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Joint Infection After Closed Fractures in Children
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Posted on: 11/30/1999
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In this report, orthopedic surgeons present three cases of a rare problem: septic arthritis in children after a bone fracture. Septic arthritis is destruction of a joint from an infection such as staphyloccocus, streptococcus, or salmonella inside the joint.
What makes these cases unique is the fact that the fractures were closed. There was no disruption of skin or other soft tissues. In other words, there was no obvious or known way for the bacteria that caused the infection to enter the body.
In some cases (usually adults), septic arthritis develops after the person has had an infection somewhere else in the body. For example, pneumonia, urinary tract infections, or an infected IV in a hospitalized patient is the source of the bacteria. In children, strep throat, measles, tonsillitis, or upper respiratory infections are more likely to cause bacteria that can move through the blood system to a joint.
But there was no history of any of those potential problems or causes in these three cases. The lack of a known mechanism for the infection that occurred inside the joint (called an intra-articular infection) was a puzzle.
Some theories put forth included bacteria from a hematoma (pocket of blood caused by the fracture) might have entered the joint. Or in one case, it looked like a pin used to hold the joint together left a pathway into the joint.
In all three cases, the infection developed days to months after the original injury. Symptoms of persistent pain, fever, and erythema (redness of the skin) brought the children back to the surgeon for further follow-up.
The injuries themselves and joints affected were all different. There was a stubbed big toe while playing soccer and an ankle fracture during football in two 14-year-old boys. The third case occurred in a two-year-old who took a fall and broke his elbow.
In the case of the football player, treatment with antibiotics and surgery to repair the fracture appeared to be successful. Two screws used to hold the broken ankle together were removed five months after surgery. He was back to his regular sports activities by the end of six months.
Then two months later, he developed a fever along with ankle pain and swelling. Septic arthritis was diagnosed and he was successfully treated with another round of antibiotics and surgery to clean the joint out. The procedure used to remove all pus and bacteria from inside the joint is referred to as irrigation and debridement.
The soccer player wasn't so lucky. The fractured big toe joint never did heal properly. Despite efforts to save the joint, infection destroyed so much of the joint surface it was necessary to fuse the joint. On a positive note, he was free of pain at his two-year follow-up appointment.
The authors offer this summary of three case reports involving septic joint arthritis after a closed fracture. The condition is rare and taking a look back and describing what happened may help other surgeons recognize the problem sooner than later. The goals of early diagnosis and treatment are to identify the bacteria present, prescribe an organism-specific antibiotic, and debride the joint in order to preserve it.
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References:
Vedant A. Kulkarni, MD, et al. Septic Arthritis Associated With Closed Intra-articular Fracture: A Case Series. In Journal of Pediatric Orthopaedics. April/May 2011. Vol. 31. No. 3. Pp. E8-E15.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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