[Stability, function, alignment and associated injuries after surgical intervention and rehabilitation of tibial plate fracture]. / Estabilidad, función, alineación y lesiones asociadas después de una intervención quirúrgica y rehabilitación de fractura de platillos tibiales.

INTRODUCTION: tibial plateau fractures affect functionality of a large load bearing joint such as the knee, due to its multiple compromises, not only articular but also the ones including soft tissues. This study aims to evaluate the stability, function, alignment, associated injuries and complications of the knee after surgery and tibial plateau fractures rehabilitation. MATERIAL AND METHODS: a descriptive prospective observational study was carried out where patients with a tibial plateau fracture who had undergone surgery, that accomplish the inclusion criteria were included, in the period from April 2018 to June 2019. Analysis of variables was performed with t tests for independent samples. RESULTS: from a total of 92 patients with tibial plateau fracture, 66 (71%) were able to achieve the minimum six months follow-up. The most common fracture according to Schatzker classification was type II with 33.3%, and the most common according to Luo classification was the medial, lateral and posterior three column with 39.4%. More than 70% of patients who underwent surgery due to tibial plateau fractures developed soft tissue injury, therefore knee instability, specially with a higher rate of anterior cruciate ligament injuries or anterior instability. CONCLUSION: an important proportion of patients who underwent surgery for tibial plateau fractures have knee ligament injuries.

INTRODUCCIÓN: las fracturas de los platillos tibiales afectan la funcionalidad de una gran articulación de carga como la rodilla debido a sus múltiples compromisos no sólo articulares, sino también de tejidos blandos. Este estudio tiene como objetivo evaluar la estabilidad, función, alineación, lesiones asociadas y complicaciones de la rodilla después de intervención quirúrgica y rehabilitación de fractura de platillos tibiales. MATERIAL Y MÉTODOS: se realizó estudio observacional prospectivo descriptivo, donde se incluyeron los pacientes con fractura de platillos tibiales intervenidos quirúrgicamente que cumplieran los criterios de inclusión en el período comprendido entre Abril de 2018 y Junio de 2019. Se hizo análisis de variables con pruebas t para muestras independientes. RESULTADOS: de un total de 92 pacientes con fractura de platillos tibiales, 66 (71%) lograron completar los seis meses mínimos de seguimiento. La fractura más común según la clasificación de Schatzker fue tipo II con 33.3% y la más común según la clasificación de Luo fue la de tres columnas medial, lateral y posterior con 39.4%. Más de 70% de los pacientes intervenidos por fracturas de platillos tibiales presentaron lesión de tejidos blandos, por ende, una inestabilidad de rodilla, especialmente con mayor índice de lesiones del ligamento cruzado anterior e inestabilidad anterior. CONCLUSIÓN: una proporción importante de los pacientes intervenidos por fractura de platillos tibiales tienen lesión ligamentaria de rodilla.

[No infected union of subtrochanteric fracture of femur, treated with autograft and plate]. / No unión infectada de fractura subtrocantérica de fémur, tratada con autoinjerto y placa.

Hip fractures are considered a public health problem in the world. Among hip fractures we find subtrochanteric fractures that are defined as proximal femur fractures located in the trochanteric region within 5 cm below the lesser trochanter; and they have an approximate incidence of 15 to 20 per 100,000 people. The objective of this case is to report the success of the reconstruction of an infected subtrochanteric fracture, with a non-vascularized fibular segment and a distal femur condylar support plate. Clinical case: 41-year-old male patient suffering from a right subtrochanteric fracture as a result of a traffic accident that required the use of osteosynthesis material. With subsequent rupture of the cephalomedullary nail in its proximal third, non-union of the fracture and infections at the fracture site. He was treated with multiple surgical lavages, antibiotic therapy, and an unconventional orthopedic and surgical procedure, such as the use of a distal femur condylar support plate and an endomedullary bone graft with a 10-cm segment of non-vascularized fibula. Patient with satisfactory and favorable evolution.

Las fracturas de cadera se consideran un problema de salud pública en el mundo, entre las fracturas de cadera encontramos las subtrocantéricas, que se definen como fracturas proximales de fémur situadas en la región trocantérea dentro de los 5 cm debajo del trocánter menor; tienen una incidencia aproximada de 15 a 20 por cada 100,000 personas. El objetivo de este de caso es reportar el éxito de la reconstrucción de una fractura subtrocantérica infectada, con un segmento del peroné no vascularizado y una placa de soporte condíleo de fémur distal. Caso clínico: masculino de 41 años de edad que sufre fractura subtrocantérica derecha producto de un accidente de tránsito que requirió manejo de osteosíntesis. Con posterior ruptura del clavo cefalomedular en su tercio proximal, no unión de la fractura e infecciones en sitio de la fractura. Fue tratado con múltiples lavados quirúrgicos, antibioticoterapia y un procedimiento ortopédico y quirúrgico poco convencional como el uso de una placa de soporte condíleo de fémur distal y un injerto óseo endomedular con un segmento de 10 cm de peroné no vascularizado. Paciente con evolución satisfactoria y favorable.

Detection of drug-resistance mechanism of Pseudomonas aeruginosa developing from a sensitive strain to a persister during carbapenem treatment.

We explored the mechanism of the development from sensitivity to resistance to carbapenem in Pseudomonas aeruginosa. Two P. aeruginosa strains were collected during treatment with carbapenem. Strain homology was investigated using pulsed-field gel electrophoresis. Porin oprD2 expression was analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). The minimum inhibitory concentrations (MICs) of imipenem and meropenem with or without MC207110 were determined using the agar dilution method. The expression level of efflux pump mRNA was tested using real-time polymerase chain reaction. Metallo-lactamases (MBLs) were screened using the EDTA-disk synergy test. Genes encoding MBLs were amplified and then analyzed by DNA sequencing. The two treated strains belonged to the same pulsed-field gel electrophoresis type. The SDS-PAGE profile of the P. aeruginosa strains revealed that the 46-kDa membrane protein OprD2 of IMP(R)MEM(R) type strains was lost, whereas OprD2 of 1 IMP(S)MEM(S) strain was normal. With or without MC207110 treatment, the MIC of carbapenem-resistant P. aeruginosa decreased by 4-fold, while the MIC of carbapenem-sensitive P. aeruginosa did not. Compared with the carbapenem-sensitive strain, MexX mRNA expression in the carbapenem-resistant strain increased by 102.5-fold, while the mRNA expression of other efflux pumps did not markedly increase. Neither carbapenem-resistant nor carbapenem-sensitive P. aeruginosa produced MBL. The mechanism of development from sensitivity to resistance of P. aeruginosa to carbapenem during carbapenem treatment is due to porin oprD2 loss and an increased expression level of MexXY-OprM.