[Hematogenous bone and joint infections in children].

Not all children with osteomyelitis or septic arthritis will present with the characteristic findings, i.e. localized pain and swelling, fever and generalized malaise. Diagnostic problems arise in case of the following four special forms or locations of the diseases: neonatal osteomyelitis, because neonates frequently have no signs of infection; osteomyelitis of the spine and septic arthritis of the sacroiliac joint; subacute hematogenous osteomyelitis; chronic osteomyelitis. Acute bone and joint infections are diagnosed clinically. Positive blood cultures are found in only about half of all cases. Cultures of joint fluid or bone cultures are positive in 50 to 90%. The aim of therapy is to avoid destruction of bones or joints or even invalidity. Effective treatment consists of sufficient antibiotics for an adequate period of time and of immobilization. Surgical drainage is mandatory in case of abscess formation in soft tissue, of intramedullary or joint abscess, mainly hip-joint and shoulder, of persistent fever and in all chronic forms of osteomyelitis where areas of sequestra, dead tissue and abscesses may be assumed.