title: Unusual implant-related soft tissue reaction presenting as a swollen leg: a case report.
abstract: BACKGROUND
  There are several causes of peri-implant edema, pain, and swelling around implants after orthopedic fixation device application for fracture repair. The most common and well-known reason is infection, however, granulomas associated with foreign body reactions are rarely seen. In this report we present a case of a granulomatous reaction mimicking a hydatid cyst and sarcoma. We emphasize the importance of differential diagnosis in triggering appropriate management of the patient. Our case was unusual; to the best of our knowledge no similar clinical or pathological findings have been reported in current literature.
  
  
  METHODS
  A 56-year-old Turkish man who had been treated for a right femoral fracture via a plate fixation 10 years prior underwent an operation to treat pain and swelling around the plate. A hydatid cyst-like mass was observed during surgery, but subsequent examination revealed that no hydatid cyst was present; both malignancy and infection were also absent.
  
  
  CONCLUSIONS
  Although infection is generally the first possibility that should be considered in a patient complaining of pain and swelling in the vicinity of an implant, malignancies, hydatid cysts, and (finally) foreign body reactions should also be kept in mind as differential diagnoses. A soft-tissue reaction around a previously implanted plate should be managed carefully. Pre-operative radiological assessment, and biopsy to allow pathological and microbiological examination, should be considered in all suspected cases.
authors.forename: Seyma
authors.initials: S
authors.lastname: Ozkanli
authors.affiliation: Department of Orthopedics and Traumatology, Göztepe Training and Research Hospital, Fahrettin Kerim Gökay Street, 2346 Istanbul, Turkey. slhsylmz@gmail.com.
authors.forename: Mehmet Salih
authors.initials: MS
authors.lastname: Soylemez
authors.forename: Adem
authors.initials: A
authors.lastname: Sahin
authors.forename: Serkan
authors.initials: S
authors.lastname: Senol
authors.forename: Kerem
authors.initials: K
authors.lastname: Bilsel
authors.forename: Hasan Hüseyin
authors.initials: HH
authors.lastname: Ceylan
mesh_terms: D001860:Bone Plates / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004443:Echinococcosis / Q000175:diagnosis; D005264:Femoral Fractures / Q000601:surgery; D005547:Foreign Bodies / Q000175:diagnosis; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D012509:Sarcoma / Q000175:diagnosis; D018461:Soft Tissue Infections / Q000175:diagnosis