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INTRODUCTION AND IMPORTANCE: Repairing massive rotator cuff tears (MRCTs) can often be technically challenging due to tendon retraction, bursal fibrosis, and muscular fatty infiltration that usually occurs, often resulting in poor outcomes and an unpredictable prognosis. Although some other surgical management options have been reported, there is a lack of literature supporting tendon transfers in the presence of combined anterior and posterior-superior irreparable rotator cuff tears. We describe a case where a combined transfer of the latissimus dorsi and lower trapezius tendons was employed to treat an MRCT affecting the anterior and posterior superior portions of the rotator cuff. CASE PRESENTATION: A 64-year-old male presented significant pain and limited range of motion in the right shoulder following a traumatic anterior shoulder dislocation seven months prior. MRI showed retracted tears (> 5 cm) of the supraspinatus, infraspinatus, and subscapularis tendons with significant fatty infiltration (Goutallier IV). The patient underwent an open transfer of the lower trapezius tendon to the greater tuberosity and the latissimus dorsi to the lesser tuberosity. At the final follow-up, 2.5 years postoperatively, the patient exhibited a painless functional range of motion and could resume daily activities. CLINICAL DISCUSSION: Although there are alternative surgical options available, the positive outcomes observed in the presented case may be attributed to the restoration of rotational strength and the re-establishment of force coupling across the shoulder. CONCLUSION: This report describes the successful implementation of a surgical treatment option for managing MRCT affecting the anterior and posterior superior portions of the rotator cuff.
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Background: Clavicle fractures are among the most common upper limb fractures in adults, with the midshaft region being the most frequently affected site. Minimally invasive plate osteosynthesis (MIPO) has emerged as an alternative to the traditional open reduction and internal fixation (ORIF) technique, offering potential advantages. The purpose of this study was to conduct a systematic review to explore the results of this technique in the existing literature, with emphasis on the occurrence of surgical complications and functional outcomes and also to provide a comprehensive comparison of MIPO and ORIF in the management of midshaft clavicle fractures. Methods: We conducted a systematic review to evaluate the complication incidence and clinical outcomes of MIPO for midshaft clavicle fractures. We searched PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, the Cochrane Database of Controlled Trials, and the Cochrane Database of Systematic Reviews databases without language or date restrictions. Studies focusing on midshaft clavicle fractures treated with MIPO were included, while other clavicle fractures and nonclinical studies were excluded. The risk of bias was assessed using the Methodological Index for Nonrandomized Studies criteria and the Risk of Bias Tool 2 Cochrane tool. Data synthesis included qualitative analysis, and if applicable, quantitative analysis and meta-analysis. Adherence to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines ensured reporting quality. Results: A total of 107 studies were initially identified, after applying inclusion and exclusion criteria, 22 studies were included for data extraction. These studies involved the evaluation of 714 clavicles treated with the MIPO technique. Of the 714 MIPO cases, 11 cases of implant failure, 5 nonunions, 2 infections, and 28 cases with neurological impairment were observed. Quantitative analysis comparing MIPO with ORIF revealed that MIPO had significantly shorter surgery time (mean difference -12.95, 95% confidence interval [-25.27 to -0.63], P = .04) and lower occurrence of numbness (odds ratio 0.29, 95% CI [0.15-0.56], P = .0002) compared to ORIF. Time to bone union, functional outcomes, and other complications were similar between MIPO and ORIF at the final follow-up. An overall moderate risk of bias was found across the studies. Conclusion: The MIPO technique yields good and comparable results to ORIF for midshaft clavicle fractures. Additionally, the MIPO technique may offer advantages such as reduced surgical time and lower chances of neurological impairment.
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Anterior shoulder instability can lead to anterior glenoid bone loss associated with humeral posterior deformity (bipolar bone loss). Latarjet procedure is a commonly used surgical option in such cases. However, the procedure is associated with complications in up 15% of the cases often associated with inadequate positioning of coracoid bone graft and screws. Considering that acknowledgment of patient anatomy and use of surgical planning intraoperatively can reduce such complications, we describe the use of 3D printing tools to obtain a 3D Patient-Specific Surgical Guide to aid in the Latarjet procedure. Such tools present advantages and limitations compared to other tools available, which are also discussed in this article.
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Resumen El presente trabajo ofrece un análisis del comportamiento de la fecundidad desagregado por nivel de instrucción de la madre en Argentina en el siglo XXI y presta especial atención a la evolución de la fecundidad adolescente en el mismo período. A diferencia de lo acontecido en otros países de la región en las últimas dos décadas, donde el descenso de la fecundidad fue casi ininterrumpida, en la Argentina la fecundidad tuvo un comportamiento estable, similar a una meseta, desde comienzos del siglo XXI hasta 2014, a partir de cuando comenzó un descenso sostenido análogo al de sus países vecinos. Para este análisis se usan datos de las estadísticas vitales y de las estimaciones y proyecciones de población del INDEC, y para el análisis por nivel de instrucción, datos de las encuestas permanentes de hogares del INDEC y del Censo Nacional de Población y Vivienda de 2010. En el análisis se puede observar una importante brecha en los niveles de fecundidad entre las mujeres más y menos instruidas, principalmente en la fecundidad adolescente. Esta brecha es un reflejo de inequidad, dado que la alta fecundidad afecta sobre todo a las mujeres de los estratos sociales más vulnerables.
Resumo Este documento faz uma análise do comportamento da fecundidade na Argentina no século 21, desagregado por nível de escolaridade da mãe, com especial atenção à evolução da fecundidade na adolescência nesse período. Ao contrário do que aconteceu em outros países da região nas últimas duas décadas, onde a fecundidade diminuiu quase continuamente, na Argentina a fecundidade teve um comportamento estável, semelhante a um plateau, desde o início do século 21 até 2014, quando começou um declínio sustentado semelhante ao observado nos países vizinhos. Utilizamos dados de estatísticas vitais, estimativas e projeções da população do INDEC e, para a análise por nível de educação, dados das Pesquisas Domésticas do INDEC e do Censo Nacional da População e Habitação 2010. A análise mostra uma lacuna significativa nos níveis de fecundidade entre as mulheres mais e menos instruídas, principalmente na fecundidade adolescente. Esta lacuna é reflexo da desigualdade, uma vez que a alta fecundidade afeta principalmente as mulheres dos estratos sociais mais vulneráveis.
Abstract This paper presents an analysis of Argentina's fertility behavior disaggregated by level of education of the mother in the 21st century, and focuses on the evolution of adolescent fertility during the same period. Unlike what other countries from the region have experienced in the last two decades, where fertility decline occurred almost uninterruptedly, Argentina's fertility had a stable behavior, similar to a plateau, from the beginning of the 21st century until 2014. Since then, it began a sustained decline similar to that evidenced in neighboring countries. Data from vital statistics, INDEC population estimates and projections are used, and data from INDEC Household Surveys and the 2010 National Population and Housing Census are used for the analysis by education level. The analysis shows a significant gap in fertility levels between the most and least educated women, mainly in adolescent fertility. This gap is a reflection of inequity, given that high fertility rates mainly affect women from the most vulnerable social strata.
