CASE REPORT article
Front. Surg.
Sec. Orthopedic Surgery
This article is part of the Research TopicManagement of Orthopedic Deformities in Rare Bone DisordersView all 3 articles
Radiographic sclerosis with intraoperative fragile bone in skeletal fluorosis: a case report
Provisionally accepted
- Department of Joint Surgery, Xi'an Honghui Hospital, Xi'an, China
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Abstract: Introduction: Skeletal fluorosis is a rare toxic osteopathy characterized by massive bone fluoride fixation. The disease occurs as an endemic problem in some parts of the world, and is the result of prolonged ingestion or inhalation of high amounts of fluoride. Radiographic presentation is mainly characterized by bone changes, with osteocondensation and ossification of many ligaments and interosseous membranes. Diagnoses: A 59-year-old woman with skeletal fluorosis underwent staged bilateral total knee arthroplasties. Preoperative radiographs showed increased bone density, thickened and fused trabecular, thickened cortical bone, and narrowed marrow cavity. Patient concerns: Severe osteoporosis combined with calcification of the capsule, ligaments, tendons was found intraoperatively, which increased both exposure difficulty and periprosthetic fracture risk. Lessons: Skeletal fluorosis is not clinically obvious and is easily misdiagnosed. It is essential to evaluate bone quality and soft tissue flexibility preoperatively in patients from endemic areas. Special exposure procedures and release techniques are useful in these cases. It is recommended to fully appreciate the preoperative "radiographic sclerosis" image and intraoperative "soft bone" facts.
Keywords: Endemic disease, Osteoporosis, radiographic sclerosis, Skeletal fluorosis, Total knee arthroplasty
Received: 29 Aug 2025; Accepted: 23 Jan 2026.
Copyright: © 2026 Hou, Liu, Jing, Lu and Yangquan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Weikun Hou
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