Hemangioendotelioma epiteloide óseo multicentrico : a propósito de un caso

El Hemangioendotelioma epiteloide óseo (HEEO) es un tumor vascular, infrecuente, con apariencia epiteloide que si no se conoce, puede confundirse con un carcinoma metastásico. Presentamos un caso de HEEO que por las características clínicas del paciente, se podría confundir con lesiones metastásicas de un carcinoma de origen desconocido. Se han descrito pocos casos de HEEO. Clínicamente el tumor cursa con un crecimiento lento y aunque el comportamiento es benigno, se han descrito metástasis a diversos niveles. Suele ser de loralización multicéntrica, teniendo especial predilección en los huesos de una extremidad. Esta característica hace necesaria una cirugía radical en estos pacientes. En nuestro caso el tratamiento realizado, aunque agresivo, fue efectivo, ya que el paciente ha vuelto a su actividad normal, una vez implantada la ortesis.The epitheloid hemangioendothelioma of bone is an infrequent vascular tumor which can be often mistaken for a metastatic carcinoma. We report a case mistaken for a metastatic carcinoma of unknown origin due to the clinical characteristics of the patient. To date, few cases of epitheloid hemangioendothelioma of bone have been described. The tumor shows a low growth rate. Although the tumor has a benign behavior, cases with metastatic spreadming have been reported. Often the tumor is multicentric with special affinitty for the bones of the extremities. This fact allows radial surgery as the best treatment choice. In our case the treatment, supracondylar amputation, was aggresive but effective, since the patient returned to his daily activities after application of the orthesis

Percutaneous suction and irrigation for the treatment of recalcitrant pyogenic spondylodiscitis.

The primary management of pyogenic spondylodiscitis is conservative. Once the causative organism has been identified, by blood culture or biopsy, administration of appropriate intravenous antibiotics is started. Occasionally patients do not respond to antibiotics and surgical irrigation and debridement is needed. The treatment of these cases is challenging and controversial. Furthermore, many affected patients have significant comorbidities often precluding more extensive surgical intervention. The aim of this study is to describe early results of a novel, minimally invasive percutaneous technique for disc irrigation and debridement in pyogenic spondylodiscitis.This article is freely available via Open Access. Click on the Additional Link above to access the full-text via the publisher's sit

Pin-site care: can we reduce the incidence of infections?

Background: This study was conducted to determine the pin-site care protocols currently in use and to analyse their effectiveness and outcomes. Methods: PubMed, the Cochrane Library and Embase databases were screened for manuscripts that described comparative studies of different methods of pin-site care and referred to complications related to any kind of external fixator application. Results: A total of 369 manuscripts were screened and only 13 of these met the inclusion criteria evaluating different protocols of pin-site care. This review is based on a total of 574 patients. Infection rates were very variable depending on the type of implant used and the protocol of pin-site care applied. Conclusions: None of the different protocols of pin-site care that were evaluated in this study were associated with a 0% infection rate. There is currently no consensus in the international literature about which protocol should be applied universally. Meticulous surgical technique during pin insertion and implementation of one of the existing protocols of pin-site care are the mainstay of prevention and/or reduction of the incidence of pin-site infections

Should concurrent viral (including COVID-19) or bacterial infections be treated before performing surgery for hip fracture?

Aims: A systematic literature review focusing on how long before surgery concurrent viral or bacterial infections (respiratory and urinary infections) should be treated in hip fracture patients, and if there is evidence for delaying this surgery. Methods: A total of 11 databases were examined using the COre, Standard, Ideal (COSI) protocol. Bibliographic searches (no chronological or linguistic restriction) were conducted using, among other methods, the Patient, Intervention, Comparison, Outcome (PICO) template. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for flow diagram and checklist. Final reading of the complete texts was conducted in English, French, and Spanish. Classification of papers was completed within five levels of evidence (LE). Results: There were a total of 621 hits (526 COre; 95 Standard, Ideal) for screening identification, and 107 records were screened. Overall 67 full-text articles were assessed for eligibility, and 21 articles were included for the study question. A total of 46 full-text articles were excluded with reasons. No studies could be included in quantitative synthesis (meta-analyses), and there were many confounding variables including surgeons' experience, prosthesis models used, and surgical technique. Conclusion: Patients with hip fracture and with a viral infection in the upper respiratory tract or without major clinical symptoms should be operated on as soon as possible (LE: I-III). There is no evidence that patients with coronavirus disease 2019 (COVID-19) should be treated differently. In relation to pneumonia, its prevention is a major issue. Antibiotics should be administered if surgery is delayed by > 72 hours or if bacterial infection is present in the lower respiratory tract (LE: III-V). In patients with hip fracture and urinary tract infection (UTI), delaying surgery may provoke further complications (LE: I). However, diabetic or immunocompromised patients may benefit from immediate antibiotic treatment. Cite this article: Bone Joint Res 2020;9(12):884-893.Ye