MRSA Osteomyelitis of the Hallux Growth Plate After Partial Nail Avulsion: A Case Report

Osteomyelitis involving the pediatric growth plate is uncommon and potentially serious. We present a rare case of methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis affecting the distal physis of the hallux in a 9-year-old boy occurring after a routine permanent partial nail avulsion for an ingrown toenail. Approximately one month after the procedure, the patient developed persistent pain, erythema, and swelling of the hallux. Imaging confirmed osteomyelitis involving the distal phalanx and growth plate. Surgical incision and drainage were performed and cultures confirmed MRSA. The patient was treated with intravenous vancomycin followed by an early transition to oral clindamycin. Symptoms resolved within two weeks and he returned to full activity without evidence of growth disturbance. This case highlights the potential for direct inoculation osteomyelitis following minor toenail procedures and supports evolving approaches to pediatric osteomyelitis treatment, which was historically managed with prolonged IV antibiotics via PICC lines. Recent studies support shorter courses and early transition to oral therapy in uncomplicated cases. This approach reduces hospital stays, avoids PICC-related complications, and has shown comparable outcomes in large pediatric cohorts. Although rare, growth plate osteomyelitis can occur after routine nail procedures. Early recognition, early imaging and combined surgical and medical management are essential for preventing long-term sequelae. This case reinforces the safety and efficacy of early oral antibiotic transition in selected pediatric osteomyelitis cases consistent with current evidence-based guidelines.