Browsing by Author "Contreras Fernández, Julio José"

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    Increasing surgical rate of clavicle fractures and acromioclavicular dislocations in Chile: analysis over the last 15 years reveals disparities in access according to insurance type
    (Springer Nature, 2025) Vidal Olate, Catalina Victoria; Marinis Acle, Rodrigo Ignacio de; Liendo Verdugo, Rodrigo Javier; Silva Canales, Isadora Camila del Carmen; Lira Salas, María Jesús; Contreras Fernández, Julio José
    Background In recent years, an increase in surgeries to treat clavicle injuries has been reported. It has been hypothesized that the studies regarding the beneficial effect of surgery in patients with displaced clavicle fractures may have contributed to raise the surgical rates for injuries around the clavicle. To our knowledge, there is a lack of data from Latin American countries on surgical rates of clavicle-related surgeries. The aim of this study is to describe the rate of clavicle surgeries, including clavicle fracture and acromioclavicular dislocation, in the last 15 years and to analyze the possible effect of sex, age, and health insurance in those rates. Methods An observational cross-sectional study was carried out. Patients over 18 years old diagnosed with the following ICD-10 codes were selected: S420 "Clavicle fracture", S431 "Dislocation of the acromioclavicular joint", and S435 "Sprains and strains of the acromioclavicular joint". We collected information on the year of surgery, sex, age and type of insurance. The annual rate of surgeries and the rate for the period studied per 100,000 people were calculated. The rate was compared through negative binomial regression, reporting Incidence Rate Ratios (IRR) with 95% confidence interval (95% CI). Results During a 15 years period of observation, 24,570 surgeries were performed. For clavicle fractures an 8.0 × 100,000 surgical rate was observed, and a 4.7 × 100,000 rate was found for acromioclavicular dislocations. The surgical rate for clavicular injuries increased from 2.8 in 2005 to 19.1 in 2019. Rates were higher in men, and ages between 20 and 35 years. The surgical rate for clavicular injuries in the public system was 11.1 × 100,000 and 30.9 × 100,000 in the private system, which represents a difference of 2.8 times between those healthcare systems. Conclusion There has been a significant increase in clavicle and acromioclavicular dislocation surgeries in Chile, with disparities influenced by age, gender, and type of health insurance.
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    Shoulder surgery in Chile: how far we have come and our future challenges
    (Elsevier Inc., 2025) Marinis Acle, Rodrigo Ignacio de; Vidal Olate, Catalina Victoria; Correa Rivas, Ignacio Andrés; Contreras Fernández, Julio José; Kuroiwa Rivero, Aron Rriky; Calvo Palma, Claudio; Liendo Verdugo, Rodrigo Javier; Cerda, Jaime; Soza Rex, José Francisco
    Shoulder surgery in Chile has seen a remarkable development in the last 2 decades. From a handful of overseas-trained pioneers, Chilean shoulder surgeons now have a growing and robust society with more than 150 members with 8 fellowship programs and around 10 new fellowship-trained shoulder surgeons graduating every year. Academic activity has been steadily improving in both quality and quantity, aspiring to reach the standards of Europe and North America. State-of-the-art clinical practice is the standard in larger cities with considerable access issues in more remote areas of the country. In the broader picture, the country has a mixed public-private insurance system with a health budget that accounts for 9% of the gross domestic product (GDP).27 Although private insurance is accessible to only approximately 18% of the population, the elevated out-of-pocket cost of health care is a growing issue, especially for elective surgery. In this narrative review, we provide an overview of the development of shoulder surgery in Chile. We will discuss our health care system, surgical rates, and waiting lists issues and address the challenges along with opportunities for future developments. By discussing our strengths, limitations, opportunities, and threats, we aim to provide the reader with useful insights into global health care issues around shoulder surgery and exemplify potential solutions and barriers.