Sequential multimodal management of methicillin-resistant Staphylococcus aureus-infected tibial pseudoarthrosis: A case report on the application of an antibiotic-loaded cement spacer and the continuous local antibiotic perfusion technique across thr

Infected pseudoarthrosis requires effective infection control and successful bone union. Hence, this pathology is challenging to manage. Herein, we report on a 41-year-old male patient who presented with methicillin-resistant Staphylococcus aureus -infected pseudoarthrosis after a primary surgery at another institution. After debridement, cement spacer insertion, and application of an intra-soft tissue antibiotic perfusion (iSAP) system for infection control, the final stage of bone fixation surgery with allogeneic bone grafting was performed. During the postoperative course, low-intensity pulsed ultrasound (LIPUS) was conducted. Ultimately, both infection control and bone union were achieved. At the latest follow-up, the patient had regained normal gait and was able to return to work. Comprehensive treatment strategies must be considered for challenging pathologies such as infected pseudoarthrosis.