Fracture of the Distal Radius by Tuberculous Osteomyelitis: A Case Report and Review of Literature.

We report a 94-year-old patient with a fractured radius that was being managed conservatively. At 2 months, an abscess was observed overlying the fracture site. An MRI scan was done and samples obtained for microbiological and pathological analyses. The patient was diagnosed with tuberculous osteomyelitis. Surgical debridement of the fracture site was performed, and the bone defect was filled with bone cement impregnated with gentamicin and rifampicin. Anti-tuberculosis therapy was administered for 9 months and the patient made an uneventful recovery. Early diagnosis and correct medical treatment depend on sound evidence of tuberculous osteomyelitis. Surgical debridement is essential if abscesses are present in the bone. Level of Evidence: Level V (Therapeutic).

Analysis of predictors of mortality after surgical and non-surgical management in proximal humerus fractures.

BACKGROUND: Proximal humerus fractures are one of the main osteoporotic fractures. Choosing between conservative or surgical treatment is a controversial topic in the literature, as is the functional impact. The main aim of our study was to analyse whether patient comorbidities should influence the final therapeutic decision for these fractures. MATERIAL AND METHODS: We collected data from 638 patients with proximal humerus fractures. The main variable collected was exitus. We also collected the following data: age, gender, type of fracture, laterality, type of treatment, production mechanism, comorbidities and the Charlson comorbidity index (CCI) for each patient. The therapeutic indication used the criteria established by the Upper Limb Unit in our centre. We performed chi-square tests, Fischer's exact tests and Student's t-tests to compare the variables. We used the Kaplan-Meier method to analyse both the overall and disease-specific survival rates. We employed the Cox regression model to analyse factors associated with mortality. RESULTS: Patients with a CCI greater than 5 showed greater mortality (HR = 3.83; p < 0.001) than those with a CCI lower than 5. Within the patients who underwent surgery, those with a CCI higher than 5 had an increased mortality rate (HR = 22.6; p < 0.001) compared with those with a CCI lower than 5. Within the patients who received conservative treatment, those with a CCI over 5 showed greater mortality (HR = 3.64; p < 0.001) than those with a CCI under 5. CONCLUSIONS: Patients with proximal humerus fractures and associated comorbidities (CCI > 5) presented higher mortality than healthier patients. This mortality risk was greater in patients with comorbidities if surgical treatment was indicated rather than conservative treatment. Patient's comorbidities should be a fundamental parameter when planning the therapeutic strategy. LEVEL OF EVIDENCE: Level 3.