Advances in managing pediatric musculoskeletal infections.

Most musculoskeletal infections in children result from hematogenous inoculation. Infections vary greatly in severity and complexity. Sequential determination of the C-reactive protein level may be the most important laboratory test in determining response to treatment. High-quality plain radiographs are essential. Ultra-sonography, technetium 99m-diphosphonate scanning, and MRI also are used. In acute osteomyelitis, focal bone pain usually is accompanied by fever or malaise; antibiotic therapy is indicated. Gradual and insidious extremity pain develops in children who have subacute osteomyelitis. Classic features of chronic osteomyelitis include dead bone and reactive new bone; surgery may be needed. Typically, septic arthritis has an acute onset. Treatment includes arthrotomy and joint irrigation. [ABSTRACT FROM AUTHOR]