Fixed drug eruptions (FDEs) are dermatological manifestations of drug reactions that often occur in the same location upon re-exposure to a drug. They usually appear as erythematous-violaceous, circular patches, but several different variants have been described. They can often present without any associated symptoms, but in some cases, patients may complain of pain and pruritus. The lesions are often underdiagnosed or mistaken for insect bites, urticaria, or erythema multiforme; thus, an effort to bring awareness to this condition is warranted.We present a 33-year-old African-American female who presented to the urgent care presenting with several violaceous patches of varying sizes that started two days ago. The lesions were located on the left shoulder, abdomen, right flank region, and behind the right knee. The lesions were associated with mild pain and pruritus. She believed she was bit by insects but denied seeing any insects at home or participating in any recent outdoor activities. She stated that she had a similar rash in the exact locations five months ago. Upon survey of new medications, she stated that she recently started taking her medications again, which include: hydrochlorothiazide, semaglutide, vitamin D supplement, and ibuprofen. Examination of the skin revealed several black, non-blanching macules with a surrounding ring of erythema on the left shoulder (3 x 3cm), abdomen (4 x 3cm), right popliteal region (3 x 2cm), and right flank region (6 x 7 cm). She was prescribed a medium-dose topical steroid cream to apply to the skin twice a day to decrease the intensity of the inflammatory reaction and thus relieve her symptoms. She was also educated on FDEs and was advised to discontinue Ibuprofen, one of the most commonly implicated drugs in FDEs. Upon returning for a follow-up four weeks later, she noted that she discontinued Ibuprofen, and her cutaneous reactions had fully resolved. This case illustrates the prompt and accurate diagnosis of FDE leading to discontinuation of the offending drug and resolution of symptoms. It also represents the essential questions to ask when suspecting FDE.

Demineralized bone matrix (DBM) is an allograft obtained from human cadaveric bone that has osteoinductive and osteoconductive properties. A wide array of specific DBM products is available, and each has its own biochemical, safety, and efficacy profiles. This study reviews comparison studies of brand-specific DBM products, including Allomatrix (Wright Medical Technology, Memphis, Tennessee), DBX (Depuy Synthes, Suchwil, Switzerland), Grafton (Osteotech, Eatontown, New Jersey), Orthoblast (Integra Orthobiologics, Plainsboro, New Jersey), and Osteosponge (Bacterin International, Belgrade, Montana), in an attempt to propose the most efficacious DBM product for bone grafting of various orthopaedic applications. Secondarily, we evaluate these specific DBM products in their potential use of tibial plateau fractures, which our future clinical research aims to achieve. A definitive gold-standard DBM product is lacking for orthopaedic use because of the scarcity of clinical research comparing specific brand products, limited study sample sizes, and lack of standardization in the creation of DBM products. Level of Evidence: Level III.

Tibial plateau fractures (TPF) are complex injuries of the tibia that involve the articular surface and commonly have depression of subchondral and metaphyseal bone. Common sequelae of this injury include arthritis and gait disturbances. A popular surgical strategy for this fracture calls for elevation of subchondral bone to restore the joint line, in turn leaving a metaphyseal bone void; this is then commonly secured with plates and screws. Autologous bone has been the gold-standard graft option to fill these voids, but other filling agents such as allografts, biologic grafts, and xenografts are gaining popularity TPF surgery. This is because bone graft substitutes provide predictable outcomes in the treatment of TPF and avoid complications such as donor site pain, infection, increased blood loss, and increased operative time that is seen with autografts. This review explores the benefits, complications, and outcomes of clinically researched graft substrates used for TPF reconstruction. Secondarily, we aim to find potential graft candidates for future clinical research that will progress the treatment of TPF. Internet searches with specific keywords were conducted on different journal databases to find clinically researched graft options in the treatment of TPF within the last 10 years. Multiple studies of various bone graft substitutes achieved similar, if not better results than autologous bone grafts in the treatment of TPF. A summary of each clinically researched graft in this review can be found in Table 1. Establishing a graft selection protocol remains a challenge for fracture surgeons, as well as choosing the best graft material. Future studies should aim to establish a superior graft substrate based clinical outcomes, while minimizing the cost and morbidity to the patient.