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STUDY DESIGN.: Case report. OBJECTIVE.: To describe a case of septic arthritis of the facet joint in an infant. SUMMARY OF BACKGROUND DATA.: To our knowledge, no more than 50 cases of septic arthritis of a facet joint are reported in literature, including only 4 cases in children and none in infants. METHODS.: A girl of age 18 months presented with a fever pattern of 4 days evolution, right lumbar paravertebral tumefaction with local inflammatory signs and limping related to pain with weight-bearing on the right lower extremity. The mother reported a pharyngeal infection 2 weeks earlier.Conventional radiology showed no alterations. MR and scintigraphy with radioactivity-marked leukocytes showed affectation only of the posterior facet joint of right L4-L5, without associated collections. Blood and urine cultures were negative. The diagnosis was established as right L4-L5 septic arthritis of a lumbar facet joint, probably of hematogenous origin. RESULTS.: The fever pattern and the limp disappeared in 24 hours with wide-spectrum empirical intravenous antibiotherapy. Although no microorganism was isolated, the good response to the empirical treatment and the background of pharyngeal infection point to a hematogenous dissemination by Staphylococcus aureus or Streptococcus spp. CONCLUSION.: Septic arthritis of a facet joint does not differ clinically from other spinal infections and its incidence is possibly underestimated in favor of other more common entities. Only imaging techniques can differentiate the affected structures and establish the exact diagnosis.MR allows the detection in initial stages, delimits the affectation and extension through the soft tissues, and rules out other more common entities such as discitis. Scintigraphy and SPECT can detect other active foci and be useful in the follow-up.The result achieved with antibiotic treatment in early stages is usually satisfactory. Surgical debridement is only necessary when associated purulent collections appear. From the pediatric point of view, spinal infections should also be taken into consideration within the differential diagnostic of limp in children. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to identify the risks factors for mortality and functional recovery in elderly patients admitted to hospital with a hip fracture., Materials and Methods: Longitudinal prospective study in patients 80 years old or more and patients between 75 and 79 in residential home care with a hip fracture and with a past medical history of dementia or followed-up by the Geriatric Unit. A total of 359 patients were included, and the demographic data, previous functional status, comorbidity, type of fracture, and dementia were recorded. The data collected during admission included time to surgery, delirium, functional recovery, length of stay, placement at discharge, and mortality. Patients were followed-up for one year and details were collected on placement at the end of follow-up, functional recovery, medical complications, and mortality., Results: The baseline characteristics of the patients with a strong association with mortality after a hip fracture were old age (> 92 years), medical complications delaying surgery (HR 2.17; 95% CI; 1.27-3.73), diagnosis of dementia (HR 1.78; 95% CI; 1.15-2.75), or heart failure (HR 1.75; 95% CI; 1.12-2.75). The fitted multivariable regression models showed that functional impairment before the hip fracture or lack of functional recovery are associated with higher mortality, and patients with increased age, delirium, dementia, and previous functional impairment showed worse functional recovery., Conclusion: In the elderly patients with a hip fracture, increased age, comorbidity and previous functional status is associated with mortality. Functional recovery prognosis will depend on age, previous functional status, past medical history of dementia, and the presence of delirium during admission., (Publicado por Elsevier España, S.L.U.)

Introduction: The posterior epidural migration of a fragment of lumbar disc herniation is a rare clinical presentation., Case Report: We report the case of a 76-year-old with back pain and progressive paraparesis in the lower limbs, with the emergence of a cauda equina syndrome 4 days after admission. MRI showed lumbar spondylosis and a well-defined intra-spinal mass in the posterior epidural space. Surgical resection of the epidural mass was performed. The pathological study revealed an intervertebral disc fragment; thus it was a complete migration of a herniated lumbar disc. The patient was healed after surgery and specific rehabilitation treatment., Conclusions: Patients with posterior migration of disc fragment may present with severe neurological deficits, such as cauda equina syndrome. Because the radiological images of disc fragments are similar to those of other lesions, such as metastasis, synovial cyst, dural abscess or haematoma, definitive diagnosis is made by excision and pathological study. Emergency surgery is required to prevent severe neurological deficits., (Copyright © 2011 SECOT. Published by Elsevier Espana. All rights reserved.)

Objective: Epidemiological description, retrospective in its classification, evolution and therapeutics of total prosthesis knee and hip infected among the arthoplasties made between 1st of January 1994 and 31st of December 2003 in our hospital., Results: The global infection rate was 2.4% (confidence interval of 95% [CI 95%], 1.6%-3.2%) over 40 cases in 1,666 joint implants. The average age +/- standard deviation (SD) was 69.5 years old +/- 5.1 years, mainly in women (67.5%). The most common location was the knee, 31 cases (77.5%). In 90.0% of the patients the aetiology was identified: 64,0% were gram-positive cocci (plasmacoagulase-negative staphylococci, and Staphylococcus aureus); 14.0% were gram-negative bacilli and mixed flora (11.0%). Acute infections were found in most of the cases (45,0%). The joint replacement had a healing rate of 66.7% in the first replacement and of 83.3% in the second replacement., Conclusions: The gram-positive cocci are the main microorganisms in these infections. More extensive studies about multiple aspects are necessary to evaluate the effectiveness of the different surgical techniques, the new antibiotics and the combined antibiotic therapies.