A rare case report: MRSA osteomyelitis after CRPP for pediatric distal both-bone forearm fracture.

backgroundDistal forearm fractures are common pediatric injuries. While Closed Reduction and Percutaneous Pinning (CRPP) is a standard treatment with excellent outcomes, subsequent poliomyelitis is a less commonly reported but serious complication. This case highlights the diagnostic and therapeutic challenges of managing Methicillin-resistant Staphylococcus aureus (MRSA) fracture-related infection (FRI), particularly in the presence of subtle initial signs. CASE PRESENTATION: A 9-year-old male underwent CRPP for a right distal forearm fracture (Fig. 1). Intraoperative radiographs confirmed satisfactory alignment and pin placement. Postoperative Day 1 radiograph confirmed satisfactory alignment (Fig. 2). At five weeks postoperatively, he developed persistent pain, wrist swelling, and skin ulceration after K-wire removal. Laboratory results showed elevated inflammatory markers (C-reactive Protein (CRP): 10 mg/L, Erythrocyte Sedimentation Rate (ESR): 52 mm/h) despite a normal white blood cell count. Magnetic resonance imaging (MRI) revealed bone marrow edema and a subperiosteal abscess in the distal ulna and radius. The patient underwent surgical debridement of the distal ulna and implantation of antibiotic-loaded bone cement. Culture of the intraoperative pus confirmed MRSA. Management included a 3-week in-hospital course of intravenous vancomycin, transitioned to oral linezolid and rifampin, guided by susceptibility testing. A second-stage surgery with iliac crest bone grafting was successfully performed after infection control. At the six-month follow-up, radiographic union was achieved, with full functional recovery of the wrist and no signs of infection recurrence. Long-term physeal monitoring is ongoing. The patient remains under annual surveillance, and follow-up will continue until skeletal maturity to monitor for potential growth disturbance.

conclusionsThis case underscores the importance of suspecting FRI in children with persistent pain despite normal radiographs, highlights the diagnostic value of CRP/ESR and MRI, and demonstrates that a guideline-based, multidisciplinary approach can achieve excellent short-term outcomes. Long-term physeal monitoring is essential. The management strategy emphasizes the role of timely surgical intervention, targeted antibiotic therapy, and staged reconstruction in complex pediatric bone infections.