title: A rare pathogen for subacute osteomyelitis in adolescent: Serratia marcescens.
abstract: BACKGROUND
  There are various pathogens reported for osteomyelitis. Osteomyelitis is bone infection which produces pain and fever, also threatens bone instability. It can lead to nonunion. The purpose of this report was to describe a case with union delay of the tibia due to serratia marcescens osteomyelitis. Serratia marcescens is an unexpected pathogen for subacute osteomyelitis in adolescence. Because of difficulty of diagnosis, treatment can be delayed or the situation can cause complications like nonunion or loss of function.
  
  
  METHODS
  Serratia marcescens is an unexpected pathogen for subacute osteomyelitis in adolescence. Because of difficulty of diagnosis, treatment can be delayed or cause complications like nonunion or loss of function. We present a meningomyelocele female adolescent operated with distal tibia varus osteotomy for correcting ankle valgus deformity. Insufficient healing was determined at osteotomy side on radiographs. The patient's erythrocyte sedimentation rate and CRP level was slightly higher with minimal clinical inflammation. MRI examination showed abscess formation at T2 imaging. Debridement, grafting and circular external fixation was performed. Sulperazon was started for drug therapy. Union was achieved after compression and distraction osteogenesis by circular external fixator. Orthopedic surgeons should be aware of opportunistic infections like serratia and keep in mind as a probable cause of disease.
  
  
  CONCLUSIONS
  Osteomyelitis is one of our main problems in orthopedics. Serratia does not come to mind as a causative factor when we learn the patient has osteomyelitis. We give treatment for the most expected pathogens like staphylococcus species firstly. This shows us the importance of bone biopsies and wound culture tests. Presented case is diagnosed as serratia osteomyelitis after culture results and given treatment with antibiotics and debridement.
  
  
  CONCLUSIONS
  Orthopedic surgeons should be aware of opportunistic infections like serratia and keep in mind when diagnosing the unexpected problem.
authors.affiliation: İstanbul University İstanbul Medicine Faculty Orthopaedics and Traumatology Department, Millet Caddesi. Çapa, Fatih/İstanbul, Turkey. Electronic address: drnecmettinturgut@hotmail.com.
authors.forename: Necmettin
authors.initials: N
authors.lastname: Turgut
authors.affiliation: İstanbul University İstanbul Medicine Faculty Orthopaedics and Traumatology Department, Millet Caddesi. Çapa, Fatih/İstanbul, Turkey. Electronic address: doktorturgut@yahoo.com.
authors.forename: Turgut
authors.initials: T
authors.lastname: Akgul
authors.affiliation: İstanbul University İstanbul Medicine Faculty Orthopaedics and Traumatology Department, Millet Caddesi. Çapa, Fatih/İstanbul, Turkey. Electronic address: ufukarzu@gmail.com.
authors.forename: Ufuk
authors.initials: U
authors.lastname: Arzu
authors.affiliation: İstanbul University İstanbul Medicine Faculty Orthopaedics and Traumatology Department, Millet Caddesi. Çapa, Fatih/İstanbul, Turkey. Electronic address: sefabatibay@hotmail.com.
authors.forename: Sefa Giray
authors.initials: SG
authors.lastname: Batıbay
authors.affiliation: İstanbul University İstanbul Medicine Faculty Orthopaedics and Traumatology Department, Millet Caddesi. Çapa, Fatih/İstanbul, Turkey. Electronic address: mekinci18@gmail.com.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ekinci
authors.affiliation: İstanbul University İstanbul Medicine Faculty Orthopaedics and Traumatology Department, Millet Caddesi. Çapa, Fatih/İstanbul, Turkey. Electronic address: cengizsen@gmail.com.
authors.forename: Cengiz
authors.initials: C
authors.lastname: Şen
authors.affiliation: İstanbul University İstanbul Medicine Faculty Orthopaedics and Traumatology Department, Millet Caddesi. Çapa, Fatih/İstanbul, Turkey. Electronic address: muratkorkmaz@hotmail.com.
authors.forename: Murat
authors.initials: M
authors.lastname: Korkmaz
keywords: Debridement; Infection; Meningomyelocele; Orthopedics; Osteomyelitis; Serratia marcescens