array:24 [
  "pii" => "S2173574313000117"
  "issn" => "21735743"
  "doi" => "10.1016/j.reumae.2013.01.006"
  "estado" => "S300"
  "fechaPublicacion" => "2013-05-01"
  "aid" => "458"
  "copyright" => "Elsevier España, S.L.. All rights reserved"
  "copyrightAnyo" => "2011"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "sco"
  "cita" => "Reumatol Clin. 2013;9:193-4"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 3348
    "formatos" => array:3 [
      "EPUB" => 60
      "HTML" => 2712
      "PDF" => 576
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1699258X12001313"
      "issn" => "1699258X"
      "doi" => "10.1016/j.reuma.2012.04.005"
      "estado" => "S300"
      "fechaPublicacion" => "2013-05-01"
      "aid" => "458"
      "copyright" => "Elsevier España, S.L."
      "documento" => "article"
      "crossmark" => 0
      "subdocumento" => "sco"
      "cita" => "Reumatol Clin. 2013;9:193-4"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 6727
        "formatos" => array:3 [
          "EPUB" => 147
          "HTML" => 5184
          "PDF" => 1396
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Reumatolog&#237;a cl&#237;nica en im&#225;genes</span>"
        "titulo" => "Evoluci&#243;n t&#243;rpida tras fractura humeral proximal"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "193"
            "paginaFinal" => "194"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Poor progression after proximal humerus fracture"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figura 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 921
                "Ancho" => 900
                "Tamanyo" => 61485
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hipercaptaci&#243;n gammagr&#225;fica en h&#250;mero proximal derecho&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Antonio Jim&#233;nez-Mart&#237;n, Francisco Javier Santos-Yubero, Laura Madrigal-Cort&#233;s, Santiago P&#233;rez-Hidalgo"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Antonio"
                "apellidos" => "Jim&#233;nez-Mart&#237;n"
              ]
              1 => array:2 [
                "nombre" => "Francisco Javier"
                "apellidos" => "Santos-Yubero"
              ]
              2 => array:2 [
                "nombre" => "Laura"
                "apellidos" => "Madrigal-Cort&#233;s"
              ]
              3 => array:2 [
                "nombre" => "Santiago"
                "apellidos" => "P&#233;rez-Hidalgo"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173574313000117"
          "doi" => "10.1016/j.reumae.2013.01.006"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574313000117?idApp=UINPBA00004M"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X12001313?idApp=UINPBA00004M"
      "url" => "/1699258X/0000000900000003/v1_201305061538/S1699258X12001313/v1_201305061538/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173574312001281"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2012.07.010"
    "estado" => "S300"
    "fechaPublicacion" => "2013-05-01"
    "aid" => "466"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "sco"
    "cita" => "Reumatol Clin. 2013;9:195-6"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 3077
      "formatos" => array:3 [
        "EPUB" => 55
        "HTML" => 2563
        "PDF" => 459
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>"
      "titulo" => "Camptocormia&#58; Case Presentation"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "195"
          "paginaFinal" => "196"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Camptocormia&#58; a prop&#243;sito de un caso"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Fig&#46; 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 796
              "Ancho" => 900
              "Tamanyo" => 139630
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Axial L4 CT&#46; Selective atrophy of the posterior paravertebral musculature and fat degeneration&#47;substitution &#40;yellow arrows&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Beatriz Tejera, Susana Holgado, Vanessa Calder&#243;n, Ricard P&#233;rez"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Beatriz"
              "apellidos" => "Tejera"
            ]
            1 => array:2 [
              "nombre" => "Susana"
              "apellidos" => "Holgado"
            ]
            2 => array:2 [
              "nombre" => "Vanessa"
              "apellidos" => "Calder&#243;n"
            ]
            3 => array:2 [
              "nombre" => "Ricard"
              "apellidos" => "P&#233;rez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X12001398"
        "doi" => "10.1016/j.reuma.2012.05.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X12001398?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574312001281?idApp=UINPBA00004M"
    "url" => "/21735743/0000000900000003/v1_201307311407/S2173574312001281/v1_201307311407/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S217357431300004X"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2013.01.002"
    "estado" => "S300"
    "fechaPublicacion" => "2013-05-01"
    "aid" => "487"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Reumatol Clin. 2013;9:188-92"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 4789
      "formatos" => array:3 [
        "EPUB" => 73
        "HTML" => 4140
        "PDF" => 576
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Clinicpathologic conference</span>"
      "titulo" => "A Woman With Systemic Lupus Erythematosus and Polyadenopathy"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "188"
          "paginaFinal" => "192"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Mujer con lupus eritematoso sist&#233;mico y poliadenopat&#237;as"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Fig&#46; 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1409
              "Ancho" => 912
              "Tamanyo" => 419065
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Right axillary lymph node biopsy showing a plasmacytoblastic lymphoma under a hematoxylin&#8211;eosin stain&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Mar&#237;a Eugenia G&#243;mez Caballero, Melania Mart&#237;nez-Morillo"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Mar&#237;a Eugenia"
              "apellidos" => "G&#243;mez Caballero"
            ]
            1 => array:2 [
              "nombre" => "Melania"
              "apellidos" => "Mart&#237;nez-Morillo"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X12002124"
        "doi" => "10.1016/j.reuma.2012.06.012"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X12002124?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357431300004X?idApp=UINPBA00004M"
    "url" => "/21735743/0000000900000003/v1_201307311407/S217357431300004X/v1_201307311407/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>"
    "titulo" => "Poor Progression After Proximal Humerus Fracture"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "193"
        "paginaFinal" => "194"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Antonio Jim&#233;nez-Mart&#237;n, Francisco Javier Santos-Yubero, Laura Madrigal-Cort&#233;s, Santiago P&#233;rez-Hidalgo"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "Antonio"
            "apellidos" => "Jim&#233;nez-Mart&#237;n"
            "email" => array:1 [
              0 => "antonio&#95;jimenez10&#64;hotmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">¿</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Francisco Javier"
            "apellidos" => "Santos-Yubero"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Laura"
            "apellidos" => "Madrigal-Cort&#233;s"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Santiago"
            "apellidos" => "P&#233;rez-Hidalgo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio de Cirug&#237;a Ortop&#233;dica y Traumatolog&#237;a&#44; Hospital FREMAP Sevilla&#44; Sevilla&#44; Spain"
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital FREMAP Sevilla&#44; Sevilla&#44; Spain"
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Evoluci&#243;n t&#243;rpida tras fractura humeral proximal"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1411
            "Ancho" => 951
            "Tamanyo" => 60982
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Image of the spacer positioned and centered in height relative to the glenoid&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Proximal humeral osteosynthesis is not without complications &#40;45&#37;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#41;&#46; Infection has a frequency of 0&#37;&#8211;4&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Our objective was to report a case of osteomyelitis&#44; after osteosynthesis and review current treatments&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case Presentation</span><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 54-year-old male with liver disease&#44; allergic to penicillin&#44; presenting a proximal humeral fracture with a cervicodiaphysal angle of 80&#176; and a trochiter ascent of 11<span class="elsevierStyleHsp" style=""></span>mm&#46; Pl osteosynthesis was performed with a Philos plate &#40;Synthes<span class="elsevierStyleSup">&#174;</span>&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The patient began rehabilitation&#44; with a limited arc &#40;60&#176; of active abduction and 50&#176; of anterior active flexion&#41;&#44; fever and wound seroma &#40;ultrasound size&#58; 25<span class="elsevierStyleHsp" style=""></span>mm&#215;12<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; at 2 months and 22 days after the intervention&#44; requiring 2 surgical debridements and the taking of cultures and antibiograms&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0015" class="elsevierStylePara elsevierViewall">Proximal humeral osteomyelitis with stage IV B Cierny&#8211;Mader&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> due to coagulase-negative <span class="elsevierStyleItalic">Staphylococcus</span>&#46; Culture antibiogram indicated susceptibility to penicillin&#44; cephotaxime&#44; erythromycin&#44; tetracycline&#44; levofloxacin&#44; and vancomycin cotrimoxazole&#46; Scintigraphic uptake &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Progression</span><p id="par0020" class="elsevierStylePara elsevierViewall">Given the pathogenic agent&#44; the clinical progression and the increased erythrocyte sedimentation rate &#40;ESR&#58; 140<span class="elsevierStyleHsp" style=""></span>mm&#47;h&#41;&#44; we removed the material and put a spacer cemented with gentamicin &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; We postsurgically started &#40;intravenous &#40;iv&#41;&#41; clindamycin&#46; The patient was under treatment with antibiotics PO&#58; levofloxacin 500<span class="elsevierStyleHsp" style=""></span>mg<span class="elsevierStyleHsp" style=""></span>1&#47;24<span class="elsevierStyleHsp" style=""></span>h vo rifampin 600<span class="elsevierStyleHsp" style=""></span>mg and 1&#47;24<span class="elsevierStyleHsp" style=""></span>h PO for the first 3 months following surgery &#40;considering the sensitivity of the pathogen and the patient&#39;s allergy to penicillin&#41;&#46; Six months after intervention the infection was controlled &#40;ESR&#58; 17<span class="elsevierStyleHsp" style=""></span>mm&#47;h&#41;&#44; with an arc of 100&#176; &#40;flexion&#47;active abduction&#41;&#46; The patient refused to undergo withdrawal of the spacer&#46; One year after surgery&#44; the infection remained controlled&#44; with a similar arc&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">Athwal et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> recommend 3&#46;3 surgical lavages to eradicate the infection&#44; achieving 53 points in the <span class="elsevierStyleItalic">American Shoulder and Elbow Surgeons Score</span> &#40;ASES&#41;&#44; but recurrences of 50&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Seitz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> recommend removing the material&#44; placing a spacer with antibiotics and arthroplasty &#40;although 33&#46;3&#37;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> of patients refuse arthroplasty&#41;&#46; Spacers improve the VAS &#40;8&#46;4&#8211;0&#46;5 points&#41;&#44; for forward flexion &#40;65&#8211;110&#176;&#41; and the ASES Score &#40;16&#8211;74 points&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Themistocleous et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> recommend keeping the spacer&#44; eradicating osteomyelitis in 81&#46;8&#37; of test with a <span class="elsevierStyleItalic">Disabilities of Arm&#44; Shoulder and Hand</span> &#40;DASH&#41; score of 37&#46;5 points&#46; Stine et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> maintain spacers if comorbidity is present&#44; although controlling renal function&#44; due to the risk of kidney failure&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion&#44; in humeral osteomyelitis cases&#44; placement of a cemented spacer may be an effective treatment for infection control&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical disclosures</span><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Protection of human and animal subjects&#46;</span> The authors declare that the procedures followed were in accordance with the regulations of the responsible Clinical Research Ethics Committee and in accordance with those of the World Medical Association and the Helsinki Declaration&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Confidentiality of Data&#46;</span> The authors declare that no patient data appears in this article&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Right to privacy and informed consent&#46;</span> The authors have obtained the informed consent of the patients and &#47;or subjects mentioned in the article&#46; The author for correspondence is in possession of this document&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:7 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Case Presentation"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Diagnosis"
        ]
        3 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Progression"
        ]
        4 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Discussion"
        ]
        5 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Ethical disclosures"
        ]
        6 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Jim&#233;nez-Mart&#237;n A&#44; et al&#46; Evoluci&#243;n t&#243;rpida tras fractura humeral proximal&#46; Reumatol Clin&#46; 2012&#46; <span class="elsevierStyleInterRef" href="doi:10.1016/j.reuma.2012.04.005">http&#58;&#47;&#47;dx&#46;doi&#46;org&#47;10&#46;1016&#47;j&#46;reuma&#46;2012&#46;04&#46;005</span>&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1267
            "Ancho" => 951
            "Tamanyo" => 87132
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Osteosynthesis with plate and screws&#46; Note the impossibility of correction of the initial cervicodiaphysal angle&#44; worsening the mobile arc and predisposing pseudoarthrosis&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 892
            "Ancho" => 900
            "Tamanyo" => 67214
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Scintigraphic uptake in the right proximal humerus&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1411
            "Ancho" => 951
            "Tamanyo" => 60982
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Image of the spacer positioned and centered in height relative to the glenoid&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:9 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute deep infection after surgical fixation of proximal humeral fractures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46;S&#46; Athwal"
                            1 => "J&#46;W&#46; Sperling"
                            2 => "D&#46;M&#46; Rispoli"
                            3 => "R&#46;H&#46; Cofield"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jse.2006.09.021"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Shoulder Elbow Surg"
                        "fecha" => "2007"
                        "volumen" => "16"
                        "paginaInicial" => "408"
                        "paginaFinal" => "412"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17448697"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "complications of operatively treated proximal humeral fractures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;M&#46; Smith"
                            1 => "R&#46;M&#46; Mardones"
                            2 => "J&#46;W&#46; Sperling"
                            3 => "R&#46;H&#46; Cofield"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Early J Shoulder Elbow Surg"
                        "fecha" => "2007"
                        "volumen" => "16"
                        "paginaInicial" => "14"
                        "paginaFinal" => "24"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of glenohumeral sepsis with a commercially produced antibiotic-impregnated cement spacer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;J&#46; Coffey"
                            1 => "E&#46;E&#46; Ely"
                            2 => "L&#46;A&#46; Crosby"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jse.2010.01.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Shoulder Elbow Surg"
                        "fecha" => "2010"
                        "volumen" => "19"
                        "paginaInicial" => "868"
                        "paginaFinal" => "873"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20392651"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A clinical staging system for adult osteomyelitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Cierny 3rd"
                            1 => "J&#46;T&#46; Mader"
                            2 => "J&#46;J&#46; Penninck"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.blo.0000088564.81746.62"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Orthop Relat Res"
                        "fecha" => "2003"
                        "volumen" => "414"
                        "paginaInicial" => "7"
                        "paginaFinal" => "24"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12966271"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An articulating interval spacer in the treatment of an infected total shoulder arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;I&#46; Loebenberg"
                            1 => "J&#46;D&#46; Zuckerman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S1058274604000333"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Shoulder Elbow Surg"
                        "fecha" => "2004"
                        "volumen" => "13"
                        "paginaInicial" => "476"
                        "paginaFinal" => "478"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15220893"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Staged exchange arthroplasty for shoulder sepsis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "W&#46;H&#46; Seitz Jr&#46;"
                            1 => "H&#46; Damacen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Arthroplasty"
                        "fecha" => "2002"
                        "volumen" => "17"
                        "numero" => "Suppl&#46; 1"
                        "paginaInicial" => "36"
                        "paginaFinal" => "40"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12068401"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prolonged implantation of an antibiotic cement spacer for management of shoulder sepsis in compromised patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46; Themistocleous"
                            1 => "C&#46; Zalavras"
                            2 => "I&#46; Stine"
                            3 => "V&#46; Zachos"
                            4 => "J&#46; Itamura"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jse.2007.02.118"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Shoulder Elbow Surg"
                        "fecha" => "2007"
                        "volumen" => "16"
                        "paginaInicial" => "701"
                        "paginaFinal" => "705"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17931905"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of chronic shoulder infections utilizing a fixed articulating antibiotic-loaded spacer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "I&#46;A&#46; Stine"
                            1 => "B&#46; Lee"
                            2 => "C&#46;G&#46; Zalavras"
                            3 => "G&#46; Hatch 3rd"
                            4 => "J&#46;M&#46; Itamura"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jse.2009.10.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Shoulder Elbow Surg"
                        "fecha" => "2010"
                        "volumen" => "19"
                        "paginaInicial" => "739"
                        "paginaFinal" => "748"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20137977"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute renal failure after antibiotic-impregnated bone cement treatment of an infected total knee arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46; Dovas"
                            1 => "V&#46; Liakopoulos"
                            2 => "L&#46; Papatheodorou"
                            3 => "I&#46; Chronopoulou"
                            4 => "V&#46; Papavasiliou"
                            5 => "E&#46; Atmatzidis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Nephrol"
                        "fecha" => "2008"
                        "volumen" => "69"
                        "paginaInicial" => "207"
                        "paginaFinal" => "212"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18397720"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735743/0000000900000003/v1_201307311407/S2173574313000117/v1_201307311407/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "5795"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Images in Clinical Rheumatology"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735743/0000000900000003/v1_201307311407/S2173574313000117/v1_201307311407/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574313000117?idApp=UINPBA00004M"
]
Share
Journal Information
Vol. 9. Issue 3.
Pages 193-194 (May - June 2013)
Visits
8502
Vol. 9. Issue 3.
Pages 193-194 (May - June 2013)
Images in Clinical Rheumatology
Full text access
Poor Progression After Proximal Humerus Fracture
Evolución tórpida tras fractura humeral proximal
Visits
8502
Antonio Jiménez-Martína,
Corresponding author
antonio_jimenez10@hotmail.com

Corresponding author.
, Francisco Javier Santos-Yuberoa, Laura Madrigal-Cortésb, Santiago Pérez-Hidalgoa
a Servicio de Cirugía Ortopédica y Traumatología, Hospital FREMAP Sevilla, Sevilla, Spain
b Servicio de Medicina Interna, Hospital FREMAP Sevilla, Sevilla, Spain
This item has received
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (3)
Show moreShow less
Full Text
Introduction

Proximal humeral osteosynthesis is not without complications (45%1). Infection has a frequency of 0%–4%.2,3 Our objective was to report a case of osteomyelitis, after osteosynthesis and review current treatments.

Case Presentation

The patient was a 54-year-old male with liver disease, allergic to penicillin, presenting a proximal humeral fracture with a cervicodiaphysal angle of 80° and a trochiter ascent of 11mm. Pl osteosynthesis was performed with a Philos plate (Synthes®) (Fig. 1). The patient began rehabilitation, with a limited arc (60° of active abduction and 50° of anterior active flexion), fever and wound seroma (ultrasound size: 25mm×12mm), at 2 months and 22 days after the intervention, requiring 2 surgical debridements and the taking of cultures and antibiograms.

Fig. 1.

Osteosynthesis with plate and screws. Note the impossibility of correction of the initial cervicodiaphysal angle, worsening the mobile arc and predisposing pseudoarthrosis.

(0.08MB).
Diagnosis

Proximal humeral osteomyelitis with stage IV B Cierny–Mader,4 due to coagulase-negative Staphylococcus. Culture antibiogram indicated susceptibility to penicillin, cephotaxime, erythromycin, tetracycline, levofloxacin, and vancomycin cotrimoxazole. Scintigraphic uptake (Fig. 2).

Fig. 2.

Scintigraphic uptake in the right proximal humerus.

(0.06MB).
Progression

Given the pathogenic agent, the clinical progression and the increased erythrocyte sedimentation rate (ESR: 140mm/h), we removed the material and put a spacer cemented with gentamicin (Fig. 3). We postsurgically started (intravenous (iv)) clindamycin. The patient was under treatment with antibiotics PO: levofloxacin 500mg1/24h vo rifampin 600mg and 1/24h PO for the first 3 months following surgery (considering the sensitivity of the pathogen and the patient's allergy to penicillin). Six months after intervention the infection was controlled (ESR: 17mm/h), with an arc of 100° (flexion/active abduction). The patient refused to undergo withdrawal of the spacer. One year after surgery, the infection remained controlled, with a similar arc.

Fig. 3.

Image of the spacer positioned and centered in height relative to the glenoid.

(0.06MB).
Discussion

Athwal et al.1 recommend 3.3 surgical lavages to eradicate the infection, achieving 53 points in the American Shoulder and Elbow Surgeons Score (ASES), but recurrences of 50%.5 Seitz et al.6 recommend removing the material, placing a spacer with antibiotics and arthroplasty (although 33.3%3 of patients refuse arthroplasty). Spacers improve the VAS (8.4–0.5 points), for forward flexion (65–110°) and the ASES Score (16–74 points).3 Themistocleous et al.7 recommend keeping the spacer, eradicating osteomyelitis in 81.8% of test with a Disabilities of Arm, Shoulder and Hand (DASH) score of 37.5 points. Stine et al.8 maintain spacers if comorbidity is present, although controlling renal function, due to the risk of kidney failure.3,9

In conclusion, in humeral osteomyelitis cases, placement of a cemented spacer may be an effective treatment for infection control.

Ethical disclosures

Protection of human and animal subjects. The authors declare that the procedures followed were in accordance with the regulations of the responsible Clinical Research Ethics Committee and in accordance with those of the World Medical Association and the Helsinki Declaration.

Confidentiality of Data. The authors declare that no patient data appears in this article.

Right to privacy and informed consent. The authors have obtained the informed consent of the patients and /or subjects mentioned in the article. The author for correspondence is in possession of this document.

References
[1]
G.S. Athwal, J.W. Sperling, D.M. Rispoli, R.H. Cofield.
Acute deep infection after surgical fixation of proximal humeral fractures.
J Shoulder Elbow Surg, 16 (2007), pp. 408-412
[2]
A.M. Smith, R.M. Mardones, J.W. Sperling, R.H. Cofield.
complications of operatively treated proximal humeral fractures.
Early J Shoulder Elbow Surg, 16 (2007), pp. 14-24
[3]
M.J. Coffey, E.E. Ely, L.A. Crosby.
Treatment of glenohumeral sepsis with a commercially produced antibiotic-impregnated cement spacer.
J Shoulder Elbow Surg, 19 (2010), pp. 868-873
[4]
G. Cierny 3rd, J.T. Mader, J.J. Penninck.
A clinical staging system for adult osteomyelitis.
Clin Orthop Relat Res, 414 (2003), pp. 7-24
[5]
M.I. Loebenberg, J.D. Zuckerman.
An articulating interval spacer in the treatment of an infected total shoulder arthroplasty.
J Shoulder Elbow Surg, 13 (2004), pp. 476-478
[6]
W.H. Seitz Jr., H. Damacen.
Staged exchange arthroplasty for shoulder sepsis.
J Arthroplasty, 17 (2002), pp. 36-40
[7]
G. Themistocleous, C. Zalavras, I. Stine, V. Zachos, J. Itamura.
Prolonged implantation of an antibiotic cement spacer for management of shoulder sepsis in compromised patients.
J Shoulder Elbow Surg, 16 (2007), pp. 701-705
[8]
I.A. Stine, B. Lee, C.G. Zalavras, G. Hatch 3rd, J.M. Itamura.
Management of chronic shoulder infections utilizing a fixed articulating antibiotic-loaded spacer.
J Shoulder Elbow Surg, 19 (2010), pp. 739-748
[9]
S. Dovas, V. Liakopoulos, L. Papatheodorou, I. Chronopoulou, V. Papavasiliou, E. Atmatzidis.
Acute renal failure after antibiotic-impregnated bone cement treatment of an infected total knee arthroplasty.
Clin Nephrol, 69 (2008), pp. 207-212

Please cite this article as: Jiménez-Martín A, et al. Evolución tórpida tras fractura humeral proximal. Reumatol Clin. 2012. http://dx.doi.org/10.1016/j.reuma.2012.04.005.

Copyright © 2011. Elsevier España, S.L.. All rights reserved
Download PDF
Idiomas
Reumatología Clínica (English Edition)
Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?