title: Lower extremity manifestations of "skin-popping" an illicit drug use technique: A report of two cases.
abstract: Presented is a rare case of tibial and fibular osteomyelitis and a case of fibular periositis, both a direct consequence of a peculiar drug use technique. The osseous manifestations secondary to presentation of necrotic wounds with indurated rim and serous drainage with associated cellulitis, both resulting from "skin popping." Due to the complex treatment plan required, the importance of a motivated patient, a strong social support system, a controlled environment, and a multidisciplinary team cannot be overstated. Despite comprehensive efforts, devastating consequences may be unavoidable as individuals plunge downward, victimized by their addiction.
  
  
  METHODS
  4.
authors.affiliation: Private Practice, St. Vincent Medical Group, Rockside Physician's Center, 6701 Rockside Road, Suite 100, Independence, OH 44131, United States; PMR+RRA Residency Training Program, St. Vincent Charity Medical Center, Department of Orthopedic Surgery, Podiatry Section: 2351 E. 22nd ST, Suite 342W, Cleveland, OH 44115, United States; Kent State University College of Podiatric Medicine, 6000 Rockside Woods Blvd., Independence, OH 44131, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Canales
authors.affiliation: PGY-3, PGY-1 PMR+RRA Residency Training Program, St. Vincent Charity Medical Center, 2351 E. 22nd St., Cleveland, OH 44115, United States. Electronic address: jp.gerhard@gmail.com.
authors.forename: John
authors.initials: J
authors.lastname: Gerhard
authors.affiliation: PGY-3, PGY-1 PMR+RRA Residency Training Program, St. Vincent Charity Medical Center, 2351 E. 22nd St., Cleveland, OH 44115, United States.
authors.forename: Erin
authors.initials: E
authors.lastname: Younce
mesh_terms: D000328:Adult; D002481:Cellulitis / Q000139:chemically induced / Q000473:pathology / Q000628:therapy; D003061:Codeine / Q000009:adverse effects / Q000031:analogs & derivatives*; D005260:Female; D005360:Fibula; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects*; D007871:Leg Ulcer / Q000139:chemically induced* / Q000473:pathology / Q000628:therapy; D010019:Osteomyelitis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D010522:Periostitis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D011859:Radiography; D015819:Substance Abuse, Intravenous / Q000150:complications*
chemical_list: D013287:Illicit Drugs; C000599494:desomorphine; D003061:Codeine
keywords: Heroin; Krokodil; Osteomyelitis; Skin popping; Wound