Operating Room Fire During Total Knee Arthroplasty Tibial Impaction: A Case Report and Review of the Literature.

A fire in the operating room is a rare but potentially deadly occurrence. We present an operating room fire during an elective total knee arthroplasty with an unclear ignition source. Flames were visualized originating from the excess bone cement while impacting the tibial component. The electrocautery device was not in use during impaction and was in a plastic sheath at the head of the bed. To our knowledge, this is the first reported case of an operating room fire involving bone cement not caused by an electrocautery device.

Repetitive Musculoskeletal Injuries: A Survey of Female Adult Reconstruction Surgeons.

BACKGROUND: Occupational injuries are a prevalent and costly problem for orthopedic surgeons, especially arthroplasty surgeons performing physically demanding and repetitive tasks. The purpose of this study was to characterize occupational musculoskeletal injuries in female adult reconstruction surgeons. METHODS: A prospective survey about workplace musculoskeletal injuries was distributed to female attending adult reconstruction surgeons in May 2020. Participants were identified using subspecialty membership data, social media, and personal contacts. Results were analyzed using descriptive statistics. RESULTS: Of the total 63 female arthroplasty surgeons who responded, 65.1% were 30-45 year old, and 42.9% were within 5 years of practice, 68.3% sustained an occupational musculoskeletal injury, most commonly forearm/wrist/hand (79.1%), shoulder (48.8%), and low back (44.2%); 10.0% of reported occupational injuries not related to pregnancy resulted in the surgeon requiring time off work, while 48.2% required temporary modifications of job performance, and 10.9% required surgical treatment. Of the injured surgeons who reported having been pregnant, 65.4% reported a workplace exacerbation of a pregnancy-related musculoskeletal condition, including low back pain (52.9%), pubic symphysis pain (35.3%), and carpal tunnel syndrome (29.4%). CONCLUSION: A total of 68.3% of female arthroplasty surgeons reported occupational musculoskeletal injuries, predominately forearm/wrist/hand, with a portion of those requiring modifications of job performance. Musculoskeletal injuries may be mitigated by performing repetitive tasks ergonomically, correcting posture, using appropriately sized instrumentation, and using automated or lighter instruments, to potentially avoid modifications to job performance, time off work, or even surgical procedures. Further studies should investigate factors that contribute to injuries in arthroplasty surgeons and how they can be prevented.

Rare Case of Diffuse Skeletal Fluorosis Due to Inhalant Abuse of Difluoroethane.

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.