The biomechanics of subscapularis repair in reverse shoulder arthroplasty: The effect of lateralization and insertion site.

Functional outcomes of subscapularis (SSc) repair following reverse shoulder arthroplasty (RSA) remains controversial. SSc repair in combination with glenosphere lateralization was reported to yield worse clinical outcomes compared with the non-lateralized glenosphere. The aim of this biomechanical study was to investigate how glenosphere lateralization and different re-insertion sites can affect the biomechanics of the SSc after RSA. Nine patient-specific RSA shoulder models were created from patients' computed tomography scans. Moment arms and SSc length were calculated for abduction, forward flexion, and internal rotation in 20° and 90° abduction for three configurations of glenosphere lateralization (standard/+0, +5, and +10 mm) and three SSc repair sites (native, superior, and inferior) and compared with the native shoulder. When compared with the native shoulder, RSA resulted in large adducting SSc moment arms that were antagonistic to the deltoid. Glenosphere lateralization had no effect on SSc moment arms in any motion. However, lateralization increased SSc tension beyond its anatomic length for +5 and +10 mm of lateralization when attached to its native insertion. A superior SSc repair site created the least adductive moment arm as well as the least amount of SSc lengthening. Increased glenosphere lateralization showed a significant increase in the SSc length, which in combination with its adductive moment arm can be antagonistic to deltoid function. However, a superior SSc repair site may help reduce the adductive SSc moment arm and allow for reduced tension on the repair as its length in that location is less than that of the native SSc. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:888-894, 2020.

Expectations Following Rotator Cuff Surgery.

PURPOSE OF REVIEW: To outline the radiographic and clinical outcomes after a rotator cuff surgery in order to set the expectations with the patient before the surgery to obtain a better outcome, taking into account the factors that can affect the outcome and the technique used for the repair. RECENT FINDINGS: The majority of surgeons use arthroscopic repair. The double-row repair has better biomechanical strength, footprint coverage, and radiographic healing rates. The principal factors that can affect the outcome of the surgery are the tendon quality, tear size and retraction, fatty infiltration, chronicity of the tear, and concomitant pathologies. Arthroscopic rotator cuff repair can decrease pain and increase function allowing patients to improve their quality of life; 90% of patients are happy 6 months after the surgery and maintain stability during 5 years. Greater preoperative expectations would show better outcomes and patient satisfaction after the surgery.

[Analysis of maternal deaths in Mexico occurred during 2009]. / Análisis de las muertes maternas en México ocurridas durante 2009.

BACKGROUND: Mexico reported 955 maternal deaths in 2011, with a ratio of 49 deaths per 100,000 live births. For 2015, the WHO commitment is to reduce the ratio to 22, equivalent to 415 maternal deaths. METHODS: it is a descriptive and retrospective study. In 1257 maternal deaths in 2009, we reviewed a sample of 173 records. Simple frequencies and percentages were calculated. RESULTS: direct causes of maternal death were preeclampsia-eclampsia, infection and obstetrical hemorrhage secondary to uterine atony, placental accreta and placenta previa. Fifteen patients died from abortion complications. Four patients died from extra-uterine pregnancy, because of delayed diagnosis and treatment. Indirect causes of maternal death were neoplasms, abdominal sepsis, vascular events, metabolic problems and heart disease; twenty-five patients died of atypical pneumonia and 11 more of influenza A H1N1. CONCLUSIONS: it is feasible to reduce maternal mortality by means of an adequate prenatal care, in quantity and quality of consultations, and avoiding high risk pregnancies caused by a history of obstetric factors and associated severe diseases. Influenza A H1N1 interrupted the downward trend in maternal mortality.

Introducción: en 2011 ocurrieron 955 defunciones maternas en México, 49.9 por 100 000 nacidos vivos. La meta de la Organización Mundial de la Salud para 2015 es reducir la tasa a 22.5: 560 defunciones anuales. Métodos: estudio descriptivo y retrospectivo de 1257 muertes maternas ocurridas en México durante 2009, con una muestra representativa de 173 expedientes. Se calcularon frecuencias simples y porcentajes. Resultados: las muertes maternas ocurrieron por causas directas como preeclampsia-eclampsia, infección y hemorragia obstétrica secundaria a atonía uterina, acretismo placentario y placenta previa. Quince mujeres tuvieron complicaciones por abortos. Cuatro murieron por embarazo extrauterino debido a diagnóstico y tratamiento tardíos. Las causas indirectas de la muerte materna fueron neoplasias, sepsis abdominal, eventos vasculares, problemas metabólicos y cardiopatías. Veinticinco pacientes fallecieron por neumonía atípica y 11 por influenza A H1N1. Conclusiones: es factible disminuir la mortalidad materna mediante suficientes consultas prenatales de calidad y evitar embarazos con riesgo alto por los antecedentes obstétricos y los padecimientos asociados. La influenza A H1N1 interrumpió la tendencia descendente de la mortalidad materna.

[Analysis of dengue fever deaths in Mexico: 2009]. / Defunciones por dengue en México. Análisis del año 2009.

OBJECTIVE: to describe the dengue fever mortality. METHODS: a descriptive and retrospective study including 104 files reported deaths caused by dengue fever during 2009 to march 2010, was done. RESULTS: sixty (58 %) were women and 44 (42 %) men. An increased mortality between the ages of 11 and 40 years old (47 %) was observed. Colima was a state with high incidence of cases and Jalisco had the highest mortality. Thrombocytopenia was the rule (90.4 %) and in one third of the cases platelets were below 50,000/mm(3). A quarter of cases were associated with comorbility. The initial clinical manifestations included: bleeding, hypovolemia by depletion or hemorrhage, tachycardia, paleness, depressed level of consciousness and circulatory failure. The main cause of death was hypovolemic shock or sepsis. In 42 cases, severe dengue was considered. CONCLUSIONS: an association between the severity of dengue fever and mortality was observed. The main cause of mortality was a shock state.