[Neonatal osteomyelitis of the proximal femur: a case with ten-year follow-up and review of the literature]. / Ostéomyélite néonatale du col du fémur avec contamination articulaire.

Acute hematogenous osteomyelitis most frequently occurs in children, generally around 6 to 9 years of age. If it occurs in early infancy, the infection usually involves both the bone and the joint, nearly simultaneously. Neonatal osteomyelitis is another presentation, with an osteomyelitic focus in the metaphysis. We report a case of septic arthritis following osteomyelitis of the hip joint in a neonate caused by a virulent pathogenic organism. Despite late diagnosis and treatment, outcome was very satisfactory with few sequelae for the joint and epiphysis. It should be emphasized that early diagnosis, with prompt and adequate treatment is essential to achieve good outcome. We discuss this case and present a review of the literature.

[Septic arthritis in neonates and infants]. / Septicni artritis novorodenceta i odojceta.

INTRODUCTION: Septic arthritis represents an intra-articular infection caused by pyogenic bacteria. During the earliest childhood it is considered to be a systemic septic condition and demands early diagnosis and prompt surgical treatment. MATERIAL AND METHODS: This is a retrospective analysis of patients with septic arthritis treated at the Department of Orthopedics of the Pediatric Surgery Clinic in Novi Sad, over a 10-year period. We are also presenting a case of a 12-day-old newborn baby, with clear radiological signs of osteoarthritis of the right knee. RESULTS: A retrospective study included the period 1991-2000, and showed that 15 patients, aged 10 days--12 months were treated for osteoarthritis. The most common localization was the hip, in 60% of cases. In 11 patients the causative agent was Staphylococcus aureus, while in the 4 remaining patients the bacteriologic finding was negative. One patient died of generalized sepsis. DISCUSSION: In neonates and infants septic arthritis is characterized by atypical clinical picture, often causing delayed diagnosis. In the initial phases of the disease ultrasonographic findings were of greater use compared to radiological imaging, due to relatively late appearance of radiological signs of disease. CONCLUSIONS: Due to possible development of serious and irreversible damage, even lethal outcome, septic arthritis requires early diagnosis, prompt administration of antibiotics and early surgical treatment. It is a quite unique area in Pediatric Orthopedics where missed or delayed diagnosis may have serious consequences.

Fortuitous diagnosis of iliac osteomyelitis: septic arthritis of the hip in the neonate.

The neonate is unable to relate specific complaints of pain and may not exhibit the usual signs of illness or infection. Septic arthritis of the hip is a surgical emergency in the neonate, and it should be considered in any irritable or ill child who has a high index of suspicion. Prompt diagnosis and immediate treatment are necessary. Nearly all babies undergo routine examination of the hip for dysplasia. It is recognized that limitation of abduction of the hip in the neonate may not represent developmental dysplasia of the hip but may represent other etiologies, such as fracture, infection, congenital anomaly, or tumor. The following case report illustrates the importance of careful clinical evaluation of an apparent asymptomatic neonate.

Bone and joint infection in neonates.

A retrospective study was done to review the clinical experience of septic arthritis and osteomyelitis in the newborns in our centre. Case records of all the neonates born from January 1989 to August 1994 and those admitted to outborn nursery from 1985 to 1993 were reviewed. Diagnosis of septic arthritis/osteomyelitis was made in the presence of relevant clinical signs and supported by positive culture from blood or joint fluid and abnormal X-ray or ultrasound findings. The incidence of septic arthritis and osteomyelitis among inborn babies was 1 in 1500. There were 25 neonates with mean gestational age 34.5 (range 27-40) weeks and mean birth weight 2269 (range 990-4750) gms. Limitation of movement (64%) and local swelling (60%) were commonest presentations. A total of 33 joints were involved in 25 babies. Eight babies (32%) had multiple joint involvement. Hip and knee were the most commonly involved joints (48% each). In 19 babies (76%) joint involvement occurred in association with a generalized septicemic illness while 6 babies (24%) had localised signs and symptoms. Joint aspirate was positive for gram stain or culture in 12 (48%) and 10 babies (40%) had positive blood culture. Klebsiella pneumoniae and Staphylococcus aureus were commonest isolates. Radiological changes were seen in 13 (52%) babies. All were treated with appropriate antibiotics and open surgical drainage was done in 5 (20%) cases. Bone and joint infections are important complications in sick septicemic neonates and need early diagnosis, appropriate management with antibiotics, surgical drainage in selected cases to prevent long term morbidity.

Bone and joint infection in the neonate.

Bone and joint infections during the neonatal period differ from those in the older child. Neonates are relatively immunocompromised and their growth plate is pierced by blood vessels. Special characteristics of skeletal infection in the neonate are: (1) multiple foci of infection; (2) simultaneous involvement of the bone and the adjacent joint; and (3) limited systemic and local inflammatory response. The more common causative organisms are group B Streptococcus, Staphylococcus aureus, and gram-negative bacteria. Clinical findings can be minimal or absent. The more common findings include local swelling and limited motion in a joint or a limb. Early soft tissue radiographic changes are found in most cases and should be looked for. Every suspected bone or joint should be aspirated. Hip joint aspiration is recommended in the presence of other skeletal infection, even without local signs. Intravenous antibiotic treatment is started according to Gram's stain results or the best "educated guess." Surgical debridement is indicated for every site of pus in the extremities. Joint destruction and bone deformity and shortening are a common outcome. The only way to minimize early and late complications is high index of suspicion, aggressive workup, and adequate early treatment.

[Osteoarthritis in the neonate. Radiologic diagnosis and follow-up observations (author's transl)]. / Osteoarthritis bei Neugeborenen. Radiologische Diagnostik und Verlaufsbeobachtungen.

A fatally ending index case of septic osteoarthritis that was diagnosed retrospectively initiated this report. This patient had severe, asymmetrically distributed metaphyseal growth disturbances at many long bones. In order to determine the features of early radiologic diagnosis we report the findings of 7 further patients with neonatal septic osteoarthritis with clinical and radiological follow-up. The most important observation for early radiologic diagnosis of osteoarthritis is the displacement of fat layers along the metaphysis. Other findings of the soft tissues have the same diagnostic value as bone destruction and subperiosteal new bone formation found one to three weeks later on roentgenfilms. Detecting early signs of osteoarthritis helps in localizing the focus for bacteriologic diagnosis, which is said to be more successful than blood cultures. Diagnosing a joint empyema initiates surgical intervention for pressure relief in order to avoid necrosis of the epiphysis as seen in the femoral head in septic arthritis of the hip joint. Early diagnosis and treatment prior to destruction of the growing cartilage is necessary to avoid growth disturbances and length discrepancies of long bones. In cases of sepsis a so called "babygram" and a repeat examination 10 to 14 days later is mandatory.

Congenital syphilis with syphilitic arthritis. Radiological quiz.

The authors report a case of congenital syphilis with involvement of a joint space and adjacent bony surfaces in a newborn infant. Although similar findings have been reported in older children, this appears to be the first such case in a newborn.