Micetoma por Actinomadura madurae en el pie: reporte de un caso en Chile / Actinomadura madurae mycetoma of the foot: report of one case

Mycetoma is a chronic infection that affects skin, subcutaneous tissue and bone. Its etiology can be mycotic or bacterial. It affects mainly the lower extremities ofmiddie age men livingin tropical climates. We repon a 44 year-old male ¡ivingin a template zone, consulting for swelling and pain in the left foot, lasting for 10 years. Physical examination showed a swollen left foot with hyperpigmented skin and a few crustedpapules. Radiology showed an extensive bone involvement of the midfoot with several oval and radiolucid images. Magnetic resonance showed son and bone tissue involvement, with múltiple oval and low intensity images in TI and T2. The biopsy was compatible with an unspecific chronic osteomyelitis. A bacterial identification by polymerase chain reaction and sequencing in the biopsy determined the presence of an Actinomadura madurae. Treatment with cotrimoxazol was started).

Plastia de Lapidus en el tratamiento quirúrgico del quinto ortejo supra aducto / Lapidus procedure for treatment of overlapped fifth toe

The varus fifth toe pathology, in spite of its relative frequency and clinical relevance, has been barely studied in relation to the treatment results. 28 overlapped fifth toes operated according to the Lapidus Technique were evaluated retrospectively, corresponding to 17 patients, age average 28 years, opered since year2003. The minimum follow up time was 6 months. The surgical technique consisted on a dorsal approach in "italic s" on the 5° metatarsophalangic joint, capsulotomy and transference of the EDL to the digiti quinti abductor. Preoperative Hallux Metatarsophalangeal-lnterphalangeal AOFAS Scale average was 88,1 and varied to 99,4 points to the six months of pursuit. 100% of the patients showed complete satisfaction with the result. Only 2 patients presented minor postoperative complications (wound infection and dehiscence), which were handled ambulatory. Lapidus Procedure is a safe procedure and effective in the correction of overlapping fifth toe.

La patología del 5° ortejo varo, a pesar de su relativa frecuencia y relevancia clínica ha sido escasamente estudiada en relación a los resultados de tratamiento. Se evaluaron retrospectivamente 28 quintos ortejos supra aducto flexibles operados según la técnica de Lapidus, correspondientes a 17 pacientes, edad promedio 28 años, operados desde el año 2003. El seguimiento mínimo fue de 6 meses. La técnica quirúrgica consistió en abordaje dorsal en "s" itálica sobre la 5° articulación metatarsofalángica, capsulotomía y transferencia del EDL al abductor digiti quinti. El promedio de la Escala AOFAS para antepie preoperatoria fue de 88,1 y varió a 99,4 puntos a los seis meses de seguimiento. 100 por ciento pacientes mostraron satisfacción completa con el resultado. Sólo 2 pacientes presentaron complicaciones menores posoperatorias (infección de la herida y dehiscencia) que se manejaron ambulatoriamente. La plastia de Lapidus es un procedimiento seguro y eficaz en la corrección del quinto ortejo varo flexible.