Orthopaedics
Fractures, the limping child and bone infection.
Use as a study guide only. These notes are part of a free open-access medical education (FOAMed) project and may contain errors or outdated information. Always verify against current guidelines (e.g. eTG, RACGP, local health district policies) and reputable sources before applying anything to patient care. See the full disclaimer.
From the wards
Clinical pearls & learnings
Tips and tricks collected over the years — a living list that grows with every rotation. Use as a study guide only and check current guidelines before acting on anything.
Bones, joints & the limping child
Osteomyelitis vs septic arthritis
- The limping child differential: septic arthritis, osteomyelitis, transient synovitis, discitis.
- Red flag: refusal to move the limb at all.
- Most osteomyelitis is haematogenous seeding into the metaphysis — usually Staphylococcus aureus. Kingella kingae is a culture-negative cause to remember, especially under 4 years.
- Use the Kocher criteria (check ESR) to help stratify septic arthritis risk.
- MRI is the investigation of choice; ultrasound is non-specific but useful to check for a joint effusion in suspected septic arthritis.
- If osteomyelitis is confirmed, arrange a TTE to exclude endocarditis as a source/complication.
- Treat with 7 days of antibiotics with early step-down to oral therapy.
- Surgical drainage is needed for an abscess, or if there is no response to antibiotics after 48 hours.