation may include:

 Juvenile rheumatoid arthritis

 Lyme disease

Rheumatic fever

Transient synovitis

Legg-Calve-Perthes disease

Psoas abscess.

TAKE HOME MESSAGE:

Potts Puffy tumor of scalp -Osteomyelits from sinisitis

Great toe-stubbing with hyperflexion of distal phalanx physeal distraction fracture and nail bed disruption can result in distal phalanx osteomyelitis.