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Tales of a Wayward Screw

Author: Adriana M. Mercado Rodríguez, MD, Miguel Agrait, MD, FACEP, FAAEM, CAQ-SM
Peer-Reviewer: Justine Ko, MD, CAQ-SM
Final Editor: Alex Tomesch, MD, CAQ-SM

A 52 year old male presents with left knee swelling and pain for the past 5 days. Patient denies recent trauma to his leg but reports a history of gout with similar symptoms. He also mentions a distant tibial fracture of the same leg for which he underwent ORIF. Pain is well localised to the medial tibial plateau area and is limiting ability to ambulate. Patient denies fever or chills, but states the area has been turning red for the past day. Visual examination of the knee reveals an area of erythema with small central ulceration which is exquisitely tender to palpation. (Image 1a). There is full active and passive range of motion of the knee, but with pain on both complete extension and complete flexion. XR of the knee were obtained (1b, 1c).

Image 1a. Patient’s knee. Author’s own image, reproduced with patient’s permission.

Image 1b-c. Plain films of the knee. Author’s own image.


Bedside limited knee ultrasound shows the following:


Image 2a, 2b. Bedside ultrasound. Author’s own image.



[1] Rasouli, M. R., Viola, J., Maltenfort, M. G., Shahi, A., Parvizi, J., & Krieg, J. C. (2015). Hardware removal due to infection after open reduction and internal fixation: trends and predictors. Archives of Bone and Joint Surgery, 3(3), 184.