Slipped Capital Femoral Epiphysis Associated With Vitamin C Deficiency in a 7-year-old Boy.

Scurvy is rare in the present world and is mostly found in children with abnormal dietary habits and physical and mental disabilities. Scurvy can present in various forms, mimicking several common diseases, thus making the diagnosis difficult. Spontaneous epiphyseal separation is known to occur in scurvy, although rarely reported. The usual locations of these epiphyseal separations are distal femur and proximal humerus. Our case is unique in that scurvy in a seemingly normal child resulted in proximal femur epiphyseal separation which was not reported previously. We report a case of a 7-year-old boy presenting with pain and swelling in multiple joints for 6 months and later inability to walk. Pseudoparalytic frog-leg posture, dietary history of selective eating, and typical radiologic features made us consider a diagnosis of scurvy which was confirmed by a low serum vitamin C level. He developed epiphyseal separation of proximal femur and was treated with percutaneous screw fixation. Vitamin C supplementation resulted in prompt improvement clinically and radiologically.

SKINTED: A Rare Complication After Total Knee Arthroplasty.

BACKGROUND: Surgery of the knee, injury to the infrapatellar branch of the saphenous nerve, traumatic eczematous dermatitis is a neuropathic dermatitis specific to total knee arthroplasty (TKA), occurring around the healed surgical scar area. Very few case reports exist in orthopaedic literature regarding this rare skin complication after TKA. We report a series of cases and estimated the incidence of this condition in our institute. METHODS: During the 1-year period from January 2018 to December 2018, patients who have undergone TKA and later presented with skin lesions adjacent to the operated site were identified. Detailed history was taken, and full clinical examination was performed for all the reported cases. RESULTS: A total of 9 lesions in 8 patients were identified out of a total of 203 consecutive TKAs operated during the study period, with an estimated incidence of 4.4%. The mean age was 64 years (range, 58-78 years). The mean time from surgery to diagnosis was 4 months (range, 3-6 months). CONCLUSIONS: This group of dermatitis caused due to surgical transection of the infrapatellar branch of the saphenous nerve during TKA is a rare cutaneous complication, with an estimated incidence of 4.4% from this study. Lesions typically appear lateral to the operative scar within an area of hypoesthesia. Lesions in all patients improved after topical steroid therapy with no recurrences at further follow-up. Arthroplasty surgeons should have awareness of this benign complication, thereby avoiding unwarranted additional workup and alleviating unnecessary psychological stress to the patient.