ABSTRACT
Osteomielitis del pubis es una patología poco frecuente y se caracteriza por fiebre, dolor pélvico severo, impotencia funcional para la marcha y destrucción ósea de los márgenes de la sínfisis púbica o de sus ramas. Generalmente se describe asociada a complicaciones de diversos procedimientos quirúrgicos en la pelvis, traumatismos, infección del tracto urinario y abuso de drogas por vía intravenosa. Mientras que, la osteomielitis del pubis debida a la infección de la prótesis tras la reparación de la hernia inguinal, es un hecho excepcional. Describimos un caso de osteomielitis de la rama ascendente del pubis en un paciente varón de 88 años de edad, tras hernioplastia inguinal realizada tres meses antes, causada por Estafilococus aureus meticilin resistente, que mejoró tras retirar la malla, limpieza quirúrgica, curetaje óseo, terapia VAC (cicatrización asistida por vacio) y tratamiento antibiótico específico Discutimos la incidencia, etiología, manifestaciones clínicas, diagnóstico, diagnóstico diferencial, tratamiento y prevención de esta patología
Pubic osteomyelitis is a rare disease characterized by fever, severe pelvic pain, and functional disability for walking and bone destruction margin of the pubic symphysis or its branches. Generally described associated to complications of the several surgical procedures in the pelvis, trauma, urinary tract infection and intravenous drug abuse. While, the pubic osteomyelitis due to infection of the prosthesis after inguinal herniarepair is a rarely described entity. We describe a case of osteomyelitis of the pubis ascending branch on a 88-year-old male patient after inguinal hernia repair performed three months earlier, caused by Staphylococcus aureus methicillin resistant, which improved after removing the mesh, surgical cleaning, VAC (Vacuum Assisted Closure) therapy and specific antibiotic treatment. We discuss the incidence, etiology, clinical manifestations, diagnosis, differential diagnosis, treatment and prevention of this disease
Subject(s)
Humans , Male , Aged, 80 and over , Osteomyelitis/complications , Osteomyelitis/etiology , Osteomyelitis/pathology , Hernia, Inguinal/diagnosis , Hernia, Inguinal/therapy , Surgical Mesh , Staphylococcal Infections , Arthritis, Infectious/diagnosis , Arthritis, Infectious/pathology , Disease Prevention , Biopsy, Fine-Needle/instrumentation , Biopsy, Fine-Needle/methods , Biopsy, Fine-NeedleABSTRACT
Hill-Sachs lesion is a defect of the posterosuperior aspect of the humeral head that occurs during an episode of instability. Under abduction and external rotation, this lesion may engage the anterior glenoid border, thus favoring instability. It may be the cause of many failed surgical stabilization procedures. We herein describe the arthroscopic remplissage technique, which consists of filling the lesion through capsulotenodesis of the infraspinatus tendon. This maneuver should be always be performed together with anterior capsulolabral repair. The results obtained by the authors and published in the literature are good, with a loss of mobility similar to the one resulting from the isolated arthroscopic Bankart technique. We recommend performing remplissage together with Bankart repair in patients with glenohumeral instability with significant Hill-Sachs lesions without a glenoid defect or with defects less than 25%.
