Imaging for bone and joint infection in children and adults

Bone and joint infection is certainly not a new disease. Despite our armamentarium of sophisticated antibiotics, the problem is not completely solved and permanent damage to bone or articular cartilage does occur, particularly in the growing child.‘,2 Clinical awareness, laboratory confirmation and accurate imaging tailored to the needs of individual patients are required to diagnose osteomyelitis and septic arthritis, establish the exact anatomic location(s), isolate the organism(s), and stage the disease. Once the location of the affected area is confirmed, aspiration and culture are the most useful tests to diagnose septic arthritis, as well as acute, and perhaps subacute, osteomyelitis.’ Aspiration may be performed blind or under fluoroscopic, ultrasonic, or computed tomographic guidance. In the acute phase, early clinical diagnosis, and immediate appropriate antibiotic treatment or intervention are crucial if one aims at eliminating the morbidity associated with bone and joint sepsis. Osteomyelitis or septic arthritis should be carefully looked for in the patient with diabetes, sepsis, sickle cell disease, intravenous drug abuse or after an open fracture, wound or the placement of an orthopaedic device. It may be haematogenous, e.g. in the patient with sepsis; or secondary to an open wound, fracture or surgery; or from a contiguous focus of soft tissue