Journal of Pediatric Orthopaedics - 2026-09-28 - Journal Article
Radiologic Sequelae of Pediatric Septic Arthritis of the Shoulder: A Retrospective Series and Proposed Classification.
Agarwal A, Iqbal MZ, Khurana S, Gupta M, Sahoo S, Deep A
Topics
Key Takeaway
Pediatric septic shoulder results in permanent radiologic sequelae in 82.6% of cases, with physeal arrest or bar formation (Type III) being the most common pattern at 47.8% over a mean 6.2-year follow-up.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This study evaluated long-term radiologic outcomes in 23 children treated for septic shoulder arthritis at a single tertiary center (2010–2024), proposing a four-type classification based on epiphyseal, physeal, and articular involvement. Only 17.4% achieved complete recovery (Type I); physeal arrest/bar formation (Type III) occurred in 47.8%, and articular destruction (Type IV) in 17.3%. Neonates (n=5) and children with multifocal infection (43.5%) disproportionately developed severe Type III/IV sequelae, with MRSA as the predominant organism at 39.1%.
Key Limitation
The single-center tertiary referral design almost certainly overestimates sequelae rates, as milder cases managed at community centers with full recovery are systematically excluded.
Original Abstract
BACKGROUND
This study aimed to evaluate the long-term radiologic sequelae of pediatric septic arthritis of the shoulder and identify characteristic patterns of residual proximal humeral deformity.
METHODS
A retrospective review was performed of children treated for septic arthritis of the shoulder at a tertiary pediatric orthopaedic center between 2010 and 2024. Inclusion criteria were confirmed septic shoulder, complete radiographic records, and a minimum 2-year follow-up. Radiographs at final follow-up were analyzed for epiphyseal, physeal, and articular abnormalities, and sequelae were classified according to severity and anatomic involvement.
RESULTS
Twenty-three children were included, with a mean age at presentation of 31.7 months and a mean follow-up of 6.2 years. Twelve children presented during infancy, including 5 neonates. Multifocal musculoskeletal infection was present in 43.5%, and associated proximal humeral osteomyelitis in 52.2%. Methicillin-resistant Staphylococcus aureus was the most commonly isolated organism (39.1%). Radiologic sequelae were classified into 4 types: type I, complete recovery (17.4%); type II, epiphyseal irregularity/dysplasia (17.4%); type III, physeal arrest/bar formation (47.8%); and type IV, articular destruction/proximal humeral loss (17.3%). Neonates and children with multifocal infection more frequently developed severe type III/IV sequelae.
CONCLUSION
Septic arthritis of the pediatric shoulder is associated with a high risk of permanent growth-related deformity, particularly in neonates and infants. Physeal injury is the most predominant long-term sequela. The proposed radiologic classification may aid prognostication, follow-up, and surgical planning in affected children.
LEVEL OF EVIDENCE
Level IV.