Background: Acute haemotogenous osteomyelitis can occur at any age group but is mainly a disease of children. They are a challenge to differentiate as they have overlapping signs and symptoms. Septic arthritis is considered a surgical emergency while acute osteomyelitis, when presented early can be treated with parenteral antibiotics. There is paucity in the approach (imaging guidelines and treatment) for cases where acute septic arthritis is associated with osteomyelitis. We aimed to analyses the role of pre operative appendicular MRI in the cases of acute bone and joint infection in paediatric age group. Methods: This is a prospective study done in 38 children suspected to have acute bone and joint infections. All the patients underwent emergency appendicular MRI in the suspicion of bone and joint infections. Based on the MRI findings, all 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 (36.84%) cases of the 38 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 36.84% in our study, which was diagnosed with pre operative 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.