The role of preoperative appendicular magnetic resonance imaging in cases of acute bone and joint infection in the paediatric age group

Background: Acute haematogenous osteomyelitis is mainly a disease of children. It is a challenge to differentiate it from septic arthritis as they have overlapping signs and symptoms. Septic arthritis is a surgical emergency while acute osteomyelitis, when presenting early, can be treated with parenteral antibiotics. There is paucity in imaging guidelines and treatment for cases where acute septic arthritis is associated with osteomyelitis.Objectives: To analyse the role of preoperative magnetic resonance imaging (MRI) in cases of suspected acute bone and joint infection in the paediatric age group.Method: This is a prospective study in 38 children suspected to have acute bone and joint infections. All the patients underwent emergency appendicular MRI on suspicion of bone and joint infections. Based on the MRI findings, the patients were classified into cases of isolated septic arthritis and cases of septic arthritis with concomitant osteomyelitis. There was a change in the treatment modality between the two categories of patients. Results: In our study 14 (36.8%) cases of suspected bone and joint infection had concomitant osteomyelitis with septic arthritis. These 14 cases were seen involving the knee, hip, elbow and shoulder joints. The incidence of septic arthritis with coexisting osteomyelitis was 36.8% in our study, which was diagnosed with preoperative emergency appendicular MRI.Conclusions: Our study concludes that MRI should be included in the work up for suspected bone and joint infections provided MRI is done in a timely fashion without unnecessarily delaying surgical intervention if needed.