Artritis séptica de rodilla por Granulicatella adiacens tras reconstrucción de ligamento cruzado anterior / Septic arthritis caused by Granulicatella adiacens after anterior cruciate ligament reconstruction

La artritis séptica tras una artroscopia de rodilla es muy poco frecuente. Se estima una tasa de infección postoperatoria en torno al 0,15-0,84%1, según las series. El procedimiento artroscópico más frecuentemente asociado a infección es la reconstrucción del ligamento cruzado anterior (LCA), cuya frecuencia está en torno al 0,3-1,7%2. El microorganismo más frecuentemente aislado es el estafilococo coagulasa negativo. Describimos un caso de artritis séptica de rodilla tras reconstrucción de ligamento cruzado anterior en la que se aisló el microorganismo Granulicatella adiacens en el cultivo del líquido sinovial. No encontramos ningún caso descrito en la literatura de infección tras artroscopia de rodilla, por dicho microorganismo; tratándose probablemente del primer caso publicado

Septic arthritis after knee arthroscopy is an extremely rare condition. A rate of 0.15-0.84% cases of postoperative infection is estimated in several series. The arthroscopy procedure most frequently related with an infectious complication is anterior cruciate ligament (ACL) reconstruction, with a prevalence of 0.3-1.7% cases. Staphylococcus sp. is the pathogen most commonly cultured. We describe a case of septic arthritis after ACL reconstruction. We found no published case of septic arthritis caused by this microorganism after knee arthroscopy. It is probably the first case published in the literature

Septic arthritis caused by Granulicatella adiacens after anterior cruciate ligament reconstruction. / Artritis séptica de rodilla por Granulicatella adiacens tras reconstrucción de ligamento cruzado anterior.

Septic arthritis after knee arthroscopy is an extremely rare condition. A rate of 0.15-0.84% cases of postoperative infection is estimated in several series. The arthroscopy procedure most frequently related with an infectious complication is anterior cruciate ligament (ACL) reconstruction, with a prevalence of 0.3-1.7% cases. Staphylococcus sp. is the pathogen most commonly cultured. We describe a case of septic arthritis after ACL reconstruction. We found no published case of septic arthritis caused by this microorganism after knee arthroscopy. It is probably the first case published in the literature.

Absceso de Brodie como forma de osteomielitis subaguda: a propósito de un caso / Abscess of Brodie as form of osteomyelitis subacute: purpose of a case

Presentamos el caso de un varón de 29 años con dolor coxofemoral de un mes de evolución, con asociación de fiebre alta. Su único antecedente de interés es la colocación de una tracción transesquelética supracondílea femoral a los 8 años de edad. En los estudios radiográficos se demuestran signos propios de esta patología. Ingresa para antibioterapia intravenosa y a la semana se realiza desbridamiento quirúrgico, curetaje y lavado. Pese a todo ello, persisten datos de infección activa y se opta por una tercera intervención de desbridamiento mediante fresado-irrigación anterógrada del fémur (AU)

We report the case of a 29 years old man, with hip pain from one month earlier, associated with high fever. The only previous interest presented is placing a transfemoral traction at 8 years old. Radiological studies show the finding of this condition. The patient is admitted for intravenous antibiotics but the evolution is torpid and after one week surgical debridement, curettage and washing are carried out. Despite all this, active infection persists and debridement third surgery is necessary, by milling-femoral anterograde irrigation (AU)

Inestabilidad glenohumeral en pacientes mayores de 40 años: lesiones, tratamiento y complicaciones / Glenohumeral instability in patients over 40 years-old: Injuries, treatment and complications

Introducción. La inestabilidad glenohumeral recurrente es poco frecuente a partir de la cuarta década de la vida y presenta diferencias respecto de la del paciente más joven. Objetivo. Comparar las lesiones y las complicaciones postoperatorias de una población de 40 años o más intervenida de inestabilidad glenohumeral respecto a un grupo control más joven. Material y métodos. Se procedió a la revisión retrospectiva de los pacientes intervenidos mediante cirugía artroscópica de inestabilidad glenohumeral desde 1999 hasta 2011. Se realizó un seguimiento medio de 64 meses. El grupo principal estaba constituido por todos los pacientes de 40 años o más intervenidos en el periodo de estudio (n = 21), el cual fue comparado con un grupo control de pacientes más jóvenes seleccionado aleatoriamente con un tamaño similar (n = 27). Resultados. En el grupo de los mayores, la media de edad fue de 54 ± 11,86 años, mientras que en el grupo de menor edad fue de 26 ± 5,80 años. No se encontraron diferencias entre ambos grupos respecto a la presencia de lesión del labrum, lesión de Hill-Sachs y lesión de Bankart óseo (p > 0,05). La lesión del manguito de los rotadores fue 7,3 veces (IC del 95%, 2,5-21,6) más frecuente en el grupo de mayor edad (81%) respecto los de menor edad (p < 0,05). En cambio, las complicaciones neurológicas posteriores a la luxación no fueron más frecuentes en dicho grupo (p > 0,05). No se encontró asociación entre las complicaciones postoperatorias y la edad agrupada según el diseño (p > 0,05). Conclusiones. La inestabilidad glenohumeral anteroinferior recurrente después de la cuarta década de la vida presenta con frecuencia lesión del manguito de los rotadores. El tratamiento artroscópico de la inestabilidad fue eficaz, sin presentar mayores complicaciones postoperatorias (AU)

Introduction. Recurrent shoulder dislocation is infrequent after forty years and presents different injuries than younger patients. Objective. To compare injuries and complications after surgery between one group older than forty years of age and another younger group. Material and methods. A review was made o all patients who had undergone arthroscopic surgery due to glenohumeral instability from 1999 until 2011. The mean follow-up was 64 months. The case group consisted of all patients older than 40 years at the time of the surgery (n = 21), which was compared with a similar sized control group of randomly selected younger patients (n = 27). Results. The mean age in the older group was 54 years (SD 11.86), while it was 26 years (SD 5.80) in the younger group. No differences were founded between both groups in labrum injury, Hill-Sachs injury, and bone Bankart lesion (P>.05). Rotator cuff tears were 7.3 times (95% CI; 2.5-21.6) more frequent in the older group (81%) compared to the younger group (P<.05). However, neurological injuries after dislocation were not more frequent in this group. There was no significant difference between the complications after surgery and the age according to the design (P>.05). Conclusions. Anterior recurrent dislocation after forty years of age is usually associated with rotator cuff tears. Arthroscopic treatment of instability was effective with no more postoperative complications (AU)

[Glenohumeral instability in patients over 40 years-old: injuries, treatment and complications]. / Inestabilidad glenohumeral en pacientes mayores de 40 años: lesiones, tratamiento y complicaciones.

INTRODUCTION: Recurrent shoulder dislocation is infrequent after forty years and presents different injuries than younger patients. OBJECTIVE: To compare injuries and complications after surgery between one group older than forty years of age and another younger group. MATERIAL AND METHODS: A review was made o all patients who had undergone arthroscopic surgery due to glenohumeral instability from 1999 until 2011. The mean follow-up was 64 months. The case group consisted of all patients older than 40 years at the time of the surgery (n=21), which was compared with a similar sized control group of randomly selected younger patients (n=27). RESULTS: The mean age in the older group was 54 years (SD 11.86), while it was 26 years (SD 5.80) in the younger group. No differences were founded between both groups in labrum injury, Hill-Sachs injury, and bone Bankart lesion (P>.05). Rotator cuff tears were 7.3 times (95% CI; 2.5-21.6) more frequent in the older group (81%) compared to the younger group (P<.05). However, neurological injuries after dislocation were not more frequent in this group. There was no significant difference between the complications after surgery and the age according to the design (P>.05). CONCLUSIONS: Anterior recurrent dislocation after forty years of age is usually associated with rotator cuff tears. Arthroscopic treatment of instability was effective with no more postoperative complications.

Lesiones vasculares asociadas a luxación de rodilla: protocolo diagnóstico / Vascular injuries associated with dislocation of the knee: diagnosis protocol

Introducción. La luxación de rodilla es una entidad infrecuente. Puede tener consecuencias devastadoras, no solo por las lesiones ligamentosas, sino también por las complicaciones vasculares y nerviosas. Objetivo. Analizar la eficacia de un protocolo para el diagnóstico precoz de lesiones vasculares asociadas a las luxaciones de rodilla. Material y métodos. Se presenta un estudio retrospectivo de las luxaciones de rodilla agudas tratadas entre 1999-2010 con un seguimiento mínimo de 12 meses. Se utilizó un protocolo diagnóstico basado en la exploración física y el índice tobillo-brazo como pruebas de cribado inicial de lesión vascular. Resultados. Se obtuvo una muestra de 10 luxaciones, de las que en un 30% se produjo lesión de la arteria poplítea que fueron diagnosticadas precozmente, recibiendo tratamiento quirúrgico urgente antes de 8 horas. Dos pacientes tuvieron lesiones nerviosas asociadas a la vascular. Ningún caso acabó en amputación. Conclusiones. La utilización sistemática del protocolo ha evitado consecuencias derivadas de un diagnóstico tardío y ha reducido drásticamente el uso abusivo de pruebas invasivas como la arteriografía (AU)

Introduction. Knee dislocation is an unusual condition, and can have catastrophic consequences, such as vascular and neurological complications, in addition to the ligament injuries. Objective. The aim of this study is to analyse the effectiveness of a protocol of early diagnosis of vascular injuries associated with knee dislocations. Materials and methods. A retrospective study was conducted which included acute knee dislocations treated in our institution, with a minimum of 12 months follow-up, between 1999-2010. A diagnostic protocol based on physical examination and ankle-brachial index was used in order to detect vascular injuries. Results. Ten dislocations, 30% with popliteal artery injury, were diagnosed early and received emergency treatment within 8hours. There were associated neurological injuries in two patients. There were no amputations. Conclusions. The systematic use of this protocol has avoided consequences of late diagnosis and has drastically reduced the abusive use of invasive tests, such as arteriography (AU)

[Vascular injuries associated with dislocation of the knee: diagnosis protocol]. / Lesiones vasculares asociadas a luxación de rodilla: protocolo diagnóstico.

INTRODUCTION: Knee dislocation is an unusual condition, and can have catastrophic consequences, such as vascular and neurological complications, in addition to the ligament injuries. OBJECTIVE: The aim of this study is to analyse the effectiveness of a protocol of early diagnosis of vascular injuries associated with knee dislocations. MATERIALS AND METHODS: A retrospective study was conducted which included acute knee dislocations treated in our institution, with a minimum of 12 months follow-up, between 1999-2010. A diagnostic protocol based on physical examination and ankle-brachial index was used in order to detect vascular injuries. RESULTS: Ten dislocations, 30% with popliteal artery injury, were diagnosed early and received emergency treatment within 8 hours. There were associated neurological injuries in two patients. There were no amputations. CONCLUSIONS: The systematic use of this protocol has avoided consequences of late diagnosis and has drastically reduced the abusive use of invasive tests, such as arteriography.