5.1. Make a diagnosis and thus know the natural history
5.1.1. Acute Disease
Ill (very ill) Baby or Child – Fever,
Malaise, Septicaemia
Pain in Limb or Joint
Not using Limb (pseudo-paralysis)
Swelling of limb/s or joint/s (Note sympathetic
joint effusions may occur with osteomyelitis in their vicinity, e.g. in the
knee when the distal end of the femur is involved)
Localised tenderness
Pain on attempted joint movement
Note, all of these symptoms and signs may be modified
or reduced if antibiotics have already been given.
5.1.2. Radiology
There will be NO RADIOLOGICAL CHANGES for a minimum
of ten days with acute osteomyelitis, and therefore NORMAL RADIOGRAPHS do
not rule out a clinical diagnosis of severe bone or joint infection. In fact
radiographic changes may not appear for three weeks or more, and can range
from very minor with minimal bone destruction and a little sub-periosteal
bone formation, to evidence of much more severe bone destruction (moth-, or
rat-eaten bones).
There may be soft tissue swelling and obliteration
of fat planes.
A joint (particularly the hip) may be dislocated – as a result of the presence of a large collection of pus in the synovial cavity which has stretched the capsule.
