No abstract

Case: We present a rare case of diffuse skeletal fluorosis in a 56-year-old man with a history of inhalation and topical abuse of aerosolized dust cleaner containing difluoroethane and prior industrial exposure to chlorofluorocarbon-rich organic solvent cleaners. This patient had diffuse osteosclerotic bone disease on radiographs that elicited concern for a potentially aggressive physiologic or pathologic process, until increased fluoremia was identified as the cause. Management was conservative with removal of the causative agent. Conclusion: Skeletal fluorosis is an osteosclerotic bone disease caused by excessive ingestion of fluoride. Although this pathology is endemic in some parts of the world where drinking water contains high levels of fluoride, it should be considered as a differential diagnosis for patients with characteristic radiographic findings and a history of inhalant abuse. Chronic exposure to chlorofluorocarbon-rich products should also be considered.

No abstract

Objectives:The purpose of this study was to identify the patient, injury, and treatment factors associated with infection of bicondylar plateau fractures and to evaluate whether center variation exists.Design:Retrospective review.Setting:Eighteen academic trauma centers.Patients/participants:A total of 1,287 patients with 1,297 OTA type 41-C bicondylar tibia plateau fractures who underwent open reduction and internal fixation were included. Exclusion criteria were follow-up less than 120 days, insufficient documentation, and definitive treatment only with external fixation.Intervention:Open reduction and internal fixation.Main outcome measurements:Superficial and deep infection.Results:One hundred one patients (7.8%) developed an infection. In multivariate regression analysis, diabetes (DM) (OR [odds ratio] 3.24; P ≤ 0.001), alcohol abuse (EtOH) (OR 1.8; P = 0.040), dual plating (OR 1.8; P ≤ 0.001), and temporary external fixation (OR 2.07; P = 0.013) were associated with infection. In a risk-adjusted model, we found center variation in infection rates (P = 0.030).Discussion:In a large series of patients undergoing open reduction and internal fixation of bicondylar plateau fractures, the infection rate was 7.8%. Infection was associated with DM, EtOH, combined dual plating, and temporary external fixation. Center expertise may also play a role because one center had a statistically lower rate and two trended toward higher rates after adjusting for confounders.Level of evidence:Level IV—Therapeutic retrospective cohort study.