Clinical Review Lesson of the week

Osteomyelitis in the well looking afebrile child

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7350.1380 (Published 08 June 2002) Cite this as: BMJ 2002;324:1380
  1. L P Ferguson, senior house officer,
  2. T F Beattie, consultant in accident and emergency care (Louise.Cowan@luht.scot.nhs.uk)
  1. Department of Accident and Emergency Medicine, Royal Hospital for Sick Children, Edinburgh EH9 1LF
  1. Correspondence to: T F Beattie
  • Accepted 5 November 2001

Osteomyelitis should be considered even if there is a history of trauma

Musculoskeletal pain and limp are common childhood presentations to general practitioners and accident and emergency departments. The differential diagnosis is broad and includes trauma, bone or joint sepsis, primary or metastatic tumours of bone, and intentional injury.1 Diagnosis of bone or joint sepsis should be straightforward in patients with limb pain who are systemically unwell and have fever. Diagnostic difficulty arises when the patient presents early or with a history of trauma. We describe two children presenting with limp after trauma who looked well but were found to have osteomyelitis.

Case reports

Case 1

A 10 year old girl presented to our department with a painful right knee. The pain had started when she struck her knee on the step of a swimming pool ladder while climbing out. She had continued to swim and play that day, but her mother noticed a limp. The following day she became unwell, with malaise, anorexia, and fever. She attended her doctor. Otitis media was diagnosed, and amoxicillin was prescribed. The knee pain was attributed to soft tissue injury. The pain worsened that night and she was brought to our department the next morning. On examination she appeared well and was afebrile. She walked with an antalgic gait. Mild swelling and tenderness was present over the right medial tibial plateau but there was no effusion. She had full range of movement of the knee. The tympanic membranes were normal, and general examination was …

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