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In this paper, assume that $ H $ is a Hopf algebra and $ A/B $ is an $ H $-Galois extension. Firstly, by introducing the concept of an $ H $-stable tilting complex $ T_{\bullet} $ over $ B $, we show that $ T_{\bullet}\otimes_BA $ is a tilting complex over $ A $ and a derived equivalence between two $ H $-module algebras can be extended to smash product algebras under some conditions. Then we observe that $ 0\rightarrow {\rm End}_{\mathcal{D}^b(B)}(T_{\bullet})\rightarrow {\rm End}_{\mathcal{D}^b(A)}(T_{\bullet}\otimes_BA) $ is an $ H $-Galois Frobenius extension if $ A/B $ is an $ H $-Galois Frobenius extension. Finally, for any perfect recollement of derived categories of $ H $-module algebras, we apply the above results to construct a perfect recollement of derived categories of their smash product algebras and generalize it to $ n $-recollements.

Background: The combination of pelvic fractures with lower urinary tract injuries (LUTIs) is a severe traumatic injury. This study was performed to determine the relationship between LUTIs and pelvic fracture types. Methods: Patients who sustained pelvic fractures combined with LUTIs between 1 January 2018 and 1 January 2022 in our institution were retrospectively analyzed. The patients’ demographics, mechanism of injury, presence of open pelvic fractures, types of pelvic fractures, patterns of LUTIs, and early complications were analyzed. The association between pelvic fracture types and the identified LUTIs was statistically analyzed. Results: This study involved 54 patients diagnosed with pelvic fractures combined with LUTIs. The overall incidence of pelvic fractures combined with LUTIs was 7.7% (n = 54/698). All patients had unstable pelvic fractures. The male:female ratio was approximately 2.4:1.0. The incidence of LUTIs was higher in men than women with pelvic fractures (9.1% vs. 4.4%). Bladder injuries occurred at roughly equal rates in men and women (4.5% vs. 4.4%, p = 0.966), but urethral injuries were more frequent in men (6.1% vs. 0.5%, p = 0.001). The most common pelvic injury pattern was a type C fracture according to the Tile classification and a vertical-shear-type fracture according to the Young–Burgess classification. The Young–Burgess fracture classification was related to the severity of bladder injury in men (p = 0.037). There was no significant difference in bladder injury according to the two classifications among women (p = 0.524 vs. p = 1.000) or among the entire cohort (p = 0.454 vs. p = 0.342). Conclusions: Men and women are equally likely to sustain a bladder injury, but a urethral injury with pelvic fracture is more frequent in men. LUTIs tend to be accompanied by unstable pelvic fractures. It is imperative to be vigilant for potential bladder injury when men sustain vertical-shear-type pelvic fractures.

Background Reports on traumatic sciatic nerve injury associated with acetabular fracture are rare. In this study, we investigated the demographics of these injuries, their clinical characteristics, management, and factors potentially influencing neurological recovery. Methods We retrospectively reviewed all patients diagnosed to have acetabular fracture at our trauma center between January 2014 and June 2021. Data on patient demographics, characteristics of sciatic nerve injury, neurological recovery, factors potentially influencing neurological recovery were analyzed. Results Eighteen patients (bilateral in one case) met the diagnostic criteria. All these injuries involved the posterior wall or posterior column, and most patients had posterior dislocation of the hip joint. Four of the 19 sides with traumatic sciatic nerve injury involved the common peroneal nerve division and 15 involved both the common peroneal and tibial nerve divisions. Seventeen patients (18 sides) underwent intraoperative nerve exploration, which revealed abnormalities in 7 sides and no obvious abnormality in 11 sides. At the last follow-up, 10 sides (52.6%) had complete recovery and 9 (47.4%) had partial recovery; the difference was statistically significant between those with or without abnormal nerve damage during exploration (P = 0.046). Linear regression analysis showed that a nerve abnormality detected intraoperatively was a predictor of nerve recovery (P = 0.009). The mean recovery time was significantly longer for partial recovery than for complete recovery (13.78 months vs. 6.70 months; P = 0.001). Conclusions All the injuries in this series involved the posterior wall or posterior column, and most patients had posterior dislocation of the hip joint. Damage to the common peroneal nerve division was more severe than that to the tibial nerve division preoperatively. However, the degree of recovery of the common peroneal division was not worse than that of the tibial division. There was a relationship between the degree of neurological recovery and whether there was an abnormality at the time of intraoperative nerve exploration. Patients with partial recovery took longer to recover.

Zhigang Liu,1,2,* Baisheng Fu,2,* Weicheng Xu,2 Fanxiao Liu,2 Jinlei Dong,2 Lianxin Li,2 Dongsheng Zhou,2 Zhenhai Hao,2 Shun Lu2 1Department of Orthopaedics Surgery, Haining People’s Hospital, Jiaxing, People’s Republic of China; 2Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Shun Lu, Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China, Tel +8618653189700, Email sdqdpdlushun@163.comPurpose: Traumatic sciatic nerve injury is one of the most serious consequences of acetabular fracture. However, reports on this type of injury are rare. In this study, we investigated the demographics of acetabular fracture with traumatic sciatic nerve injury, the clinical characteristics of patients with these injuries, and potential risk factors.Patients and Methods: We retrospectively reviewed patients diagnosed to have acetabular fracture at our trauma center between January 2014 and June 2021. Data on patient demographics, characteristics of the acetabular fracture, whether or not sciatic nerve injury occurred, types of sciatic nerve injury, and risk factors were analyzed.Results: A total of 195 patients met the diagnostic criteria for acetabular fractures. The average Injury Severity Score was 25.9 and the average Abbreviated Injury Scale score was 12.4. Road traffic accidents and falls from height were the main causes. Chest injuries and lower extremity fractures were the most common associated injuries. Posterior wall fractures were the most common fracture type. After exclusion of spinal cord and iatrogenic sciatic nerve injuries, 18 patients with acetabular fractures had traumatic sciatic nerve injury. Four of the 19 sides with traumatic sciatic nerve injury involved the common peroneal nerve division and 15 involved both the common peroneal and tibial nerve divisions. Logistic regression analysis identified a higher AIS score, posterior column fracture, and posterior hip dislocation to be predictors of traumatic sciatic nerve injury.Conclusion: Acetabular fractures were mostly high-energy injuries. Posterior wall fractures were the most common acetabular fracture types. Most patients sustained injury to the sciatic nerve as well as injury to the common peroneal and tibial nerve divisions. A higher AIS score, posterior column fracture, and posterior hip dislocation were predictors of acetabular fracture combined with traumatic sciatic nerve injury.Keywords: acetabular fractures, traumatic sciatic nerve injury, posterior hip dislocation

Shun Lu,1 Fanxiao Liu,1 Weicheng Xu,1 Xiaofeng Zhou,2 Lianxin Li,1 Dongsheng Zhou,1 Qinghu Li,1 Jinlei Dong1 1Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan City, Shandong Providence, People’s Republic of China; 2Department of Orthopaedics Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, Shandong Providence, People’s Republic of ChinaCorrespondence: Qinghu Li; Jinlei Dong, Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan City, Shandong Providence, People’s Republic of China, Tel +8613402214695 ; +861509874540, Email sdliqinghu@163.com; dongjinlei@163.comBackground: Open Tile C pelvic fractures are particularly severe. However, reports on their management and outcomes are relatively rare. This study analyzed the demographic and clinical characteristics of patients with open Tile C pelvic fractures and describes our management and outcomes of these injuries.Methods: This retrospective review included all patients with open Tile C pelvic fractures treated in our department between January 2014 and June 2021. Data on patient demographics, characteristics of the injuries, surgical management, and outcomes were analyzed.Results: Thirty patients with a mean age of 34.0 years met the diagnostic criteria. The average Injury Severity Score was 40.3. According to the Tile fracture classification, 6 patients sustained type C1.1, 12 sustained type C1.2, 3 sustained type C1.3, 5 sustained C2 and 4 sustained type C3. Most patients had soft tissue injuries in multiple zones. All patients sustained associated injuries. Management consisted of bed rest in 8 cases, external fixation as the final strategy in 14, conversion from external fixation to internal fixation in 3, open reduction with internal fixation in 5, and amputation in 6. The average amount of packed red blood cells transfused was 33.3 units, the average intensive care unit stay was 11.3 days, the mean number of operations required was 6.2, and the mean length of hospital stay was 81.8 days. The main complications were early soft tissue infections and venous thrombosis. One patient died of sepsis and multi-organ failure. Soft tissue injuries in multiple zones increased utilization of hospital resources whereas anorectal injuries did not. Vascular damage accompanying truck crush injuries had a high amputation rate.Conclusion: Open Tile C pelvic fractures require multidisciplinary diagnosis and management and consume considerable hospital resources. More emphasis needs to be placed on this complex injury.Keywords: open tile C fractures, management, outcomes

Xiaofeng Zhou,1 Bingzhi Wang,2 Yu Liu,1 Zicheng Wang,2 Xuehui Zhao,2 Fanxiao Liu,2 Shun Lu,2 Weicheng Xu,2 Lianxin Li,1,2 Jinlei Dong2 1Department of Orthopaedics Surgery, Shandong Provincial Hospital, Shandong University, Jinan, People’s Republic of China; 2Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of ChinaCorrespondence: Lianxin Li, Department of Orthopaedics, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, 250021, People’s Republic of China, Tel +8613505312449, Email lilianxin@hotmail.com Jinlei Dong, Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China, Tel +861509874540, Email dongjinlei@163.comPurpose: The conventional lateral approach is widely used to treat radial head fractures with screws. However, the traditional incision may have shortcomings, including excessive exposure and significant scarring. We propose an innovative method – a mini-open lateral approach of less than 2.5 cm for surgical treatment of radial head fractures with screws.Methods: From Jan 2017 to Dec 2020, 34 patients diagnosed with closed radial head fracture were treated with open reduction and internal fixation (ORIF) in this study. The novel group (mini-open group) included 15 patients, and the other 19 patients were in the traditional group. The time of operation and the blood loss during operation were recorded. Postoperative clinical outcomes and radiographic results were recorded and compared between the two groups. The range of motion (ROM) in the elbow, the Visual Analogue Scale (VAS), the Mayo Elbow Performance Score (MEPS), Rating Scale of the American Shoulder and Elbow Surgeons (ASES), and the Shortened Disabilities of the Arm, Shoulder and Hand Questionnaire (Q-DASH) score and complications, such as wound infection, vascular and nerve damage, and fragment redisplacement were observed in the two groups.Results: In the comparison between the two groups, there was no significant difference in age, sex, cause of radial head fracture, or other basic information. The operation time, intraoperative blood loss, and VAS score at 3 days postoperation were significantly reduced in the novel group (p < 0.05). The follow-up results showed that there was no significant difference in MEPS, ASES, or Q-DASH scores between the two groups.Conclusion: The mini-open approach reduced intraoperative blood loss, shortened operation time, relieved patient pain, and achieved a satisfactory postoperative clinical result, which demonstrates that the novel approach is a safe and effective option for treating radial head fractures.Keywords: radial head, mini-open, fracture, screw, clinical efficacy

Objective Bariatric surgery (malabsorptive [i.e., biliopancreatic diversion, BPD], restrictive [i.e., sleeve gastrectomy, SG; adjustable gastric banding, AGB] and mixed [i.e., gastric bypass, GB] procedures) has been reported to be associated with an increased risk of fracture; however, which procedure poses the greatest risk of fracture is still controversial. The aim of the current meta-analysis was to investigate the degree of fracture risk after different bariatric procedures. Material and methods Electronic databases, including Medline/PubMed, EMBASE and Cochrane library, were systematically searched from inception to July 11, 2019 with no language restrictions to retrieve randomized controlled trials (RCTs) or cohort studies evaluating the impact of any kind of bariatric surgery on postoperative fractures in patients with obesity. Pairwise meta-analysis and Bayesian network meta-analysis were performed to pool the outcome estimates of interest, including fracture incidence and fracture risk. The values of the surface under the cumulative ranking (SUCRA) probability for fracture risk were calculated and sorted according to the different surgical procedures. Results A total of twelve studies published between 2010 and 2019, comprising 159,916 participants with obesity were identified for the analysis. The incidence of fracture increased from 3% (95% confidence interval [CI] 2–4%) in patients with non-surgical intervention (drug treatment, alteration in life style and diet control) to 5% (95% CI 4–7%) in those who had undergone bariatric surgery (pooled relative risk [RR] = 1.41 95% CI: 1.22–1.63). Network meta-analysis revealed that based on the SUCRA ranking of the different surgical procedures, the malabsorptive procedure had the highest possibility of increased fracture risk in patients with obesity (74.75%), followed by the mixed procedures (73.85%), nonsurgical intervention (43.55%) and the restrictive procedure (7.85%); for different surgery types. The BPD group had the highest possibility of increased fracture risk (99.49%), followed by the GB (74.92%), nonsurgical intervention (44.49%), AGB (26.64%) and SG (4.45%) groups. Conclusions Significant differences exist among different bariatric surgeries impacting on fracture risk. The malabsorptive and mixed procedures, but not the restrictive procedure, increase the postoperative risk of fracture. Considering the weight-reduction effects and fracture risk, the sleeve gastrectomy procedure may be the best choice for patients with obesity, especially those who are susceptible to osteoporosis.

This meta-analysis was performed systematically to evaluate the efficacy of subacromial balloon spacers for patients with massive, irreparable rotator cuff tears. Electronic databases, including Medline/PubMed, Embase and Cochrane Library, were systematically searched to identify studies evaluating the efficacy of subacromial spacers for patients with irreparable or massive rotator cuff tears. Meta-analyses were performed to pool the outcome estimates of interest, such as the total constant score (TCS) and its sub-score (pain, activities of daily living [ADL], range of motion [ROM], and strength), Oxford shoulder score (OSS), American Shoulder and Elbow Society scores (ASES) and numeric rating scale (NRS), as well as different outcomes at different time points in the follow-up period. Ten studies with a total of 261 patients involving 270 shoulders were deemed viable for inclusion in the meta-analysis. The combined results demonstrated significant improvements in the TCS at the final follow-up (pooled mean difference = 26.4, 95% confidence intervals [CIs] 23.3 to 29.5). A sensitivity analysis and subgroup analysis, which were implemented based on two factors, different follow-up points and sub-scores (pain, ADL, ROM, and strength), revealed a consistent trend. The combined shoulder motion results demonstrated significant improvements in the forward flexion and external rotation (0° abduction) variables rather than in the abduction and external rotation (90° abduction) variables. Additionally, significant improvements in the OSS and ASES and a decrease in the NRS were observed in the middle of the follow-up period. This meta-analysis indicated that subacromial balloon spacer implantation for patients with massive irreparable rotator cuff tears may achieve satisfactory outcomes between 3 months and 3 years of follow-ups. Although the short- and middle- term effect is significant, the long-term effect needs to be confirmed by large-sample randomized controlled trial. IV.

BackgroundThe purpose of this study was to evaluate a new method for treating neglected hip dislocation with limb length discrepancy by using external fixation-assisted pre-reduction.MethodsThirteen patients admitted between January 2010 to February 2018 with a mean duration from injury to surgery of 5.0 ± 2.1 months and an average preoperative leg-length discrepancy of 7.7 ± 2.3 cm were enrolled in this study. The dislocation and associated acetabular fracture type, clinical outcomes and residual limb length discrepancy were evaluated.ResultsAll patients had posterior dislocations, and nine patients presented with acetabular fractures and were followed-up for at least 12 months. The average traction duration of external fixators was 28.8 ± 8.0 days and all patients received second-stage open reduction and internal fixation. Six patients showed residual limb length discrepancy within 2 cm. Patients showed significant improvement in hip function and pain relief. Complications including avascular femoral head necrosis and osteoarthritis occurred in three patients.ConclusionEffective correction of limb length discrepancy and improved function were observed in patients with neglected hip dislocations and limb equality using traction by external fixation combined with second-stage open reduction. Further follow-up is required to determine long-term outcomes.

Background Numerous quantitatively based studies measuring the association between gout and the risk of fractures remain inconclusive. In order to determine whether gout could increase the risk of fractures, a meta-analysis was performed systematically. Methods Electronic databases, MEDLINE/PubMed, Embase, and Cochrane Library were systematically searched to identify studies evaluating the association of gout and the risk of fractures. No restrictions on language, publication date, or journal of publication were imposed. Meta-analysis was performed to pool the outcome estimates of interest such as fracture incidence, fracture risk, and fracture risk in different sites and at different time points in the follow-up period. Results Screening determined that seven studies involving a total of 684,964 participants (151,002 in the gout group and 533,962 in the control group) were deemed viable for inclusion in the meta-analysis. The results of the analysis showed that gout would not significantly have a relatively higher risk of any fracture (RR = 1.11, 95% CI 0.98–1.26). Subgroup analysis showed consistent results for sexuality (female: RR = 1.13, 95% CI 0.93–1.37; male: RR = 0.99, 95% CI 0.91–1.07) and several occurring sites (humerus, wrist, vertebra, hip, upper limbs, and lower limbs). Additionally, the results demonstrated that urate-lowering drugs prescribed early during disease had neither adverse nor beneficial effect on the long-term risk of fractures (RR = 0.89, 95% CI 0.76–1.05). Conclusions This meta-analysis confirmed that gout was not associated with an increased risk of fractures. Urate-lowering drugs prescribed early during the course of disease had neither adverse nor beneficial effect on the long-term risk of fractures. Electronic supplementary material The online version of this article (10.1186/s13018-019-1317-4) contains supplementary material, which is available to authorized users.

Background Multiple trials have attempted to assess the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in osteosarcoma with results remaining inconclusive. This study aims to investigate the effectiveness of 18F-FDG PET and PET/CT in the diagnosis, staging, recurrence and metastasis formation observations of osteosarcoma through systematic review followed by meta-analysis. Methods Three electronic databases, Medline/PubMed, Embase and the Cochrane Library were utilized in this study. Eligible studies that assessed the performance of 18F-FDG PET/CT for the diagnosis, staging, restaging and recurrence monitoring of osteosarcoma were retrieved utilizing specific search criteria. After screening and diluting out the non-conforming articles, all relevant articles and their data were identified and extracted to calculate the summary metrics involving sensitivity, specificity, diagnostic odd ratio (DOR), and area under the curve (AUC) to determine the effectiveness of 18F-FDG PET in diagnosing osteosarcoma clinically. Results Out of 1976 articles searched, twenty-six studies were identified that were viable. All data from these articles, utilized in the quantitative analyses, showed after meta-analysis that when utilizing 18F-FDG PET or PET/CT it was better with a success rate of 90–100% for detecting primary lesions and distant metastases of patients with osteosarcoma. Similar results were also obtained for detecting lung and bone metastases in a subgroup analysis. Conclusions As such the investigation demonstrated that 18F-FDG PET and PET/CT are very accurate for the diagnosis, staging and recurrence monitoring of osteosarcoma. 18F-FDG-avid lesions should be further examined in osteosarcoma, especially for suspicious lung lesions.

Background and hypothesis The typical anterolateral approach is widely used to treat proximal humerus fractures with lateral locking fixation. However, lateral fixation cannot completely avoid medial reduction loss and varus deformity especially in the cases of an unstable medial column. We present a novel medial surgical approach and technique together with a minimally invasive lateral locking plate to fix proximal humerus fractures with an unstable medial column. Materials and methods We performed an anatomical study and reported 8 cases of proximal humerus fractures with unstable medial columns treated with plate fixation through a minimally invasive anterolateral approach and medial approach. All surgeries were performed by the same single surgeon. Patients were followed clinically and radiographically at 1, 3, 6, and 12 months postoperatively. Results There was a safe region located at the medial part of the proximal humerus just beneath the articular surface. An anatomical medial locking proximal humerus plate could be placed in the medial column and did not affect the axillary nerve, blood supply of the humeral head, or stability of the shoulder joint. Successful fracture healing was achieved in all 8 cases. The function and range of motion of the shoulder joint were satisfactory 24 months postoperatively, with an average Constant score (CS) of 82.8. No reduction loss (≥ 10° in any direction), screw cutout, nonunion, or deep infection occurred. Conclusions The combined application of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation is effective in maintaining operative reduction and preventing varus collapse and implant failure in proximal humerus fractures with an unstable medial column.

Background: This study aims to compare the diagnostic accuracy of magnetic resonance imaging (MRI) and MR arthrography (MRA) for the articular-sided partial-thickness rotator cuff tear (PTRCT).Methods: Three electronic databases, PubMed/Medline, Embase and Cochrane Library, were utilized to retrieve articles comparing the diagnostic value of MRA and MRI for detecting articular-sided PTRCTs. The pooled statistical indexes included sensitivity, specificity, positive/negative predictive value, diagnostic odds ratio (DOR) and the area under receiver operating characteristic curve (AUC). Results: Eleven studies involving 1703 patients and 1704 shoulders were included. The pooled sensitivity, specificity, DOR and AUC and their 95% CIs of MRA to diagnose articular-sided PTRCTs were 0.81 (95% CI, 0.65-0.90), 0.96 (95% CI, 0.91-0.98), 68.14 (95% CI, 33.20-139.84) and 0.96 (95% CI, 0.94-0.97), respectively. The pooled sensitivity, specificity, DOR and AUC and their 95% CIs of MRI were 0.78 (95% CI, 0.65-0.87) and 0.97 (95% CI, 0.84-0.99), 47.82 (95% CI, 8.29-275.89) and 0.89 (95% CI, 0.86-0.92), respectively.Conclusions: This meta-analysis reveals that MRA has a better diagnostic value than that of MRI for the diagnosis of articular-sided partial-thickness rotator cuff tears, but only small improvement of sensitivity. Considering the price and invasion of MRA, MRI is recommended as an initial examination to detect patients suspected with articular-side partial-thickness rotator cuff tears.

Background Pelvic packing (PP) has been increasingly used for bleeding control in severe pelvic trauma. However, its effectiveness remains controversial. This meta-analysis was performed systematically to determine the efficiency of PP in pelvic fracture patients with hemodynamic instability. Methods Three databases, PubMed, Embase and Cochrane Library were systematically searched to identify studies presenting comparisons between protocol including PP and protocol without PP. Mortality, transfusion requirement and length of hospitalization were extracted and pooled for meta-analysis. Relative risk (RR) or standard mean difference (SMD) with their confidence interval (CI) was used for the pooled statistical indexes included mortality, transfusion requirement and length of hospitalization. Results Ten studies involving 560 patients were identified eligible for meta-analysis. A significantly reduced overall mortality (RR = 0.63, 95% CI = 0.50 to 0.79, p

Additional file 1: Appendix Table 1. Included studies, with website links enabling direct access to each corresponding article abstract. Appendix figure 1. Contribution plot for the comparison of micromotions in four directions at the proximal, middle and distal portion of femoral stem surface.

Open pelvic fractures associated with rectal injuries are uncommon. They often cause serious pelvic infection, even death. This combination of injuries has been reviewed infrequently. Herein, we report factors associated with pelvic infection and death in a group of patients with open pelvic fractures and concurrent rectal injuries.We retrospectively reviewed the records of patients with open pelvic fractures and rectal injuries who were treated at our institution from January 2010-April 2014. From the medical records, age, gender, Injury Severity Score (ISS), cause of fracture, associated injuries, classification of the fracture, degree of soft-tissue injury, Glasgow Coma Score (GCS), Revised Trauma Score (RTS), packed red blood cells (PRBCs) needed, presence/absence of shock, early colostomy (yes or no), drainage (yes or no), and rectal washout (yes or no) were extracted. Univariable and multivariable analysis were performed to determine the association between risk factors and pelvic infection or death.Twenty patients were identified. Pelvic infection occurred in 50% (n = 10) of the patients. Four patients suffered septicemia, and three patients died of multiple organ dysfunction. The mortality rate thus was 15%. According to the univariable analysis, the patients in whom pelvic infection developed had shock, RTS ≤8, GCS ≤8, blood transfusion ≥10 units in the first 24 h, no colostomy, or Gustilo grade III soft-tissue injury. According to the multivariable analysis, shock and absence of colostomy were independently associated with pelvic infection. By univariable analysis, the only factor associated with death was RTS ≤8.The incidence of pelvic infection was lower in patients having early colostomy (p 0.05). Patients with shock had a higher risk of pelvic infection, and we recommend aggressive measures to treat these patients. According to our results, RTS ≤8 could be a predictor of poor outcomes in patients with open pelvic fracture and concurrent rectal injury. Open reduction and internal fixation after extensive debridement is recommended in patients with unstable pelvic fractures.

The aim of this study was to compare the accuracy of available nuclear imaging modalities in the diagnosis of suspected fracture-related infection (FRI). We conducted a comprehensive literature search of PubMed, EMBASE and the Cochrane Library to retrieve diagnostic accuracy studies in which FRI was investigated using different nuclear imaging modalities. The pooled sensitivity, specificity, likelihood ratios and diagnostic odds ratios were constructed using the bivariate meta-analysis framework, while the superior index was pooled using Bayesian network meta-analysis. 22 eligible studies (1,565 patients) were included in the quantitative analysis. A broad overlapping confidence interval (CI) of pooled sensitivity was observed among bone scintigraphy (0.94; 95% CI 0.85–0.98), 18F-FDG PET and PET/CT (0.91; 95% CI 0.85–0.94) and leukocyte scintigraphy (0.86; 95% CI 0.53–0.97). Bone scintigraphy (0.34; 95% CI 0.08–0.75) seemed to be less specific than all the other modalities, while leukocyte scintigraphy (0.96, 95% CI 0.92–0.98) was notably more specific than 18F-FDG PET and PET/CT (0.78; 95% CI 0.69–0.85). Based on the superiority index, 18F-FDG PET/CT (3.78; 95% CI 0.14–11.00), 18F-FDG PET (2.98; 95% CI 0.14–9.00) and leukocyte scintigraphy (1.51; 95% CI 0.11–7.00) all achieved high accuracy in detecting FRI. Bone scintigraphy is a highly sensitive nuclear imaging technique but lacks the specificity needed to unequivocally differentiate among various conditions suspected to be FRI. Leukocyte scintigraphy, 18F-FDG PET/CT and PET all present good satisfactory accuracy for the diagnosis of FRI, but their costs should be further reduced to promote their wide application.

Background Multiple published studies quantitatively analysing the diagnostic value of MRI, MR arthrography (MRA) and CT arthrography (CTA) for labral lesions of the shoulder have had inconsistent results. The aim of this meta-analysis was to systematically compare the diagnostic performance of MRI, MRA, CTA and CT. Methods Two databases, PubMed and EMBASE, were used to retrieve studies targeting the accuracy of MRI, MRA, CTA and CT in detecting labral lesions of the shoulder. After carefully screening and excluding studies, the studies that met the inclusion criteria were used for a pooled analysis, including calculation of sensitivity and specificity with 95% confidence intervals (CIs) and the area under the hierarchical summary receiver operating characteristic (HSROC) curves. Results The retrieval process identified 2633 studies, out of which two reviewers screened out all but 14 studies, involving a total of 1216 patients who were deemed eligible for inclusion in the meta-analysis. The results assessing the diagnostic performance of MRI vs. MRA for detecting labral lesions showed a pooled sensitivity of 0.77 (95% CI 0.70–0.84) vs. 0.92 (95% CI 0.84–0.96), a specificity of 0.95 (95% CI 0.85–0.98) vs. 0.98 (95% CI 0.91–0.99), and an area under the HSROC curve of 3.78 (95% CI 2.73–4.83) vs. 6.01 (95% CI 4.30–7.73), respectively. Conclusion MRA was suggested for use in patients with chronic shoulder symptoms or a pathologic abnormality. MRI is by far the first choice recommendation for the detection of acute labral lesions. CT should be a necessary supplemental imaging technique when there is highly suspected glenoid bone damage.

Abstract Background: The purpose of this study is to evaluate a new method for treating obsolete acetabular dislocation with limb discrepancy by external fixation assisted pre-reduction. Methods: Thirteen patients admitted from January 2010 to February 2018 with a mean duration from injury to surgery of 5.0±2.1 months and an average preoperative leg-length discrepancy of 7.7±2.3 cm were enrolled in this study. The dislocation and associated acetabular fracture type, clinical outcomes and residual limb equality were evaluated. Results: All patients were posterior dislocations and nine presented with acetabular fractures and were followed-up at least 12 months. The average traction duration of external fixators was 28.8±8.0 days and all patients received second-stage open reduction and internal fixation. Six patients showed residual limb discrepancy within 2 cm. Patients showed significant improvement in hip function and pain relief. Complications including avascular femoral head necrosis and osteoarthritis occurred in 3 patients. Conclusion: Effective correction of limb discrepancy and improved function showed in patients with obsolete acetabular dislocations and limb equality using traction by external fixation combined with second-stage open reduction. The long-term outcomes need continued follow-up.

Abstract Background: The purpose of this study is to evaluate a new method for treating obsolete acetabular dislocation with limb discrepancy by external fixation assisted pre-reduction. Methods: Thirteen patients admitted from January 2010 to February 2018 with a mean duration from injury to surgery of 5.0±2.1 months and an average preoperative leg-length discrepancy of 7.7±2.3 cm were enrolled in this study. The dislocation and associated acetabular fracture type, clinical outcomes and residual limb equality were evaluated. Results: All patients were posterior dislocations and nine presented with acetabular fractures and were followed-up at least 12 months. The average traction duration of external fixators was 28.8±8.0 days and all patients received second-stage open reduction and internal fixation. Six patients showed residual limb discrepancy within 2 cm. Patients showed significant improvement in hip function and pain relief. Complications including avascular femoral head necrosis and osteoarthritis occurred in 3 patients. Conclusion: Effective correction of limb discrepancy and improved function showed in patients with obsolete acetabular dislocations and limb equality using traction by external fixation combined with second-stage open reduction. The long-term outcomes need continued follow-up.

Background Pelvic ring fractures associated with vaginal injuries were rarely reported due to low incidence. The displaced segments of pelvic ring may increase the risk of vaginal injury. The aim of this retrospective study was to evaluate the correlation between pelvic fracture and vaginal injury. Methods We conducted a retrospective review of 25 patients with pelvic fractures associated with vaginal injury treated at our institution. The medical records of these patients were collected and 24 patients were followed-up for 10–36 months. Results All patients suffered anterior pelvic ring fracture. Young-Burgess fracture classification and compromised pubic symphysis were related to severity of vaginal injury. Gauze packing was done in 6 patients and 18 patients received surgical repair. Infection occurred in 6 patients, among them 4 were due to delayed diagnosis. Factors associated with pelvic outcome were age, urethral injury, and infection. Four patients suffered pain in sexual intercourse but no influence factor found correlated to sexual function. Conclusion VS type pelvic fracture and compromised pubic symphysis were related to higher severity of vaginal injury. Disruption of anterior ring and an unstable pelvic ring caused by forces on coronary and axial plane may increase the risk of vaginal injury. Trial registration ChiCTR1900020540. Registered 28 January 2019. Retrospectively registered. Trial registry: Chinese Clinical Trial Registry.

Table S2. Detailed information of the RNA-Seq data. (DOCX 22 kb)

Table S4. Significantly enriched GO biological process terms for 2422 common up-regulated differentially expressed genes. (DOCX 16 kb)

Table S3. Significantly enriched GO biological process terms for 2096 common down-regulated differentially expressed genes. (DOCX 22 kb)

Supplementary figures 1â 3 and table 1. (DOC 2252 kb)

PRISMA checklist. The checklist of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). (DOC 64 kb)

To investigate the feasibility of using hyperspectral imaging technology to discriminate kiwifruits treated with forchlorfenuron at different concentrations, “Hayward” kiwifruits were treated with forchlorfenuron solutions at concentrations of 2.5, 5.0, 7.5, 10.0, and 12.5 mg/L at 15 days after petal fall. Hyperspectral images of 400 samples, including 100 untreated kiwifruits and 60 treated kiwifruits at each forchlorfenuron concentration, were acquired. Mask was done for each image and mean spectrum was calculated for analysis. The original spectra were preprocessed by standard normal variate and all samples were divided into calibration set and prediction set based on Duplex algorithm according to the ratio of 2:1. The calibration set included 67 untreated kiwifruits and 200 treated kiwifruits, including 40 kiwifruits at each forchlorfenuron concentration. Other 133 kiwifruits were used as the prediction set. Twenty-nine characteristic wavelengths were selected from the full spectra from 928.19 to 1,658.19 nm using successive projection algorithm (SPA). Four discrimination models, i.e., partial least squares discriminant analysis, support vector machine, extreme learning machine, and random forests were established with the full spectra and the selected characteristic wavelengths as inputs, respectively. The results showed that the best model, with 97.7 % accuracy rate, for “Hayward” kiwifruits treated with forchlorfenuron was SVM established using selected characteristic wavelengths by SPA. This study indicates that hyperspectral imaging technology can be used to nondestructively and accurately discriminate forchlorfenuron-treated kiwifruits with different concentrations from untreated ones.

Background Numerous quantitatively based studies measuring the accuracy of MRI and MRA for the diagnosis of rotator cuff tears remain inconclusive. In order to compare the accuracy of MRI with MRA in detection of rotator cuff tears a meta-analysis was performed systematically. Methods PubMed/Medline and Embase were utilized to retrieve articles comparing the diagnostic performance of MRI and MRA for use in detecting rotator cuff tears. After screening and diluting out the articles that met inclusion criteria to be used for statistical analysis the pooled evaluation indexes including sensitivity and specificity as well as hierarchical summary receiver operating characteristic (HSROC) curves with 95% confidence interval (CI) were calculated. Results Screening determined that 12 studies involving a total of 1030 patients and 1032 shoulders were deemed viable for inclusion in the meta-analysis. The results of the analysis showed that MRA has a higher sensitivity and specificity than MRI for the detection of any tear; similar results were observed in the detection of full-thickness tears. However, for the detection of partial-thickness tear, MRI has similar performance with MRA. Conclusion MRI is recommended to be a first-choice imaging modality for the detection of rotator cuff tears. Although MRA have a higher sensitivity and specificity, it cannot replace MRI after the comprehensive consideration of accuracy and practicality.