Treatment of intraarticular calcaneal fractures by reconstruction plate. Results and complications of 86 fractures. / Tratamiento de las fracturas intraarticulares de calcáneo mediante placa de reconstrucción. Resultados y complicaciones de 86 fracturas.

OBJECTIVE: To evaluate the results of surgical treatment of intraarticular calcaneal fractures, and also to analyze the variables that influence the final clinical and radiological outcomes as well as the complications. MATERIAL AND METHODS: We retrospectively analyzed 86 intraarticular calcaneal fractures in 78 patients, who underwent surgery with an extended lateral approach and reconstruction plate. The mean age was 48 years (16-74 years) and the mean follow-up was 4.6 years (9-99 months); 54 patients (69.2%) suffered falls from less than 3m in height or banal injuries and 24 patients (30.8%) falls from more than 3m in height or high energy-accidents. According to the Sanders classification we operated 12 (15%) typeII, 54 (62.8%) typeIII and 20 (23.2%) typeIV fractures. RESULTS: The postoperative mean AOFAS score was 73.9 points, with good or excellent results in 57% of the patients. Twelve cases (14%) suffered surgical wound complications and 11 (12.8%) required subtalar arthrodesis. Significantly better results were obtained in the patients younger than 30 years old, patients that fell from less than 3m in height and patients with Sanders fractures types II and III compared to typeIV, which were associated with higher rate of subtalar arthrodesis. CONCLUSIONS: We consider that open reduction and internal fixation of intraarticular fractures of the calcaneus with reconstruction plate is a valid treatment alternative. Given the complications described and the secondary subtalar arthrodesis rate, we recommend a meticulous technique carried out by experienced surgeons.

Tratamiento de las fracturas de húmero proximal en pacientes mayores de 65 años con prótesis inversa: resultados y complicaciones / Reverse shoulder arthroplasty in 3 and 4 part proximal humeral fractures in patients aged more than 65 years: results and complications

Introducción. El tratamiento de las fracturas en 3 y 4 fragmentos de húmero proximal en el paciente anciano resulta controvertido. La frecuente coexistencia de un hueso de mala calidad y la afección del manguito rotador con dificultades para el tratamiento rehabilitador en pacientes pluripatológicos conlleva, en muchas ocasiones, resultados clínicos decepcionantes, aun cuando el resultado radiológico sea aceptable. Objetivo. Evaluar los resultados clínicos, radiológicos y funcionales obtenidos en el tratamiento de las fracturas de húmero proximal complejas con prótesis inversa en pacientes mayores de 65 años de nuestro servicio. Material y métodos. Revisión prospectiva en la que incluimos a 30 pacientes con fractura de húmero proximal intervenidos en nuestro servicio con prótesis total inversa de hombro. De ellos, 26 eran mujeres y 4 hombres. La edad media fue de 74,9 años (DE=6,6). El seguimiento medio fue de 34,5 meses (DE=19,3). Resultados. El resultado clínico y funcional ha sido aceptable, con una antepulsión activa media de 124° y una rotación externa media de 13°. La puntuación media en la escala abreviada de Constant fue de 49,1 puntos (DE=14,1), en la escala UCLA fue de 27 puntos (SD=6,3) y en el cuestionario QuickDASH de 32,2 puntos (DE=19,2). El 80% de los pacientes están libres de dolor sin precisar analgesia para la realización de sus actividades habituales. El 95% de los pacientes estaban satisfechos o muy satisfechos tras la intervención. La tasa de complicaciones fue del 13,3%. Conclusiones. Consideramos la artroplastia total inversa como una opción válida en el tratamiento de las fracturas en 3 y 4 fragmentos de húmero proximal en pacientes mayores de 65 años. Los objetivos de la cirugía deben incluir la reconstrucción anatómica de las tuberosidades, evitando incrementos de la longitud del miembro intervenido superiores a 2cm (AU)

Introduction. The treatment of 3 and 4 part proximal humeral fractures in elderly patients is still controversial. The frequent co-existence of poor quality bone and rotator cuff abnormalities in patients with multiple clinical conditions and with difficulties for physical rehabilitation leads to disappointing clinical results, even when the radiological images are acceptable. Objective. To evaluate the clinical, radiological, and functional results in patients over 65 years old with complex proximal humerus fractures treated with reverse shoulder arthroplasty. Material and methods. A prospective review was carried out on 30 patients (26 women and 4 men) with proximal humeral fractures treated with reverse shoulder arthroplasty in our department. The mean age was 74.9 years (SD=6.3), and the mean follow-up was 34.5 months (SD=19.3). Results. Clinical and functional results were acceptable, with a mean forward flexion of 124° and a mean external rotation of 13°. The mean abbreviated Constant abbreviated score was 49.1 (SD=14.1), 27 (SD=6.3) in the UCLA scale, and 32.2 (SD=19.2) in the QuickDASH questionnaire. The large majority (80%) of the patients are pain free, and they do not need medication to do daily activities. The complication rate was 13.3%. Conclusions. We consider that reverse shoulder arthroplasty is a valid option to treat 3and 4 part proximal humeral fractures in elderly patients. The surgical goals should include the anatomical reconstruction of the tuberosities, avoiding enlargement of the operated arm greater than 2cm (AU)

Reverse shoulder arthroplasty in 3 and 4 part proximal humeral fractures in patients aged more than 65 years: Results and complications. / Tratamiento de las fracturas de húmero proximal en pacientes mayores de 65 años con prótesis inversa: resultados y complicaciones.

INTRODUCTION: The treatment of 3and 4 part proximal humeral fractures in elderly patients is still controversial. The frequent co-existence of poor quality bone and rotator cuff abnormalities in patients with multiple clinical conditions and with difficulties for physical rehabilitation leads to disappointing clinical results, even when the radiological images are acceptable. OBJECTIVE: To evaluate the clinical, radiological, and functional results in patients over 65 years old with complex proximal humerus fractures treated with reverse shoulder arthroplasty. MATERIAL AND METHODS: A prospective review was carried out on 30 patients (26 women and 4 men) with proximal humeral fractures treated with reverse shoulder arthroplasty in our department. The mean age was 74.9 years (SD=6.3), and the mean follow-up was 34.5 months (SD=19.3). RESULTS: Clinical and functional results were acceptable, with a mean forward flexion of 124° and a mean external rotation of 13°. The mean abbreviated Constant abbreviated score was 49.1 (SD=14.1), 27 (SD=6.3) in the UCLA scale, and 32.2 (SD=19.2) in the QuickDASH questionnaire. The large majority (80%) of the patients are pain free, and they do not need medication to do daily activities. The complication rate was 13.3%. CONCLUSIONS: We consider that reverse shoulder arthroplasty is a valid option to treat 3and 4 part proximal humeral fractures in elderly patients. The surgical goals should include the anatomical reconstruction of the tuberosities, avoiding enlargement of the operated arm greater than 2cm.

Skin Abscess due to Serratia marcescens in an Immunocompetent Patient after Receiving a Tattoo.

The incidence of skin infections caused by Serratia marcescens is extremely low and such infections are typically observed in immunocompromised patients. The clinical manifestations of these infections include cellulitis, abscesses, fluctuant nodules, or granulomatous lesions. Infections caused by S. marcescens are very difficult to treat due to their resistance to many antibiotics, which often leads to specific and prolonged treatment. Infections after receiving a tattoo are very rare and are caused by unhygienic conditions or the inexperience of the tattooist. In this paper we present the case of a 32-year-old male with no comorbidity, who presented an abscess caused by S. marcescens in a area that was tattooed one month earlier. The case was resolved with surgery and antimicrobial therapy that was based on the antibiogram. To our knowledge, this is the first reported case of a S. marcescens skin infection following a tattoo, in the absence of immunosuppression.