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Introduction: Bone and Joint Infections (BJI) have high morbidity. Methicillin resistant Staphylococcus aureus (MRSA) has increased. Culture-based diagnosis has difficult to recovering fastidious bacteria and detecting polymicrobial infections, molecular methods offer a promising improvement for the diagnosis of BJI with reduced time to result. The aim of the study was to determine the correlation between culture results and the Biofire joint infection panel (BJIP) in a cohort of pediatric patients with BJI. Materials and methods: Descriptive study. Patients admitted with probable o confirmed BJI between July 1, 2019 and February 28, 2021 at HOMI. Blood cultures, synovial and bone fluid samples were taken. Samples were kept at -70 °C. On September 2022, the panel was performed. Results: 32 patients were included. The average age was 83m (RIQ: 32-145). 23 (71.8%) patients had a positive culture. The most frequent microorganism were S. aureus 19 (83%), 11/19 (57.9%) Staphylococci isolates were MRSA. 24/32 (75%) were positive by panel, 20 positive detections were concordant with culture, there were 6 additional isolates by panel (2 S. aureus, 2 S. pyogenes, 1 K. kingae and 1 C. albicans), three microorganisms were isolated in culture but not in the panel. (2 S. aureus and 1 S. agalactiae). Two patients with coinfection were detected. All MRSA were detected by culture and panel. In 26 (81.3%) patients the etiology was documented by any method. Conclusion: These results showed a moderate level of agreement between BJIP and culture (κ = 0.47). The panel allowed the detection of fastidious bacteria including K. kingae and polymicrobial samples. There was a very good level of agreement between the panel and culture for the MRSA detection (κ = 1).
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El músculo extensor digitorum brevis manus es una variante de los extensores de la mano. Se trata de un músculo supernumerario en el dorso de la muñeca ubicado en el cuarto compartimento extensor. Suele ser asintomático, pero ocasionalmente se presenta como una masa dolorosa; en estos casos, está indicado el tratamiento quirúrgico que consiste en la resección del músculo o la liberación del retináculo extensor del cuarto compartimento. Presentamos a una paciente de 30 años, con una masa dolorosa en el dorso de la mano izquierda. Según las evaluaciones clínica y ecográfica, se sospechó un ganglión y se programó la resección quirúrgica. En la cirugía, se encontró tejido muscular compatible clínicamente con el extensor digitorum brevis manus, y se liberó el retináculo extensor. Los estudios publicados sobre su incidencia y prevalencia son escasos y, en su mayoría, se trata de informes post mortem, por lo que este caso presentado reviste particular interés. Nivel de Evidencia: IV
The extensor digitorum brevis manus muscle is a variant of the hand extensors. It is a supernumerary muscle on the dorsum of the wrist, located in the fourth extensor compartment. It is usually asymptomatic, but when it causes discomfort, it manifests as a painful mass. When it is symptomatic, surgical treatment is recommended, which may include muscle excision or extensor retinaculum release. We present a 30-year-old patient with a painful mass on the dorsum of the left hand; clinically, a ganglion was suspected and scheduled for surgical resection. She underwent surgery and was diagnosed with symptomatic EDBM, which was treated with extensor retinaculum release. EDBM was found incidentally in a cadaveric dissection; therefore, its true incidence is unknown. EDBM originates in the wrist joint capsule, below the dorsal radiocarpal ligament; its distal insertion is the ulnar side of the extensor mechanism in the metacarpophalangeal joint where it is present. Innervated by the posterior interosseous, research has shown that its purpose is to extend and deviate the finger towards the side where it is inserted. This case is particularly interesting given the scarcity of information on its incidence and prevalence, with the majority of that information coming from postmortem reports. Level of Evidence: IV
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Mano , MúsculosRESUMEN
Introducción: El diagnóstico del síndrome de túnel del carpo se basa en los síntomas y signos clínicos del paciente y se apoya en estudios de electrodiagnóstico. Objetivos: Determinar el rendimiento diagnóstico de los signos clínicos de síndrome de túnel del carpo y la evaluación de un nuevo modelo como propuesta diagnóstica. Métodos: Estudio prospectivo de pruebas diagnósticas para síndrome de túnel del carpo en pacientes que asistieron a la consulta de cirugía de mano: Tinel, Phalen, Elevación de manos, y una nueva propuesta que llamaremos Elevación/Phalen, Resultados: Se evaluaron 88 manos en 47 pacientes con un promedio de edad de 45 años. El Tinel fue positivo en 63 (71,59 %), el Phalen en 67 (76,13 %), la Elevación de manos en 69 (78,4 %) y la Elevación/Phalen en 74 (84,09 %). Respecto al patrón establecido para la comparación clínica, los resultados fueron positivos en 71 (80,6 %) y negativos en 17 (19,4 %). El rendimiento clínico de Elevación/Phalen mostró una sensibilidad del 88,8 % y una especificidad de 78,6 %, con un valor predictivo positivo del 95,9 %. Conclusiones: La prueba Elevación/Phalen es equiparable a las pruebas clásicas de Tinel, Phalen y Elevación de manos, por tanto, puede ser utilizada para el diagnóstico clínico del síndrome de túnel del carpo.
Introduction: The diagnosis of carpal tunnel syndrome is based on the patient's clinical signs and symptoms, supported by electrodiagnostic studies. Objectives: To determine the diagnostic performance of the clinical signs of carpal tunnel syndrome and the evaluation of a new model as a diagnostic proposal. Methods: A prospective study was carried out for diagnostic tests for carpal tunnel syndrome in patients who attended the hand surgery consultation: Tinel, Phalen, Elevation of hands, and a new proposal that we will call Elevation/Phalen. Results: Eighty eight (88) hands were evaluated in 47 patients with a mean age of 45 years. Tinel was positive in 63 (71.59%), Phalen in 67 (76.13%), Hand Elevation in 69 (78.4%) and Elevation/Phalen in 74 (84.09%). Regarding the pattern established for clinical comparison, the results were positive in 71 (80.6%) and negative in 17 (19.4%). The clinical performance of Elevation/Phalen showed 88.8% of sensitivity and 78.6% of specificity, with 95.9% of positive predictive value. Conclusions: The Elevation/Phalen test is comparable to the classic Tinel, Phalen and Hand Elevation tests, therefore, it can be used for the clinical diagnosis of carpal tunnel syndrome.