Pyomyositis of the inner thigh muscles due to Escherichia coli in a young patient with severe aplastic anemia / Piomiositis del muslo debida a Escherichia coli en un paciente joven con anemia aplásica

Pyomyositis, an acute bacterial infection of skeletal muscle, is caused by Staphylococcus aureus or other gram-positive organisms in >90% of cases. A 19-year-old boy with severe idiopathic aplastic anemia presented a pyomyositis of inner thigh muscles due to Escherichia coli as a complication of his underlying disease. The diagnosis was established by means of soft tissue ultrasound, magnetic resonance imaging (MRI) and blood culture. Surgical debridement and antibiotic treatment were performed. Postoperative course was uneventful and pyomyositis was successfully resolved. Pyomyositis caused by E. coli is uncommon condition, and very few cases have been reported, most of them being severe immunodeficiency patients, but we should know the existence of this entity and its management

La piomiositis es una infección bacteriana aguda del músculo esquelético que es causada por Staphylococcus aureus u otros organismos gram positivos en >90% de los casos. Presentamos el caso de un hombre de 19 años de edad con anemia aplásica idiopática severa quien presentó una piomiositis de los músculos internos del muslo debido a Escherichia coli como una complicación de su enfermedad de base. El diagnóstico se estableció por medio de ultrasonidos de tejido blando, resonancia magnética (RM) y hemocultivo. Se llevaron a cabo desbridamiento quirúrgico y tratamiento antibiótico. El postoperatorio transcurrió sin complicaciones y la piomiositis se resolvió con éxito. La piomiositis causada por E. coli es una condición poco común, y muy pocos casos han sido reportados, la mayoría de ellos son pacientes con inmunodeficiencia grave, pero debemos conocer la existencia de esta entidad y su tratamiento (AU)

Pyomyositis of the inner thigh muscles due to Escherichia coli in a young patient with severe aplastic anemia.

Pyomyositis, an acute bacterial infection of skeletal muscle, is caused by Staphylococcus aureus or other gram-positive organisms in >90% of cases. A 19-year-old boy with severe idiopathic aplastic anemia presented a pyomyositis of inner thigh muscles due to Escherichia coli as a complication of his underlying disease. The diagnosis was established by means of soft tissue ultrasound, magnetic resonance imaging (MRI) and blood culture. Surgical debridement and antibiotic treatment were performed. Postoperative course was uneventful and pyomyositis was successfully resolved. Pyomyositis caused by E. coli is uncommon condition, and very few cases have been reported, most of them being severe immunodeficiency patients, but we should know the existence of this entity and its management.

Iatrogenic femoral neck fracture during closed nailing of the femoral shaft fracture.

BACKGROUND: Intramedullary nails have become a popular implant in the management of femoral shaft fractures. The occurrence of a femoral neck fracture after closed intramedullary nailing is an exceptional complication of this technique that has been rarely reported in the literature. METHODS: We report a retrospective study to identify the possible causes that could produce a fracture of the femoral neck after nailing of the ipsilateral femur. RESULTS: A total of four neck fractures were identified in a series of 494 femoral shaft nailing, all of them not visible on the initial plain films. In two cases, the nail entry point was located lateral to the tip of the greater trochanter. In the other two cases, the entry point was located too medial to the greater trochanter, violating the superoexternal cortex of the femoral neck. CONCLUSION: The event of a femoral neck fracture during closed intramedullary nailing is an unusual complication that may be caused due to a technical mistake related to the location of the nail entry portal in the proximal femur.

Fractura por sobrecarga en la carilla articular vertebral en un jugador de tenis de competición / Strees fracture of the vertebral articular facet in a competitive tennis player

La fractura por sobrecarga de los elementos vertebrales posterioreses una causa relativamente frecuente de dolor de espalda enlos atletas. Esta lesión ocurre normalmente en el istmo, y laespondilolisis resultante puede ser uni o bilateral. Las fracturaspor sobrecarga que asientan en los restantes elementos de la parteposterior de la columna vertebral son muy raras.Se presenta el caso inusual de una fractura aislada de la carillaarticular inferior de la tercera vértebra lumbar en un jugador detenis profesional que aquejaba dolor de espalda. Las radiografíasanteroposterior, lateral y oblicuas sugerían la presencia de undefecto en la carilla articular derecha de L3. La tomografía fueconfirmativa. La gammagrafía topográfica computarizada(SPECT) demostró un aumento de captación a nivel de la articularinferior derecha de L3 que permitió establecer el diagnósticode fractura por sobrecarga. El paciente fue controlado con tratamientoconservador (AU)

A stress fracture of the posterior elements of the lumbar spine isa relative common cause of pain in the back in athletes. Thislesion usually occurs in the isthmus, and the resultant spondylolysismay be uni or bilateral. Stress fractures rarely involve theremainder of the posterior part of the spinal column.An unusual case of an isolated inferior facet fracture of the thirdlumbar vertebra is described in a professional tennis player complainingback pain. Anteroposterior, lateral and standard obliqueradiographs were suspicious for a defect in L3 lumbar right facet.Tomograms were confirmatory. A single-photon emission computedtopographic (SPECT) scan demonstrated increased tracer uptakein the L3 right inferior facet. The working diagnosis was lumbarfacet stress fracture. The patient was treated conservatively (AU)

Rotura del ligamento interespinoso lumbar en un atleta practicante de remo / Rupture of the lumbar interspinous ligament in a rower

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Direct repair of spondylolysis using a new pedicle screw hook fixation: clinical and CT-assessed study: an analysis of 19 patients.

OBJECTIVE: A prospective analysis of 19 consecutive cases of spondylolysis repair using a new hook screw device is presented. The objective of the study was to assess the clinical, radiologic, and computed tomography (CT) scan outcomes to establish the indications of isthmic repair in the treatment of spondylolysis. METHODS: Nineteen patients treated with a new segmental pedicle screw hook fixation were followed up for a minimum of 2 years (mean 30 months, range 24-48 months). Mean age was 20.5 years (range 13-29 years). All lytic defects were bilateral and located at L5, except for one at L3. CT scans were obtained at 6 months and 1 year postoperatively. CT scans were performed using both traditional and reverse gantry angled cuts to assess the healing of the defect. Fusion was considered to be present when trabeculae passed across the lytic defect. CT scan images were not considered conclusive until 1 year after surgery, because in two cases, trabecular pass across the pars was observed on only one side after 6 months, becoming bilateral 1 year postoperatively. CONCLUSIONS: Twelve of 13 patients who were 20 years or younger at the time of the study (average age 17.2 years) had fusion (92%), whereas in the group of 6 patients age 21 and older (average age 27.5 years), no cases of fusion were observed. Clinical outcome was excellent to good in 15 patients, fair in 3 cases, and poor in 1. The group of patients age 20 or younger had significantly better clinical results (84% excellent or good) (P = 0.00097) than those obtained in the group of patients age 21 and older (66% excellent or good) (P = 0.016). According to the current findings, the authors believe that segmental pedicle screw hook fixation is a useful alternative in the treatment of spondylolysis in adolescents but do not recommend this procedure in patients over age 20.