Pyoderma gangrenosum is an immunologic, ulcerative cutaneous condition often associated with systemic disease and frequently precipitated by trauma. It is noninfectious, but the inflammatory assault can resemble a malignant infection such as necrotizing fasciitis. Despite its clinical resemblance to infection, surgical de ´bridement worsens the condition and may remove morphologic clues to the true disease, thus creating a vicious cycle of surgical de ´bridements and disease progression. Furthermore, diagnostic histopathologic and laboratory features are nonspecific, requiring exclusion of other processes. Therefore, appropriate nonsurgical treatment and immunosuppression are commonly delayed, often at a significant cost to the patient. We present a case of pyoderma gangrenosum occurring after outpatient knee arthroscopy that masqueraded as a postsurgical infection. We discuss the diagnostic approach and how a complex reconstruction involving cartilage restoration and soft-tissue coverage was achieved. P yoderma gangrenosum (PG) is an immunologic ulcerative cutaneous condition of an undetermined cause that is often precipitated by trauma. The incidence varies between studies with estimates typically ranging from 3 to 10 per million per year. [1][2][3][4] The disease typically presents in the fourth through sixth decade of life and has a female predominance. 1,[5][6][7] It can be easily mistaken for an infectious process such as necrotizing fasciitis (NF) due to the rapidly progressing wound deterioration in the presence of elevated inflammatory markers and leukocytosis. In contrast to infectious processes, such as NF, surgical débridement promotes the malignant immunologic response, leading to further skin breakdown.A high index of suspicion and the use of a multidisciplinary approach can help differentiate PG from other etiologies, such as a surgical site infection (SSI). Timely workup is paramount because a failure to differentiate the two processes-immunologic and infectious-will lead to misdiagnosis and detrimental interventions. Therefore, early involvement of infectious disease specialists and dermatologists when the diagnosis is in question can help determine whether serial débridements should be initiated or continued.
Oxidized zirconium was introduced as an alternative bearing surface to decrease polyethylene wear and reduce aseptic mechanical failure of hip and knee arthroplasties. Oxidized zirconium combines the strength of a metal with wear properties of ceramic, proposing increased survivorship of implant components, and possible decreased rate of revision. Despite a harder surface than cobalt-chromium, the substrate of zirconium is a softer metal. Although uncommon, prior reports have described accelerated wear and severe metallosis after femoral head dislocation in oxidized zirconium total hip arthroplasty; however, this has not been described in total knee arthroplasty. We report a case of an oxidized zirconium total knee arthroplasty failure in a patient with knee instability. This is the first report of catastrophic failure of an oxidized zirconium total knee arthroplasty implant.
Complication rates associated with intercalary allograft reconstruction may be reduced by maximizing tenants of allograft reconstruction. Intercalary allograft reconstruction using a hemispherical reaming technique for graft-host interface may increase surface contact areas, provide intimate contact between surfaces, and equally distribute pressure subsequently decreasing risk of nonunion. The purpose of these case reports was to present short-term results for limb salvage using this novel technique for two young, active duty military members who returned to full-impact activity.
Malignant giant cell tumor of bone (GCTB) is a rare, aggressive, sarcoma occurring in adolescent and young adults. It is characterized by the presence of multinucleated giant cells and an aggressive clinical course. Because of the rarity of this tumor, no standard therapies have been identified. Current treatment regimens often include osteosarcoma chemotherapy protocols. We present a case of a malignant GCTB with a KRAS G12V mutation. This mutation is a known oncogenic driver that has not previously been reported on patients with malignant GCTB.
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