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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La osteomielitis de la articulaci&#243;n esternocostoclavicular &#40;ECC&#41; es una infecci&#243;n poco frecuente producida mayoritariamente por <span class="elsevierStyleItalic">Staphylococcus aureus</span> y enterobacterias&#46; Suele presentarse en personas con alguna enfermedad osteoarticular o con factores predisponentes&#46; En general&#44; se acepta el tratamiento antibi&#243;tico prolongado y la punci&#243;n articular&#46; No existe ninguna pauta de tratamiento quir&#250;rgico admitida por todos los autores&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Presentamos 3 casos de artritis s&#233;ptica ECC en 2 pacientes previamente sanos con dos focos infecciosos &#40;un absceso perianal y una extracci&#243;n dentaria&#41; y un caso con una enfermedad de Still del adulto&#46; Refer&#237;an dolor e inflamaci&#243;n intensa del hombro con escasa leucocitosis y liebre de hasta 38 &#176;<span class="elsevierStyleSmallCaps">C</span>&#46; Los g&#233;rmenes responsables fueron <span class="elsevierStyleItalic">Staphylococcus aureus&#44; Bacteroides fragilis</span> y <span class="elsevierStyleItalic">Bacteroides oralis</span>&#46; Dos casos cursaron con abscesos locorregionales&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En todos los casos fracas&#243; el tratamiento antibi&#243;tico prolongado y fue necesaria la cirug&#237;a&#44; practicando una resecci&#243;n esternocostoclavicular y mioplastia de pectoral mayor&#46; La evoluci&#243;n fue buena y la movilidad del hombro y del brazo excelente&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En conclusi&#243;n&#44; propugnamos el tratamiento m&#233;dico y la punci&#243;n articular diagn&#243;stico-terap&#233;utica como primera intenci&#243;n en el control de esta enfermedad&#46; Ante la mala evoluci&#243;n del paciente o la aparici&#243;n de complicaciones&#44; como absceso o mediastinitis&#44; indicamos el desbridamiento radical y mioplastia del pectoral mayor&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Osteomyelitis of the sternocosto-clavicular &#40;SCC&#41; articulation is a rare infection usually caused by <span class="elsevierStyleItalic">Staphylococcus aureus</span> and enterobacteria&#46; It usually occurs in individuals with osteoarticular disease or predisposing factors&#46; Prolonged antibiotic treatment and articular puncture are generally accepted&#46; Authors do not agree on an established protocol&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We report three cases of SCC septic arthritis in two previously healthy patients with two foci of infection &#40;one perianal abcess and one dental extraction&#41; and in one adult patient with Still&#39;s disease&#46; Pain and intense inflammation was referred to the shoulder&#44; with scarce leukocytosis and fever reaching 38 &#176;C&#46; The germs responsible were <span class="elsevierStyleItalic">S&#46; aureus&#44; Bacteroides fragilis</span> and <span class="elsevierStyleItalic">B&#46; oralis</span>&#46; Two of the patients had local&#44; regional abscesses&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Long-term antibiotic treatment failed in all cases and surgery for SCC resection and myoplasty of the pectoralis major muscle was required&#46; Recovery was good and shoulder and arm mobility was excellent&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">We propose medical treatment and articular diagnostic-therapeutic puncture as the first line of therapy for this disease&#46; When evolution is poor or when complications appear&#44; such as abscesses or mediastinitis&#44; we conclude that radical debridement and myoplasty of the pectoralis major muscle are indicated&#46;</p></span>"
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Vol. 32. Issue 10.
Pages 541-543 (December 1996)
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Vol. 32. Issue 10.
Pages 541-543 (December 1996)
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Tratamiento quirúrgico de la osteomielitis esternoclavicular
Surgical treatment of sterno-clavicular osteomyelitis
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J.I. González Muñoz, M. Córdoba Peláez, E. Tébar Boti, J.C. Téllez Cantero, E. Castedo Mejuto, A. Varela de Ugarte*
Servicio de Cirugía Torácica y Cardiovascular. Clínica Puerta de Hierro. Madrid
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La osteomielitis de la articulación esternocostoclavicular (ECC) es una infección poco frecuente producida mayoritariamente por Staphylococcus aureus y enterobacterias. Suele presentarse en personas con alguna enfermedad osteoarticular o con factores predisponentes. En general, se acepta el tratamiento antibiótico prolongado y la punción articular. No existe ninguna pauta de tratamiento quirúrgico admitida por todos los autores.

Presentamos 3 casos de artritis séptica ECC en 2 pacientes previamente sanos con dos focos infecciosos (un absceso perianal y una extracción dentaria) y un caso con una enfermedad de Still del adulto. Referían dolor e inflamación intensa del hombro con escasa leucocitosis y liebre de hasta 38 °C. Los gérmenes responsables fueron Staphylococcus aureus, Bacteroides fragilis y Bacteroides oralis. Dos casos cursaron con abscesos locorregionales.

En todos los casos fracasó el tratamiento antibiótico prolongado y fue necesaria la cirugía, practicando una resección esternocostoclavicular y mioplastia de pectoral mayor. La evolución fue buena y la movilidad del hombro y del brazo excelente.

En conclusión, propugnamos el tratamiento médico y la punción articular diagnóstico-terapéutica como primera intención en el control de esta enfermedad. Ante la mala evolución del paciente o la aparición de complicaciones, como absceso o mediastinitis, indicamos el desbridamiento radical y mioplastia del pectoral mayor.

Palabras clave:
Articulación esternoclavicular
Artritis
Mioplastia

Osteomyelitis of the sternocosto-clavicular (SCC) articulation is a rare infection usually caused by Staphylococcus aureus and enterobacteria. It usually occurs in individuals with osteoarticular disease or predisposing factors. Prolonged antibiotic treatment and articular puncture are generally accepted. Authors do not agree on an established protocol.

We report three cases of SCC septic arthritis in two previously healthy patients with two foci of infection (one perianal abcess and one dental extraction) and in one adult patient with Still's disease. Pain and intense inflammation was referred to the shoulder, with scarce leukocytosis and fever reaching 38 °C. The germs responsible were S. aureus, Bacteroides fragilis and B. oralis. Two of the patients had local, regional abscesses.

Long-term antibiotic treatment failed in all cases and surgery for SCC resection and myoplasty of the pectoralis major muscle was required. Recovery was good and shoulder and arm mobility was excellent.

We propose medical treatment and articular diagnostic-therapeutic puncture as the first line of therapy for this disease. When evolution is poor or when complications appear, such as abscesses or mediastinitis, we conclude that radical debridement and myoplasty of the pectoralis major muscle are indicated.

Key words:
Sternoclavicular articulation
Arthritis
Myoplasty
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