A 9-year-old boy presents with 5 days of fever, severe pain, and localised tenderness over the distal femoral metaphysis. ESR is 80 mm/hr, CRP elevated. X-ray is normal. MRI shows periosteal oedema and subperiosteal fluid. What is the most appropriate initial management?
- A Oral antibiotics for 6 weeks as outpatient without surgical intervention
- B Immediate amputation to prevent systemic sepsis
- C IV antibiotics targeting Staphylococcus aureus and urgent surgical drainage if no improvement in 24–48 hours ✓
- D Bone biopsy first, then culture-directed antibiotics before surgical intervention
Correct answer: C. IV antibiotics targeting Staphylococcus aureus and urgent surgical drainage if no improvement in 24–48 hours
Explanation
Acute haematogenous osteomyelitis in children most commonly affects the distal femoral and proximal tibial metaphyses; the causative organism is Staphylococcus aureus in over 80% of cases. MRI demonstrating subperiosteal collection indicates an abscess requiring surgical drainage. High-dose IV anti-staphylococcal antibiotics (flucloxacillin or cefazolin) should begin immediately, with surgical drainage indicated if there is no clinical improvement within 24–48 hours or if a definite abscess is present.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.