{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T12:40:20Z","timestamp":1734957620788,"version":"3.32.0"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T00:00:00Z","timestamp":1734912000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T00:00:00Z","timestamp":1734912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Musculoskelet Disord"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Achondroplasia, the most common form of rhizomelic dwarfism, occurs in approximately 1 in 25,000 individuals. Clinical features include attenuated growth, rhizomelic limb shortening, and craniofacial abnormalities. Limb-lengthening surgery is widely employed to improve quality of life. However, reports on Methicillin-Resistant Staphylococcus aureus (MRSA) infections in femoral nonunions at lengthening sites are scarce.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 15-year-old boy with achondroplasia presented with MRSA-infected femoral nonunion. Bilateral femoral lengthening had been performed at age 13 using unilateral external fixators. Following a 7\u00a0cm lengthening of the right femur, surgical site infection occurred, with MRSA detected on postoperative day 127. Despite debridement and autologous iliac bone graft with non-locking screws, nonunion persisted. Referred to our hospital at age 15, the patient underwent radical debridement until punctate bleeding appeared, and vancomycin-loaded cement beads were implanted. A circular external fixator, effective even with bone weakened by prolonged non-weight bearing, was applied. Six weeks later, further debridement and vancomycin bead replacement were performed. Final fixation included refreshing the nonunion site and placing a cancellous bone graft from the contralateral iliac bone. Bone fusion progressed, and the ring was removed 9 months post-surgery. After seven years, no recurrence of infection was noted. Although slight knee flexion limitation persisted, the patient experiences no pain while walking and has become a healthy working adult.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>This case highlights the effectiveness of radical debridement, antibiotic-loaded cement beads, autologous bone grafting, and circular external fixation in treating MRSA-induced nonunion at femoral lengthening sites in achondroplasia. Circular external fixators provide stable fixation even in cases of prolonged bone weakness.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12891-024-08224-0","type":"journal-article","created":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T11:40:46Z","timestamp":1734954046000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Management of Methicillin-Resistant Staphylococcus aureus-infected femoral nonunion during lengthening in achondroplasia using circular external fixator: a case report"],"prefix":"10.1186","volume":"25","author":[{"given":"Koji","family":"Nozaka","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsuyoshi","family":"Shirahata","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusuke","family":"Yuasa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naohisa","family":"Miyakoshi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,12,23]]},"reference":[{"key":"8224_CR1","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.jpeds.2006.10.058","volume":"150","author":"T Takken","year":"2007","unstructured":"Takken T, van Bergen MW, Sakkers RJ, Helders PJ, Engelbert RH. Cardiopulmonary exercise capacity, muscle strength, and physical activity in children and adolescents with achondroplasia. J Pediatr. 2007;150:26\u201330.","journal-title":"J Pediatr"},{"key":"8224_CR2","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1016\/S0030-5898(20)31511-X","volume":"21","author":"D Paley","year":"1990","unstructured":"Paley D, Chaudray M, Pirone AM, Lentz P, Kautz D. Treatment of malunions and mal-nonunions of the femur and tibia by detailed preoperative planning and the Ilizarov techniques. Orthop Clin North Am. 1990;21:667\u201391.","journal-title":"Orthop Clin North Am"},{"key":"8224_CR3","doi-asserted-by":"publisher","first-page":"477","DOI":"10.4103\/0019-5413.43400","volume":"42","author":"A Tandon","year":"2008","unstructured":"Tandon A, Bhargava SK, Goel S, Bhatt S. Pseudoachondroplasia: a rare cause of rhizomelic dwarfism. Indian J Orthop. 2008;42:477\u20139.","journal-title":"Indian J Orthop"},{"key":"8224_CR4","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1007\/BF00547160","volume":"12","author":"R Cattaneo","year":"1988","unstructured":"Cattaneo R, Villa A, Catagni M, Tentori L. Limb lengthening in achondroplasia by Ilizarov\u2019s method. Int Orthop. 1988;12:173\u20139.","journal-title":"Int Orthop"},{"key":"8224_CR5","doi-asserted-by":"publisher","first-page":"1656","DOI":"10.3349\/ymj.2015.56.6.1656","volume":"56","author":"KW Park","year":"2015","unstructured":"Park KW, Garcia RA, Rejuso CA, Choi JW, Song HR. Limb lengthening in patients with Achondroplasia. Yonsei Med J. 2015;56:1656\u201362.","journal-title":"Yonsei Med J"},{"key":"8224_CR6","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1007\/s00264-019-04464-1","volume":"44","author":"GA Hosny","year":"2020","unstructured":"Hosny GA, Ahmed AA. Paediatric infected femoral nonunion; mid-term results of a rare problem with a single-stage treatment and up to eleven and half years follow-up. Int Orthop. 2020;44:503\u20139.","journal-title":"Int Orthop"},{"key":"8224_CR7","doi-asserted-by":"publisher","first-page":"S299","DOI":"10.1007\/s00590-012-1062-4","volume":"23","author":"V Mounasamy","year":"2013","unstructured":"Mounasamy V, Fulco P, Desai P, Adelaar R, Bearman G. The successful use of Vancomycin-impregnated cement beads in a patient with Vancomycin systemic toxicity: a case report with review of literature. Eur J Orthop Surg Traumatol. 2013;23:S299\u2013302.","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"8224_CR8","first-page":"425","volume":"95","author":"B Blondel","year":"2009","unstructured":"Blondel B, Launay F, Glard Y, Jacopin S, Jouve J-, Bollini G. Limb lengthening and deformity correction in children using hexapodal external fixation: preliminary results for 36 cases Orthop Traumatol. Surg Res. 2009;95:425\u201330.","journal-title":"Surg Res"},{"key":"8224_CR9","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1302\/0301-620X.94B1.27567","volume":"94","author":"SJ Kim","year":"2012","unstructured":"Kim SJ, Agashe MV, Song SH, Choi HJ, Lee H, Song HR. Comparison between upper and lower limb lengthening in patients with achondroplasia: a retrospective study. J Bone Joint Surg Br. 2012;94:128\u201333.","journal-title":"J Bone Joint Surg Br"},{"key":"8224_CR10","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1007\/s004020050242","volume":"117","author":"K Tanaka","year":"1998","unstructured":"Tanaka K, Nakamura K, Matsushita T, Horinaka S, Kusaba I, Kurokawa T. Callus formation in the humerus compared with the femur and tibia during limb lengthening. Arch Orthop Trauma Surg. 1998;117:262\u20134.","journal-title":"Arch Orthop Trauma Surg"},{"key":"8224_CR11","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s00264-019-04426-7","volume":"44","author":"C Li","year":"2020","unstructured":"Li C, Renz N, Trampuz A, Ojeda-Thies C. Twenty common errors in the diagnosis and treatment of periprosthetic joint infection. Int Orthop. 2020;44:3\u201314.","journal-title":"Int Orthop"},{"key":"8224_CR12","doi-asserted-by":"publisher","first-page":"1124","DOI":"10.1186\/s12891-022-06105-y","volume":"23","author":"B Wang","year":"2022","unstructured":"Wang B, Cheng W, Liu F, Guo Z, Ji Z, Sun K, Yao M. Efficacy and safety of Vancomycin-loaded calcium sulfate versus conventional surgical debridement for pediatric acute osteomyelitis: a retrospective study. BMC Musculoskelet Disord. 2022;23:1124.","journal-title":"BMC Musculoskelet Disord"},{"key":"8224_CR13","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1007\/s11751-018-0303-4","volume":"13","author":"KZ Masrouha","year":"2018","unstructured":"Masrouha KZ, Raad ME, Saghieh SS. A novel treatment approach to infected nonunion of long bones without systemic antibiotics. Strategies Trauma Limb Reconstr. 2018;13:13\u20138.","journal-title":"Strategies Trauma Limb Reconstr"},{"issue":"5","key":"8224_CR14","doi-asserted-by":"publisher","first-page":"415","DOI":"10.3928\/0147-7447-19940501-06","volume":"17","author":"C Nelson","year":"1994","unstructured":"Nelson C, Hickmon S, Harrison B. Elution characteristics of gentamicin-PMMA beads after implantation in humans. Orthopedics. 1994;17(5):415\u20136.","journal-title":"Orthopedics"},{"key":"8224_CR15","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1002\/jor.1100150214","volume":"15","author":"C Nelson","year":"1997","unstructured":"Nelson C, Hickmon S, Skinner R. Treatment of experimental osteomyelitis by surgical debridement and the implantation of biodegradable polyanhydride-gentamicin beads. J Orthop Res. 1997;15:249\u201355.","journal-title":"J Orthop Res"},{"key":"8224_CR16","doi-asserted-by":"publisher","first-page":"2133","DOI":"10.1007\/s00264-012-1620-8","volume":"36","author":"M El-Sayed","year":"2012","unstructured":"El-Sayed M, Atef A. Management of simple (types A and B) closed tibial shaft fractures using percutaneous lag-screw fixation and Ilizarov external fixation in adults. Int Orthop. 2012;36:2133\u20138.","journal-title":"Int Orthop"}],"container-title":["BMC Musculoskeletal Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12891-024-08224-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12891-024-08224-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12891-024-08224-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T12:04:06Z","timestamp":1734955446000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmusculoskeletdisord.biomedcentral.com\/articles\/10.1186\/s12891-024-08224-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,23]]},"references-count":16,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["8224"],"URL":"https:\/\/doi.org\/10.1186\/s12891-024-08224-0","relation":{},"ISSN":["1471-2474"],"issn-type":[{"value":"1471-2474","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,23]]},"assertion":[{"value":"24 November 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 December 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 December 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from the patient for the publication of this case report and any accompanying images. The article was approved by the ethics committee of Akita University Hospital (registration number 1970).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"A copy of the written permission is available for review from the Editor of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1062"}}