{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T07:02:47Z","timestamp":1774940567609,"version":"3.50.1"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2023YFC3604905"],"award-info":[{"award-number":["2023YFC3604905"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Skeletal fluorosis is a rare toxic osteopathy characterized by massive bone fluoride fixation. The disease is an endemic problem in some parts of the world and is the result of the prolonged ingestion or inhalation of large amounts of fluoride. The radiographic presentation is mainly characterized by bone changes, with osteocondensation and ossification of many ligaments and interosseous membranes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Diagnoses<\/jats:title>\n                    <jats:p>A 59-year-old woman with skeletal fluorosis underwent staged bilateral total knee arthroplasty. Preoperative radiographs showed increased bone density, thickened and fused trabecular, a thickened cortical bone, and a narrowed marrow cavity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient concerns<\/jats:title>\n                    <jats:p>Severe osteoporosis combined with calcification of the capsule, ligaments, and tendons was found intraoperatively, which increased both exposure difficulty and periprosthetic fracture risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Lessons<\/jats:title>\n                    <jats:p>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 that clinicians fully appreciate that skeletal fluorosis can occur in the presence of preoperative radiographic sclerosis and intraoperative osteoporosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1695296","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T05:32:01Z","timestamp":1774935121000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Radiographic sclerosis with intraoperative fragile bone in skeletal fluorosis: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Weikun","family":"Hou","sequence":"first","affiliation":[{"name":"Department of Osteonecrosis and Joint Reconstruction, Xi\u2019an Honghui Hospital, Health Science Center of Xi\u2019an Jiaotong University","place":["Xi'an, Shaan\u2019xi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lin","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Osteonecrosis and Joint Reconstruction, Xi\u2019an Honghui Hospital, Health Science Center of Xi\u2019an Jiaotong University","place":["Xi'an, Shaan\u2019xi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wensen","family":"Jing","sequence":"additional","affiliation":[{"name":"Department of Osteonecrosis and Joint Reconstruction, Xi\u2019an Honghui Hospital, Health Science Center of Xi\u2019an Jiaotong University","place":["Xi'an, Shaan\u2019xi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chao","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Osteonecrosis and Joint Reconstruction, Xi\u2019an Honghui Hospital, Health Science Center of Xi\u2019an Jiaotong University","place":["Xi'an, Shaan\u2019xi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yangquan","family":"Hao","sequence":"additional","affiliation":[{"name":"Department of Osteonecrosis and Joint Reconstruction, Xi\u2019an Honghui Hospital, Health Science Center of Xi\u2019an Jiaotong University","place":["Xi'an, Shaan\u2019xi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"B1","first-page":"279","article-title":"Skeletal fluorosis in humans: a review of recent progress in the understanding of the disease","volume":"10","author":"Krishnamachari","year":"1986","journal-title":"Prog Food Nutr Sci"},{"key":"B2","doi-asserted-by":"publisher","first-page":"193","DOI":"10.2478\/v10102-010-0038-7","article-title":"Skeletal fluorosis from the point of view of an occupational exposure to fluorides in former Czechoslovakia","volume":"1","author":"Buchancov\u00e1","year":"2008","journal-title":"Interdiscip 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