Antimicrobial resistance in Aeromonas species isolated from aquatic environments in Brazil.

AIM: The current study was conducted to determine the antimicrobial resistance profile and genetic relatedness of Aeromonas sp. isolated from healthcare and urban effluents, wastewater treatment plant (WWTP) and river water. METHODS AND RESULTS: We detected the presence of genes conferring resistance to ß-lactam, quinolone and aminoglycoside. Multilocus sequence typing was carried out to differentiate the strains, and multilocus phylogenetic analysis was used to identify the species. A total of 28 cefotaxime-resistant Aeromonas sp. strains were identified, harbouring uncommon Guiana-extended-spectrum (GES)-type ß-lactamases (GES-1, GES-5, GES-7 and GES-16). Multidrug-resistant Aeromonas sp. were found in hospital wastewater, WWTP and sanitary effluent, and A. caviae was identified as the most prevalent species (85·7%). CONCLUSION: The release of untreated healthcare effluents, presence of antimicrobials in the environment, in addition to multidrug-resistant Aeromonas sp., are all potential factors for the spread of resistance. SIGNIFICANCE AND IMPACT OF THE STUDY: We identified a vast repertoire of antimicrobial resistance genes (ARG) in Aeromonas sp. from diverse aquatic ecosystems, including those that encode enzymes degrading broad-spectrum antimicrobials widely used to treat healthcare-associated infections. Hospital and sanitary effluents serve as potential sources of bacteria harbouring ARG and are a threat to public health.

Chromosome evolution in dendropsophini (Amphibia, Anura, Hylinae).

Dendropsophini is the most species-rich tribe within Hylidae with 234 described species. Although cytogenetic information is sparse, chromosome numbers and morphology have been considered as an important character system for systematic inferences in this group. Using a diversity of standard and molecular techniques, we describe the previously unknown karyotypes of the genera Xenohyla, Scarthyla and Sphaenorhynchus and provide new information on Dendropsophus and Lysapsus. Our results reveal significant karyotype diversity among Dendropsophini, with diploid chromosome numbers ranging from 2n = 22 in S. goinorum, 2n = 24 in Lysapsus, Scinax, Xenohyla, and almost all species of Sphaenorhynchus and Pseudis, 2n = 26 in S. carneus, 2n = 28 in P. cardosoi, to 2n = 30 in all known Dendropsophus species. Although nucleolar organizer regions (NORs) and C-banding patterns show a high degree of variability, NOR positions in 2n = 22, 24 and 28 karyotypes and C-banding patterns in Lysapsus and Pseudis are informative cytological markers. Interstitial telomeric sequences reveal a diploid number reduction from 24 to 22 in Scarthyla by a chromosome fusion event. The diploid number of X. truncata corroborates the character state of 2n = 30 as a synapomorphy of Dendropsophus.

Influence of KIR genes and their HLA ligands in susceptibility to dengue in a population from southern Brazil.

Killer cell immunoglobulin-like receptors (KIR) form a group of regulatory molecules that specifically recognise human leukocyte antigen (HLA) class I molecules, modulating the cytolytic activity of natural killer cells. The purpose of this study was to investigate the influence of KIR genes and their class I HLA ligands in susceptibility to dengue fever in a population from southern Brazil through a case-control study. One hundred four subjects with confirmed diagnoses of dengue participated in this study, along with a control group of 172 individuals from the same geographic area. HLA and KIR genotyping was performed by polymerase chain reaction with sequence-specific oligonucleotide probes (PCR-SSOP) and with sequence-specific primer (PCR-SSP) techniques, respectively. Data analysis showed significant differences for the KIR2DS1 (54.8% vs 40.7%, P = 0.03), KIR2DS5 (50.0% vs 36.0%, P = 0.03) and KIR2DL5 (76.0% vs 56.4%, P = 0.001) genes. With regard to KIR-ligand pairs, positive associations with dengue were observed in KIR3DS1-Bw4 (45.2% vs 29.7%, P = 0.01), KIR3DL1-Bw4 (80.7% vs 65.1%, P < 0.001), KIR2DL1-C2 (75.0% vs 62.2%, P = 0.03) and KIR2DS1-C2 (40.4% vs 25.6%, P = 0.01) interactions, and a negative association in KIR2DL3-C1/C1 (18.2% vs 33.1%, P = 0.01). Furthermore, the analysis of KIR haplogroups showed a possible protective factor against dengue fever in individuals with the AA genotype. Taken together, these results suggest the existence of genetic predisposition to dengue fever in the population from southern Brazil.

Use of microsatellite markers in molecular analysis of segregating populations of papaya (Carica papaya L.) derived from backcrossing.

Brazil is the world leader in papaya production. However, only a small number of cultivars are registered for commercial planting, mainly owing to delays in obtaining cultivars and the high costs of the field phase of breeding programs. These costs can be reduced when molecular tools are combined with conventional breeding methods. In the present study, we conducted a molecular analysis of a self-fertilized population of a first backcrossing generation of BC1S1 papaya plants via microsatellite markers both to monitor the level of homozygosity and the gene/allele transfer that confers the Golden trait (fruit color) and to assess the parental genomic proportion in the genotypes studied. Based on the analysis of 20 polymorphic microsatellite loci, 19 genotypes with the Golden trait belonging to BC1S1 were evaluated in addition to the parental genotypes. Genetic distance was estimated through weighted index. The genotypes were then grouped using the hierarchical nearest neighbor method, and the analysis of principal coordinates was used to measure the proportion of parental genomes in the segregating genotypes. The mean value of the inbreeding coefficient was 0.36. The analysis of the principal coordinates revealed that on average, 64% of the recurrent parent genome was present in the population. Together, the analyses allowed the selection of 3 individuals for the next backcross cycle (33BC1S1-18, 34BC1S1-16, and 37BC1S1-10). These individuals had a higher proportion of the recurrent parent and were grouped close to the recurrent parent in the cluster analysis.

EGL-36 Shaw channels regulate C. elegans egg-laying muscle activity.

The C. elegans egl-36 gene encodes a Shaw-type potassium channel that regulates egg-laying behavior. Gain of function [egl-36(gf)] and dominant negative [egl-36(dn)] mutations in egl-36 cause reciprocal defects in egg laying. An egl-36::gfp reporter is expressed in the egg-laying muscles and in a few other tissues. Expression of an egl-36(gf) cDNA in the egg-laying muscles causes behavioral defects similar to those observed in egl-36(gf) mutants. Gain of function EGL-36 subunits form channels that are active at more negative potentials than wild-type channels. The egl-36(gf) alleles correspond to missense mutations in an amino terminal subunit assembly domain (E138K) and in the S6 transmembrane domain (P435S), neither of which were previously implicated in the voltage dependence of channel activation. Altogether, these results suggest that EGL-36 channels regulate the excitability of the egg-laying muscles.

Primary cerebral fibrosarcoma in a child.

OBJECTIVE: To describe the case of a primary cerebral fibrosarcoma in a child. CLINICAL CASE: A 6-year-old boy presented with a history of headache, drowsiness, vomiting and seizures. He was referred to our institution and died shortly upon arrival to the ER. The autopsy revealed a large left frontoparietal mass with histopathologic features characteristic of fibrosarcoma. Immunohistochemical and ultrastructural studies allowed the exclusion of other mimickers such as meningiomas, and neoplasms of glial or neuronal origin. No other growths were found in the CNS or in other parts of the body. CONCLUSIONS: Brain fibrosarcoma is an exceedingly uncommon tumor. Only 41 cases have been reported to date. The diagnosis of fibrosarcoma must be based on the identification of a predominant herringbone architectural pattern, and immunohistochemical features, although the latter are of limited diagnostic value, its importance being that they facilitate the exclusion of other entities considered in the differential diagnosis.

[Osteosynthesis with locking plate and minimally invasive technique for proximal humeral fractures]. / Osteosíntesis con placa bloqueada y técnica de mínima invasión para las fracturas de húmero proximal.

OBJECTIVE: To report our experience in the treatment of 2-3 fragment proximal humeral fractures using a minimally invasive technique that involves an angular-stable locking implant and find out the factors affecting patients outcomes. MATERIAL AND METHODS: Descriptive, prospective study of the case series type. Twenty-two patients, 13 females and 9 males, were operated on between February 2010 and August 2012. Mean age was 50.8 years (24-82 years). Patients were placed in a beach-chair position. A lateral acromial approach was used under fluoroscopic guidance. Minimal follow-up period was 24.3 months (11-32). Follow-up consisted of X-ray review to check for bone healing and avascular necrosis, and functional assessment using the Constant-Murley scale. RESULTS: Bone healing occurred in all cases at 6 months. There were no cases of avascular necrosis. Two patients had varus healing (109º), and two had plate impingement. The functional assessment score according to the Constant-Murley scale was 68.8. There were no associated neurologic lesions. CONCLUSIONS: Fixation of proximal humeral fractures with a minimally invasive technique using locking plates represents a valid surgical approach. The avascular necrosis rate was low and early rehabilitation was possible in patients with poor bone quality.

OBJETIVO: Dar a conocer nuestra experiencia en el tratamiento de las fracturas de húmero proximal de 2 a 3 partes con técnica de mínima invasión mediante el uso de un implante con estabilidad angular bloqueado e investigar los factores que afectan los resultados de los pacientes. MATERIAL Y MÉTODOS: Estudio descriptivo y prospectivo tipo serie de casos. De 22 pacientes fueron intervenidos 13 mujeres y nueve hombres en el período comprendido entre Febrero de 2010 y Agosto de 2012. El rango de edad media fue 50.8 años (24-82 años). Se hizo un abordaje acromial lateral con el paciente en posición de silla de playa bajo visión fluoroscópica. El tiempo de seguimiento mínimo fue de 24.3 meses (11-32). El seguimiento se hizo mediante revisión de radiografías para la consolidación y necrosis avascular y la valoración funcional de la escala de Constant. RESULTADOS: En todos los casos se observó consolidación de la fractura a los seis meses. No se detectaron casos con necrosis avascular. Dos pacientes mostraron consolidación en varo (109o). Dos pacientes presentaron pinzamiento por la placa. El resultado funcional según la escala de valoración de Constant-Murley fue de 68.8 puntos. No hubo lesiones neurológicas asociadas. CONCLUSIONES: La fijación con técnica mínimamente invasiva para las fracturas de húmero proximal con placas bloqueadas es una alternativa válida como tratamiento quirúrgico. La incidencia de necrosis avascular fue baja y se permitió una rehabilitación temprana en pacientes de mala calidad ósea.

[Surgical treatment of subtrochanteric fractures in children]. / Tratamiento quirúrgico de fracturas subtrocantéricas en niños.

Subtrochanteric fractures in children are rare events, occur in only 4% of all femur fractures, most injuries occur as a result of high energy trauma, being young males patient the most affected. The management of this type of injury is controversial, there are many forms of treatment, including the use of plaster spica 90-90, closed reduction and use of elastic or rigid intramedullary nails, open reduction and plate placement and external fixators. Most suggest that children under 10 should be preferred non-operative and for older than 12 surgical management is indicated, but the discussion is between 6 and 12 years old. Through this article we present the treatment of such entity with a proximal fracture plate using a minimally invasive technique.

Las fracturas subtrocantéricas en niños son eventos poco frecuentes que se presentan en sólo 4% de todas las fracturas de fémur, la mayoría de lesiones ocurren como resultado de traumas de alta energía, siendo el paciente joven de sexo masculino el más afectado. El manejo de este tipo de lesión es controversial, existen muchas modalidades de tratamiento como el uso de espica de yeso en 90-90, reducción cerrada y uso de clavos elásticos o rígidos endomedulares, reducción abierta y fijación con placas y finalmente, el uso de fijadores externos. La mayoría propone que para niños menores de 10 años debe preferirse el manejo no quirúrgico y en mayores el manejo quirúrgico, pero la discusión se produce entre los 6 y 12 años de edad, período en el que radica la mayor parte de la polémica. En la actualidad tratamos este tipo de fracturas en el hospital universitario mediante técnica de mínima incisión con placa autobloqueada para fémur proximal en niños con buenos resultados.

[Subtrochanteric fracture in children treated with minimally invasive surgery: case report]. / Fractura subtrocantérica en niños manejada con cirugía de mínima invasión: Reporte de casos.

Subtrochanteric fractures in children are rare events that occur in only 4% of all femur fractures; most injuries occur as a result of high-energy trauma, being young male patients the most affected. The management of this type of injury is controversial; there are many forms of treatment, including the use of plaster spica 90-90, closed reduction and use of elastic or rigid intramedullary nails, open reduction and plate placement, and the use of external fixators. Most suggest that for children under 10 a nonoperative approach should be preferred and that older ones should be managed surgically, but it is between six and 12-year-olds that most of the controversy exists. In this article, we present the management of this entity with a proximal fracture plate using a minimally invasive technique.

Las fracturas subtrocantéricas en niños son eventos poco frecuentes que se presentan en solo 4% de todas las fracturas de fémur; la mayoría de las lesiones ocurren como resultado de traumas de alta energía, siendo el paciente joven de sexo masculino el más afectado. El manejo de este tipo de lesión es controversial; existen muchas modalidades de tratamiento, como el uso de espica de yeso en 90-90, reducción cerrada y uso de clavos elásticos o rígidos endomedulares, reducción abierta y fijación con placas y, finalmente, el uso de fijadores externos. La mayoría proponen que para niños menores de 10 años, se debe preferir el manejo no quirúrgico y en mayores, el manejo quirúrgico, pero la discusión se produce entre los seis y 12 años de edad, en donde está la mayor parte de la polémica. En la actualidad, en el Hospital Universitario de Santander, tratamos este tipo de fracturas mediante técnica de mínima incisión con placa autobloqueada para fémur proximal en niños, con buenos resultados.

[Prevalence and frequency of factors associated with infection in patients older than 18 years with closed fractures]. / Prevalencia y frecuencia de factores asociados a infección en pacientes mayores de 18 años con fracturas cerradas.

INTRODUCTION: Surgical site infection (ISO) is the most common nosocomial infection and is a process associated with multiple factors, which together generate a condition that directly affects the welfare of the patient. MATERIAL AND METHODS: Cross-sectional study, conducted over 1 year period, the sample size was established for all patients who met the inclusion criteria. An instrument takes the variables; double tabulation of patients is performed in Excel 2013 and data are analyzed in Stata version 11. RESULTS: The average age was 44.3 ± 18.8 years and the male: female ratio is 1.7:1. Clinical features, lower limbs are the most affected and 21.9 % of cases affect the femur. A prevalence of 6.6 % was found, being the most common deep infection classification. Staphylococcus aureus was cultured in 38.5% of which 40% were methicillin sensible. CONCLUSION: ISO prevalence in patients with closed fractures in HUS is 6.6% higher compared with literature data. The findings of this study it was established that hemoglobin below 10 g/dl, transfusion, reoperation and surgical risk ASA were associated statistically with ISO.

La infección de sitio operatorio (ISO) es la infección nosocomial más común y es un proceso asociado a múltiples factores, los cuales en conjunto generan una alteración que afecta directamente el bienestar del paciente.

Midbrain dopaminergic neurons from postnatal rat in long-term primary culture.

Midbrain dopamine neurons project extensively throughout the vertebrate forebrain and influence a wide variety of brain functions. These neurons, which are believed to form a major brain reward system, are involved in initiation and control of motor programs, addictive behaviors, and determination of mood. Given their critical role in behavioral function, relatively little is known about their fundamental cellular physiological and pharmacological properties. A long-term dissociated culture system for postnatal rat dopamine neurons was developed to permit both acute and chronic studies of these cells. Dopamine neurons were dissociated from slices of ventral midbrain from neonatal rat pups and maintained in cell culture for several months. The dopaminergic phenotype was confirmed by catecholamine fluorescence and by tyrosine hydroxylase immunocytochemistry. After four weeks in culture, dopamine neurons had cell bodies 10-40 microns in diameter, displayed either fusiform or multipolar morphology, and had processes with varicosities of 0.5-2 microns in diameter. Electrophysiological recordings were made from 71 dopamine neurons identified by 5,7-dihydroxytryptamine fluorescence after six to 67 days in culture. The neurons had resting potentials of -51 +/- 5 mV, broad action potentials with durations of 2.9 +/- 1.3 ms, and the majority of the neurons (65%) displayed anomalous rectification. Most dopamine neurons in culture fired spontaneously in a pacemaker-like manner with a frequency of 2.3 +/- 1.3 Hz, or in a bursting pattern, typically having two to seven action potentials per burst. All neurons tested had glutamate and gamma-aminobutyric acid receptors, and 90% of neurons responded to dopamine or quinpirole with inhibition of firing, suggesting the presence of dopamine autoreceptors. Some neurons were inhibited by concentrations of quinpirole as low as 10 nM. The results show that midbrain dopamine neurons can be maintained in dissociated cell culture for periods of several months. These neurons can be identified prior to electrophysiological recording, and they express many of the physiological characteristics that have been reported for midbrain dopamine neurons in vivo.

Solitary fibrous tumor of the meninges.

Intracranial fibrous tumors are unusual growths that occur almost exclusively in young individuals. Most of these lesions are intra-axial, however, on extremely rare occasions they arise from the leptomeninges and compress the adjacent brain. The authors report the case of a benign solitary fibrous tumor of the meninges in a 14-year-old girl who presented with a 5-month history of generalized headaches. NMR imaging displayed a left parietal mass, which mimicked a meningioma.

Extraventricular cerebral anaplastic ependymomas.

BACKGROUND: Anaplastic ependymomas are considered to be uncommon cerebral tumors by most authors. We have had the opportunity to study 34 cases of such lesions in 13 years. METHODS: 34 cases of anaplastic ependymoma operated in different hospitals of Maracaibo, Venezuela, during the period of 1983-1995 were analyzed. Cases of ependymoblastoma were excluded. RESULTS: Adult patients made up most of the present series. All patients harbored supratentorial growths in locations distant from the ventricular system. The microscopic pattern was of limited value to establish prognosis, for there was no constant correlation between the histologic features and tumor relapse; only in sporadic cases in which high cell density and conspicuous mitotic activity were maximally expressed, did tumor relapse occur shortly after removal of the lesion. CONCLUSION: This type of paradoxical behavior being the rule makes all attempts at predicting prognosis in these entities a disappointing task.

[Causes of dementia in Maracaibo, Venezuela: a re-evaluation]. / Reevaluación de las causas de demencia en Maracaibo, Venezuela.

INTRODUCTION AND OBJECTIVES: In a previous report we analyzed the causes of dementia in an autopsy population from four hospitals of Maracaibo, Venezuela. Our results showed that vascular dementia (VD) accounted for 86.7% of all clinically diagnosed demented patients, whereas no cases of Alzheimer's disease (AD) were neuropathologically demonstrated. Six years later, we undertook a similar study, in order to re-evaluate the frequency of the different causes of dementia in our country. MATERIAL AND METHODS: We studied 611 adult brains obtained from autopsies performed during the period 1992-1998; 39 of these came from clinically demented patients. RESULTS: Vascular dementia was disclosed in 33 cases (84.6%), five cases (12.82%) showed evidence of specific causes for dementia other than VD or AD, and in one of the cases (2.56%) the neuropathological changes were specific for AD. CONCLUSIONS: Our current results confirm the conclusions of our previous study and contrast with the vast majority of reports in the medical literature regarding the frequency of the different causes of dementia, except for studies from China, Japan and Russia that yielded similar findings as ours. At present, further investigations are being undertaken in order to come up with possible explanations for these differences.

[Epidemiologic studies of cerebellopontine angle tumors surgically treated in Maracaibo, Venezuela, in 1985-1999]. / Estudio epidemiológico de los tumores del ángulo pontocerebeloso operados en Maracaibo, Venezuela, durante el lapso 1985-1999.

OBJECTIVE: To analyze the epidemiological, clinical and neuropathological data of cases of cerebellopontine angle (CPA) tumors. MATERIAL AND METHODS: The clinical records, neuroimaging and neuropathological studies of 50 patients with diagnosis of CPA tumor operated in different hospitals of Maracaibo, Venezuela, during the lapse January 1st, 1985-December 31, 1999 were reviewed. The variables age, gender, side of the lesion and neuropathological diagnosis were analyzed. RESULTS: A 2:1 female to male ratio was observed. Median age was 48 +/- 12.7 years. Acoustic neuromas (AN) represented 48% of the cases, whereas nonacoustic neuroma tumors (NANT) made up for the rest (52%). Meningiomas were the second more commonly diagnosed lesions, they constituted 32% of the cases. Meningiomas and AN were more frequent in women, their ratios being 7:1 and 1.6:1, respectively. In 60% of the cases the signs and symptoms became eloquent in patients of the fourth and fifth decades of life. CONCLUSIONS: The difference between our results and the ones previously reported in the medical literature are due in part to the predominance of female patients in our series. Endocrinologic, genetic and biochemical factors could also be responsible; nevertheless, this does not constitute the objective of the present study.

[Venezuelan equine encephalitis. 1995 outbreak: clinical profile of the case with neurologic involvement]. / Encefalitis equina venezolana. Epidemia de 1995: perfil clínico de los casos con compromiso neurológico.

INTRODUCTION: Venezuelan equine encephalitis virus has caused periodic epidemics and epizootics in the American continent since the 1920s. Such events have been profusely documented from the epidemiologic point of view, however, reports concerning the clinical features of this disease are rather scarce. OBJECTIVE: To analyze the clinical characteristics evidenced by Venezuelan equine encephalitis patients from Zulia state (western Venezuela) studied during the outbreak that occurred in Colombia and Venezuela in 1995. These cases, classified as complicated, were hospitalized at the Hospital Universitario de Maracaibo, state of Zulia, Venezuela. PATIENTS AND METHODS: The clinical charts of 313 Venezuelan equine encephalitis patients hospitalized during the period January 1st 1995-March 31st 1996 were reviewed. These cases accounted for 2.82% of 11,072 patients that were medically assisted during the outbreak. The following variables were analyzed: age, gender, signs and symptoms, contact history, complications and evolution. RESULTS: Intracranial hypertension signs became eloquent in 55.9% of these patients. Neurologic complications were represented by two cases of cerebellitis, two cases of meningoencephalitis and one case of encephalomyelitis. The mortality rate was 1.7%. CONCLUSION: Our results corroborate the benign evolutionary profile that is typical of this entity.

[The classical clinical and neuroimaging features of meningiomas are mimicked by other intracranial, supratentorial expansive lesions]. / Las características clínico-imaginológicas clásicas de los meningiomas son imitadas por otras lesiones expansivas.

OBJECTIVE: To analyze the surgical neurology cases in which both the clinical and neuroimaging features suggested supratentorial meningioma, and resulted in different entities from the neuropathological point of view. PATIENTS AND METHODS: The clinical histories of patients harboring intracranial, supratentorial mass lesions diagnosed as meningioma operated in different hospitals of Maracaibo, Venezuela, during the period 1993-1997 were reviewed. RESULTS: Our analysis revealed 15 cases with different neuropathological diagnosis. They were distributed as follows: three cases of hemangiopericytoma, two cases each of anaplastic ependymoma, metastatic carcinoma, and solitary intracranial plasmacytoma, and one case each of plasma cell granuloma, pleomorphic xanthoastrocytoma, chondroma, actinomycetoma, meningeal fibroma and chronic inflammation not otherwise specified. CONCLUSION: A heterogeneous group of intracranial, supratentorial expansive mass lesions can masquerade as meningiomas both from the clinical and neuroimaging points of view.

[Femoral head chondroblastoma and reconstruction with osteochondral allograft. Case report]. / Condroblastoma de la cabeza femoral y reconstrucción con aloinjerto osteocondral. Reporte de caso.

Femoral head chondroblastoma is an infrequent tumor, accounting for approximately 1-2% of benign bone tumors. It occurs more frequently in young male patients. It's most frequent locations include the proximal humerus, proximal femur, distal femur and proximal tibia. The femoral head is the third most frequent site of this tumor. There is no specific treatment for this entity; reported treatments range from acetabular osteotomies and osteochondral grafts, to vascularized fibular grafts, all of them with good results. However, this tumor is clinically unpredictable if left untreated. We report a case managed with osteochondral graft and followed-up for three years after the surgical procedure.

[Dislocation and necrosis of the first, second and third wedges. Management with the Masquelet technique. A case report]. / Luxación y necrosis de la primera, segunda y tercera cuña, manejo con técnica de Masquelet. Reporte de un caso.

The induced membrane technique was first described by Masquelet in 1986. It was initially used for the reconstruction of long bone shaft defects, particularly of the femur and tibia. The technique consists of two stages. During the first stage a membrane is induced to provide support to the grafts and supply growth factors that contribute to provide a favorable receiving bed for the future graft. During the second stage the poly-methyl-methacrylate spacer is removed and replaced with bone grafts, usually harvested from the iliac crest. Given that this technique has proven good results, it started to be used at other bone sites. We present herein the case of a patient with a large bone defect in the midfoot in whom the Masquelet technique was used with iliac crest grafts. Arthrodesis with a distal radius plate was performed to improve medial column stability, with favorable clinical and functional results.

Osteosíntesis con placa bloqueada y técnica de mínima invasión para las fracturas de húmero proximal / Osteosynthesis with locking plate and minimally invasive technique for proximal humeral fractures

Resumen: Objetivo: Dar a conocer nuestra experiencia en el tratamiento de las fracturas de húmero proximal de 2 a 3 partes con técnica de mínima invasión mediante el uso de un implante con estabilidad angular bloqueado e investigar los factores que afectan los resultados de los pacientes. Material y métodos: Estudio descriptivo y prospectivo tipo serie de casos. De 22 pacientes fueron intervenidos 13 mujeres y nueve hombres en el período comprendido entre Febrero de 2010 y Agosto de 2012. El rango de edad media fue 50.8 años (24-82 años). Se hizo un abordaje acromial lateral con el paciente en posición de silla de playa bajo visión fluoroscópica. El tiempo de seguimiento mínimo fue de 24.3 meses (11-32). El seguimiento se hizo mediante revisión de radiografías para la consolidación y necrosis avascular y la valoración funcional de la escala de Constant. Resultados: En todos los casos se observó consolidación de la fractura a los seis meses. No se detectaron casos con necrosis avascular. Dos pacientes mostraron consolidación en varo (109o). Dos pacientes presentaron pinzamiento por la placa. El resultado funcional según la escala de valoración de Constant-Murley fue de 68.8 puntos. No hubo lesiones neurológicas asociadas. Conclusiones: La fijación con técnica mínimamente invasiva para las fracturas de húmero proximal con placas bloqueadas es una alternativa válida como tratamiento quirúrgico. La incidencia de necrosis avascular fue baja y se permitió una rehabilitación temprana en pacientes de mala calidad ósea.

Abstract: Objective: To report our experience in the treatment of 2-3 fragment proximal humeral fractures using a minimally invasive technique that involves an angular-stable locking implant and find out the factors affecting patients' outcomes. Material and methods: Descriptive, prospective study of the case series type. Twenty-two patients, 13 females and 9 males, were operated on between February 2010 and August 2012. Mean age was 50.8 years (24-82 years). Patients were placed in a beach-chair position. A lateral acromial approach was used under fluoroscopic guidance. Minimal follow-up period was 24.3 months (11-32). Follow-up consisted of X-ray review to check for bone healing and avascular necrosis, and functional assessment using the Constant-Murley scale. Results: Bone healing occurred in all cases at 6 months. There were no cases of avascular necrosis. Two patients had varus healing (109º), and two had plate impingement. The functional assessment score according to the Constant-Murley scale was 68.8. There were no associated neurologic lesions. Conclusions: Fixation of proximal humeral fractures with a minimally invasive technique using locking plates represents a valid surgical approach. The avascular necrosis rate was low and early rehabilitation was possible in patients with poor bone quality.