Violence-related injuries (VRIs) remain a major contributor to trauma-related mortality worldwide. We evaluated the case fatality rates (CFRs) of VRIs stratified by sex. We hypothesized that sex differences affect the CRF following VRIs.
Methods
A retrospective analysis was conducted using data from the American College of Surgeons Trauma Quality Programs and ICD-10 for VRIs.
Results
Among 522,939 VRIs patients, males accounted for 82.8% with higher mortality than females (7.5% vs. 5.6%). Males had higher CFRs than females among firearm-related injuries (16.3% vs. 15.2%), and Self-inflicted harm (SIH) (21.9% vs. 12.1%). In Interpersonal violence, CFRs among White females and Black males were 19.7% and 15.8%, respectively. For SIH, firearm lethality was higher among older White males ≥ 65 years (64.3%) and young Black males aged 36–45 (57.8%). Firearm injury (OR 18.49) and male sex (OR 1.21) were independent predictors for mortality.
Conclusion
Sex-based disparities in VRIs in the United States are evident, notably in firearm injuries and SIH, underscoring the need for targeted injury prevention.
背景：与暴力有关的伤害（VRIs）仍然是世界范围内与创伤有关的死亡率的主要原因。我们评估了按性别分层的vri病死率（CFRs）。我们假设性别差异影响vri后的CRF。方法：回顾性分析美国外科医师学会创伤质量计划和ICD-10关于vri的数据。结果：522,939例VRIs患者中，男性占82.8%，死亡率高于女性（7.5% vs. 5.6%）。在枪支相关伤害（16.3%比15.2%）和自我伤害（21.9%比12.1%）中，男性的CFRs高于女性。在人际暴力中，白人女性和黑人男性的CFRs分别为19.7%和15.8%。对于SIH，年龄≥65岁的老年白人男性（64.3%）和年龄36-45岁的年轻黑人男性（57.8%）的枪支致死率较高。火器伤害（OR 18.49）和男性性别（OR 1.21）是死亡率的独立预测因素。结论：在美国，基于性别的vri差异是明显的，特别是在枪支伤害和SIH方面，强调了有针对性的伤害预防的必要性。
{"title":"Sex-based case fatality rate of violence-related injuries among 522,939 patients: Retrospective analysis","authors":"Ayman El-Menyar , Ahammed Mekkodathil , Sandro Rizoli , Sagar Galwnkar , Peter Cameron , Ibrahim Fawzy Hassan , Hassan Al-Thani","doi":"10.1016/j.injury.2026.113078","DOIUrl":"10.1016/j.injury.2026.113078","url":null,"abstract":"<div><h3>Background</h3><div>Violence-related injuries (VRIs) remain a major contributor to trauma-related mortality worldwide. We evaluated the case fatality rates (CFRs) of VRIs stratified by sex. We hypothesized that sex differences affect the CRF following VRIs.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted using data from the American College of Surgeons Trauma Quality Programs and ICD-10 for VRIs.</div></div><div><h3>Results</h3><div>Among 522,939 VRIs patients, males accounted for 82.8% with higher mortality than females (7.5% vs. 5.6%). Males had higher CFRs than females among firearm-related injuries (16.3% vs. 15.2%), and Self-inflicted harm (SIH) (21.9% vs. 12.1%). In Interpersonal violence, CFRs among White females and Black males were 19.7% and 15.8%, respectively. For SIH, firearm lethality was higher among older White males ≥ 65 years (64.3%) and young Black males aged 36–45 (57.8%). Firearm injury (OR 18.49) and male sex (OR 1.21) were independent predictors for mortality.</div></div><div><h3>Conclusion</h3><div>Sex-based disparities in VRIs in the United States are evident, notably in firearm injuries and SIH, underscoring the need for targeted injury prevention.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113078"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-12-13DOI: 10.1016/j.injury.2025.112966
Zhenglong Liu , Fei Zhang , Jiaqi Li, Lei Guo, Wei Zhang, Yapeng Sun
Objective
To investigate the clinical application value of a novel tappable, lateral-hole, variable-angle bone grafting tool for injured vertebra bone grafting combined with screw placement in the injured vertebra, in the context of short-segment fixation via an intermuscular approach for thoracolumbar fractures.
Methods
A retrospective study was conducted on 74 patients treated between January 2022 and June 2024. Patients were divided into three groups: Group A (n = 25) received conventional bone grafting without screw placement in the injured vertebra; Group B (n = 26) received conventional bone grafting with screw fixation; Group C (n = 23) received grafting with the novel tool plus screw fixation. Vertebral kyphosis angle (VKA), local kyphosis angle (LKA), superior endplate displacement (SED), Visual Analog Scale (VAS) scores, and complications were analyzed preoperatively, postoperatively, and at 3-month follow-up. Bone defect volume in Groups B and C was assessed using Mimics software on CT 3D reconstructions.
Results
There were no significant differences in sex, age, operative time, or hospital stay among the three groups (P > 0.05). Preoperative and 1-week postoperative VAS scores were similar among the groups (P > 0.05). At 3 months postoperatively, VAS scores in Group C were significantly lower than in Groups A and B (P < 0.05). Groups B and C exhibited significantly less loss of vertebral kyphosis angle (VKAloss) compared to Group A (p = 0.011). There were no significant differences in LKA among the three groups before surgery, after surgery, or at the 3-month follow-up (P > 0.05). Changes in SED values before and after surgery were consistent with VKA, and the SEDloss value in Group C was significantly lower than in Groups A and B at 3 months postoperatively (p < 0.001). Compared to Group B, Group C showed a significant reduction in fracture defect volume at 3 months postoperatively (p = 0.006).
Conclusion
The novel bone grafting tool provides effective vertebral support with high grafting efficiency, reduced pedicle damage, and improved postoperative outcomes. Its ease of use makes it a valuable addition to thoracolumbar fracture treatment via the intermuscular approach.
{"title":"Application value of a novel tappable bone grafting tool with variable angle lateral window in short-segment fixation via intermuscular approach for thoracolumbar fractures","authors":"Zhenglong Liu , Fei Zhang , Jiaqi Li, Lei Guo, Wei Zhang, Yapeng Sun","doi":"10.1016/j.injury.2025.112966","DOIUrl":"10.1016/j.injury.2025.112966","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the clinical application value of a novel tappable, lateral-hole, variable-angle bone grafting tool for injured vertebra bone grafting combined with screw placement in the injured vertebra, in the context of short-segment fixation via an intermuscular approach for thoracolumbar fractures.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted on 74 patients treated between January 2022 and June 2024. Patients were divided into three groups: Group A (<em>n</em> = 25) received conventional bone grafting without screw placement in the injured vertebra; Group B (<em>n</em> = 26) received conventional bone grafting with screw fixation; Group C (<em>n</em> = 23) received grafting with the novel tool plus screw fixation. Vertebral kyphosis angle (VKA), local kyphosis angle (LKA), superior endplate displacement (SED), Visual Analog Scale (VAS) scores, and complications were analyzed preoperatively, postoperatively, and at 3-month follow-up. Bone defect volume in Groups B and C was assessed using Mimics software on CT 3D reconstructions.</div></div><div><h3>Results</h3><div>There were no significant differences in sex, age, operative time, or hospital stay among the three groups (<em>P</em> > 0.05). Preoperative and 1-week postoperative VAS scores were similar among the groups (<em>P</em> > 0.05). At 3 months postoperatively, VAS scores in Group C were significantly lower than in Groups A and B (<em>P</em> < 0.05). Groups B and C exhibited significantly less loss of vertebral kyphosis angle (VKAloss) compared to Group A (<em>p</em> = 0.011). There were no significant differences in LKA among the three groups before surgery, after surgery, or at the 3-month follow-up (<em>P</em> > 0.05). Changes in SED values before and after surgery were consistent with VKA, and the SEDloss value in Group C was significantly lower than in Groups A and B at 3 months postoperatively (<em>p</em> < 0.001). Compared to Group B, Group C showed a significant reduction in fracture defect volume at 3 months postoperatively (<em>p</em> = 0.006).</div></div><div><h3>Conclusion</h3><div>The novel bone grafting tool provides effective vertebral support with high grafting efficiency, reduced pedicle damage, and improved postoperative outcomes. Its ease of use makes it a valuable addition to thoracolumbar fracture treatment via the intermuscular approach.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 112966"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-08DOI: 10.1016/j.injury.2026.113015
Avinash Kumar Rai , Shaheer Mujahid , Mohammed Suhail, Yash Jain, Rachael McManus, Anwar Jafri, Manju Ramappa, Antoni Nargol, Nick Cooke, Raghavendra Sidaginamale
Background
Periprosthetic femoral fractures (PFFs) are increasingly common as arthroplasty rates rise, with incidence projected to double in the next two decades. Mortality approaches that of hip fractures, with 1-year rates of 22–27 % reported in multicentre datasets. While favourable outcomes are often described from high-volume centres, most PFFs present to secondary care, where resources and surgical expertise may be limited. This study evaluates whether a structured multidisciplinary team (MDT) pathway with a weekly dedicated periprosthetic theatre list can achieve outcomes comparable to national and international benchmarks in a UK district hospital.
Methods
We retrospectively reviewed all PFFs managed between 2013 and 2024 at a district hospital (n = 258) in a trauma unit with fellowship trained arthroplasty surgeons, a dedicated Orthogeriatric team and weekly periprosthetic lists. Demographics, comorbidities (Charlson Comorbidity Index, ASA), fracture type (Vancouver classification), surgical management (fixation vs revision), and outcomes were analysed. Primary outcomes were 30-day and 1-year mortality. Secondary outcomes included discharge destination, restoration of mobility, complications, and reoperation rates. Results were compared with national and international studies.
Results
Mean age was 80 years (median 82) with majority (60 %) being female. 213 (82.8 %) patients were managed operatively after multidisciplinary discussions. In-hospital mortality was 1.2 % (n = 3), 30-day mortality 3.5 %(n = 9) and one year mortality rate was 19.8 %. Mean CCI was 4.8 and one-year mortality was markedly higher in patients with CCI ≥4. Length of hospital stay increased progressively with surgical delay. Among those managed operatively, 63.5 % (n = 87) returned to their original place of residence.
Conclusion
A weekly dedicated periprosthetic list with MDT involvement allowed a district hospital to achieve mortality and functional outcomes equal to, or better than, those reported from high-volume centres. These findings highlight that system-level interventions, not hospital size, are the decisive factor in PFF outcomes, and provides a scalable model for hospitals globally.
{"title":"Long term outcomes in periprosthetic femoral fractures: Experience from a UK district general hospital with a weekly dedicated periprosthetic theatre list and MDT approach","authors":"Avinash Kumar Rai , Shaheer Mujahid , Mohammed Suhail, Yash Jain, Rachael McManus, Anwar Jafri, Manju Ramappa, Antoni Nargol, Nick Cooke, Raghavendra Sidaginamale","doi":"10.1016/j.injury.2026.113015","DOIUrl":"10.1016/j.injury.2026.113015","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic femoral fractures (PFFs) are increasingly common as arthroplasty rates rise, with incidence projected to double in the next two decades. Mortality approaches that of hip fractures, with 1-year rates of 22–27 % reported in multicentre datasets. While favourable outcomes are often described from high-volume centres, most PFFs present to secondary care, where resources and surgical expertise may be limited. This study evaluates whether a structured multidisciplinary team (MDT) pathway with a weekly dedicated periprosthetic theatre list can achieve outcomes comparable to national and international benchmarks in a UK district hospital.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed all PFFs managed between 2013 and 2024 at a district hospital (<em>n</em> = 258) in a trauma unit with fellowship trained arthroplasty surgeons, a dedicated Orthogeriatric team and weekly periprosthetic lists. Demographics, comorbidities (Charlson Comorbidity Index, ASA), fracture type (Vancouver classification), surgical management (fixation vs revision), and outcomes were analysed. Primary outcomes were 30-day and 1-year mortality. Secondary outcomes included discharge destination, restoration of mobility, complications, and reoperation rates. Results were compared with national and international studies.</div></div><div><h3>Results</h3><div>Mean age was 80 years (median 82) with majority (60 %) being female. 213 (82.8 %) patients were managed operatively after multidisciplinary discussions. In-hospital mortality was 1.2 % (<em>n</em> = 3), 30-day mortality 3.5 %(<em>n</em> = 9) and one year mortality rate was 19.8 %. Mean CCI was 4.8 and one-year mortality was markedly higher in patients with CCI ≥4. Length of hospital stay increased progressively with surgical delay. Among those managed operatively, 63.5 % (<em>n</em> = 87) returned to their original place of residence.</div></div><div><h3>Conclusion</h3><div>A weekly dedicated periprosthetic list with MDT involvement allowed a district hospital to achieve mortality and functional outcomes equal to, or better than, those reported from high-volume centres. These findings highlight that system-level interventions, not hospital size, are the decisive factor in PFF outcomes, and provides a scalable model for hospitals globally.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113015"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-10DOI: 10.1016/j.injury.2026.113040
Mao Xu , Xin Gao , Shujin Li , Xuhuizi Liu , Bing Li , Xinxin Jin
Background
Osteoarthritis (OA) is a chronic joint disease characterized by degeneration of the articular cartilage, synovial inflammation and subchondral bone sclerosis. There is currently no effective drug treatments for late stage OA.
Methods
Here, we prepare injectable resveratrol (Res) thermosensitive hydrogels, detect its microscopic morphology and release in vitro. Then observing its therapeutic effect on C57BL/6 mice in vivo and femoral heads in vitro also used. Characterization of temperature-sensitive resveratrol gel, chondrosynthesis and catabolism genes, morphology of joint and femoral head from mice. Expression of sirtuin1(SIRT1) and hypoxia inducible factor-1α (HIF1α) is also detected in vivo and in vitro. IL-1β is used to imitate an in vitro osteoarthritis model.
Results
Res hydrogels show excellent strain, injectability and temperature sensitive properties, and have an apparent protective effect on the OA articular cartilage. P53 and P21 elevated in DMM mice, when HIF1α and matrix metalloproteinase 13 (MMP13) both increased similarly. While Res activates SIRT1 by suppressing HIF1α nucleus-shuttling to promote chondrocytes proliferation and reduce hypertrophy.
Conclusion
Taken together, injectable resveratrol thermosensitive hydrogel protects the articular cartilage from degradation and reduces the damage to joints caused by mechanical stress via SIRT1/ HIF1α/MMP13 pathway.
{"title":"Injectable thermosensitive hydrogel delivering resveratrol protects articular cartilage via SIRT1/HIF1α/MMP13 signaling","authors":"Mao Xu , Xin Gao , Shujin Li , Xuhuizi Liu , Bing Li , Xinxin Jin","doi":"10.1016/j.injury.2026.113040","DOIUrl":"10.1016/j.injury.2026.113040","url":null,"abstract":"<div><h3>Background</h3><div>Osteoarthritis (OA) is a chronic joint disease characterized by degeneration of the articular cartilage, synovial inflammation and subchondral bone sclerosis. There is currently no effective drug treatments for late stage OA.</div></div><div><h3>Methods</h3><div>Here, we prepare injectable resveratrol (Res) thermosensitive hydrogels, detect its microscopic morphology and release <em>in vitro</em>. Then observing its therapeutic effect on C57BL/6 mice <em>in vivo</em> and femoral heads <em>in vitro</em> also used. Characterization of temperature-sensitive resveratrol gel, chondrosynthesis and catabolism genes, morphology of joint and femoral head from mice. Expression of sirtuin1(SIRT1) and hypoxia inducible factor-1α (HIF1α) is also detected <em>in vivo</em> and <em>in vitro</em>. IL-1β is used to imitate an <em>in vitro</em> osteoarthritis model.</div></div><div><h3>Results</h3><div>Res hydrogels show excellent strain, injectability and temperature sensitive properties, and have an apparent protective effect on the OA articular cartilage. P53 and P21 elevated in DMM mice, when HIF1α and matrix metalloproteinase 13 (MMP13) both increased similarly. While Res activates SIRT1 by suppressing HIF1α nucleus-shuttling to promote chondrocytes proliferation and reduce hypertrophy.</div></div><div><h3>Conclusion</h3><div>Taken together, injectable resveratrol thermosensitive hydrogel protects the articular cartilage from degradation and reduces the damage to joints caused by mechanical stress via SIRT1/ HIF1α/MMP13 pathway.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113040"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-22DOI: 10.1016/j.injury.2026.113060
Linda Xu , Lauren Whitney , Huiyin Tu , Anthony J. Evans, Abigail Klammer, Aaron N. Barksdale, Michael C. Wadman, Yu-Long Li
Tourniquet use is the most effective tool for controlling life-threatening extremity hemorrhage before other treatments and for creating bloodless operating fields in surgical procedures. However, tourniquet-induced ischemia-reperfusion (tourniquet/IR) also causes skeletal muscle injury and is associated with secondary remote organ injuries. Our previous studies have demonstrated that there is involvement of inflammatory cytokines in tourniquet-induced skeletal muscle IR injuries. In this study, we investigated the inflammatory responses and tissue injuries in remote organs after tourniquet/IR. The unilateral hindlimbs of mice were subjected to 3 h of tourniquet application by placing a rubber band at the hip joint. Then the rubber bands were released to initiate reperfusion, and tissues were harvested after 1, 3, 7, 14, and 28 days of reperfusion. The data from real-time RT-PCR and western blot showed that the levels of IL-1β and TNFα (two pro-inflammatory cytokines) mRNAs and proteins increased in the lungs and livers, whereas these cytokines did not rise in hearts and kidneys during 28 days of tourniquet/IR, compared to the sham tissues. Histological images also confirmed the infiltration of inflammatory cells in lungs and livers, but not in hearts and kidneys during 28 days of tourniquet/IR. Tourniquet/IR induced tissue structural injuries in the lungs but not the livers, hearts, and kidneys. Additionally, 21.8 % (12/55) of mice died at 1 day and 3 days of tourniquet/IR. These results suggest that inflammatory responses and severity of tissue injuries are different among remote organs and tourniquet/IR-related lung injuries could be a major cause of death during tourniquet/IR, which can help to develop therapeutic strategies for reducing mortality and improving outcomes after the use of tourniquet.
{"title":"Different inflammatory responses in the remote organs after tourniquet-induced ischemia-reperfusion in mouse hindlimb","authors":"Linda Xu , Lauren Whitney , Huiyin Tu , Anthony J. Evans, Abigail Klammer, Aaron N. Barksdale, Michael C. Wadman, Yu-Long Li","doi":"10.1016/j.injury.2026.113060","DOIUrl":"10.1016/j.injury.2026.113060","url":null,"abstract":"<div><div>Tourniquet use is the most effective tool for controlling life-threatening extremity hemorrhage before other treatments and for creating bloodless operating fields in surgical procedures. However, tourniquet-induced ischemia-reperfusion (tourniquet/IR) also causes skeletal muscle injury and is associated with secondary remote organ injuries. Our previous studies have demonstrated that there is involvement of inflammatory cytokines in tourniquet-induced skeletal muscle IR injuries. In this study, we investigated the inflammatory responses and tissue injuries in remote organs after tourniquet/IR. The unilateral hindlimbs of mice were subjected to 3 h of tourniquet application by placing a rubber band at the hip joint. Then the rubber bands were released to initiate reperfusion, and tissues were harvested after 1, 3, 7, 14, and 28 days of reperfusion. The data from real-time RT-PCR and western blot showed that the levels of IL-1β and TNFα (two pro-inflammatory cytokines) mRNAs and proteins increased in the lungs and livers, whereas these cytokines did not rise in hearts and kidneys during 28 days of tourniquet/IR, compared to the sham tissues. Histological images also confirmed the infiltration of inflammatory cells in lungs and livers, but not in hearts and kidneys during 28 days of tourniquet/IR. Tourniquet/IR induced tissue structural injuries in the lungs but not the livers, hearts, and kidneys. Additionally, 21.8 % (12/55) of mice died at 1 day and 3 days of tourniquet/IR. These results suggest that inflammatory responses and severity of tissue injuries are different among remote organs and tourniquet/IR-related lung injuries could be a major cause of death during tourniquet/IR, which can help to develop therapeutic strategies for reducing mortality and improving outcomes after the use of tourniquet.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113060"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-22DOI: 10.1016/j.injury.2026.113056
Andrea Audisio , Tracy Zhu , Alexander Joeris , An Sermon , Frank F.A. IJpma , Vincenzo Giordano , Dhaval Desai , Peter V. Giannoudis , Alessandro Aprato
Purpose
This pilot study aims to validate the "ground truth" accuracy and consistency of proximal femur fracture classification using a large radiographic image database. The project, a collaboration between expert groups from the University of Turin and the AO Foundation, seeks to ensure that expert consensus-based annotations are reliable for future artificial intelligence (AI) model development.
Methods
A cross-sectional, diagnostic accuracy study was conducted using a randomly selected subset of 300 anteroposterior pelvic radiographs from a single-center image repository created at the University of Turin within the AO Innovation Translation Center framework. Fracture classification annotations were independently provided by the local clinical expert group (LC-EG) and by an independent AO expert group of surgeons (AO-EG). To assess interrater reliability between the two groups, Cohen’s kappa coefficient was calculated for categorical agreement on the presence of a fracture and AO/OTA classification.
Results
The comparison of annotations from LC-EG and AO-EG yielded a Cohen’s kappa of 0.81 (95 % confidence interval: 0.75–0.87) and a percentage agreement of 87.67 % (95 % confidence interval: 87.63–87.70) for the classification of proximal femur fractures into three defined categories: no fracture, fracture type 31A, and fracture type 31B. These results confirm a high level of consistency between the two expert groups in annotating the image dataset.
Conclusion
The observed interrater reliability between the LC-EG and AO-EG supports the credibility of the reference annotations, establishing a validated ground truth for proximal femur fractures. This evidence justifies using the radiographic image database as a benchmark for future studies and as a foundation for transparent, reproducible AI development and evaluation, thereby facilitating safer integration of decision support tools into orthopedic trauma workflows.
{"title":"Pilot validation study for a large image database of proximal femur fracture anteroposterior radiographs: Searching for the ground truth","authors":"Andrea Audisio , Tracy Zhu , Alexander Joeris , An Sermon , Frank F.A. IJpma , Vincenzo Giordano , Dhaval Desai , Peter V. Giannoudis , Alessandro Aprato","doi":"10.1016/j.injury.2026.113056","DOIUrl":"10.1016/j.injury.2026.113056","url":null,"abstract":"<div><h3>Purpose</h3><div>This pilot study aims to validate the \"ground truth\" accuracy and consistency of proximal femur fracture classification using a large radiographic image database. The project, a collaboration between expert groups from the University of Turin and the AO Foundation, seeks to ensure that expert consensus-based annotations are reliable for future artificial intelligence (AI) model development.</div></div><div><h3>Methods</h3><div>A cross-sectional, diagnostic accuracy study was conducted using a randomly selected subset of 300 anteroposterior pelvic radiographs from a single-center image repository created at the University of Turin within the AO Innovation Translation Center framework. Fracture classification annotations were independently provided by the local clinical expert group (LC-EG) and by an independent AO expert group of surgeons (AO-EG). To assess interrater reliability between the two groups, Cohen’s kappa coefficient was calculated for categorical agreement on the presence of a fracture and AO/OTA classification.</div></div><div><h3>Results</h3><div>The comparison of annotations from LC-EG and AO-EG yielded a Cohen’s kappa of 0.81 (95 % confidence interval: 0.75–0.87) and a percentage agreement of 87.67 % (95 % confidence interval: 87.63–87.70) for the classification of proximal femur fractures into three defined categories: no fracture, fracture type 31A, and fracture type 31B. These results confirm a high level of consistency between the two expert groups in annotating the image dataset.</div></div><div><h3>Conclusion</h3><div>The observed interrater reliability between the LC-EG and AO-EG supports the credibility of the reference annotations, establishing a validated ground truth for proximal femur fractures. This evidence justifies using the radiographic image database as a benchmark for future studies and as a foundation for transparent, reproducible AI development and evaluation, thereby facilitating safer integration of decision support tools into orthopedic trauma workflows.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113056"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-09DOI: 10.1016/j.injury.2026.113021
Heng Zhang, Yue Wang, Zhiliang Guo, Minhui Zhang, Ruojie Bi
Background
This study aims to compare the efficacy of the posterolateral and posteromedial approaches in the surgical treatment of trimalleolar ankle fractures involving the posterior malleolus.
Methods
A total of 120 patients with trimalleolar ankle fractures (Haraguchi type II posterior malleolar fractures confirmed by computed tomography scans involving >30% of the tibial articular surface) admitted to our hospital were separated into two subgroups according to different intervention methods. The posterolateral approach subgroup had 60 patients (finally, 58 patients were included), and the posteromedial approach subgroup had 60 patients (finally, 57 patients were included). Open reduction and internal fixation (ORIF) were conducted in all patients, addressing the fibula through the same posterolateral incision or through a separate lateral incision in the posteromedial group. The general operation, fracture healing and complication rate of the two subgroups were compared.
Results
The operation time, intraoperative bleeding, incision length and postoperative hospitalisation time of the posterolateral approach subgroup were significantly shorter than those of the posteromedial approach subgroup. The fracture healing time in the posterolateral approach subgroup was significantly shorter than that in the posteromedial approach subgroup, and the complication rate was significantly less than that in the posteromedial approach subgroup. At a mean follow-up of 14.3 months (range: 12–18 months), there was no notable distinction in the excellent and good rates for the posterolateral approach subgroup (94.83%) and the posteromedial approach subgroup (87.72%).
Conclusion
The posterolateral approach for the treatment of trimalleolar ankle fractures shortens the operation time, promotes fracture healing through improved visualisation and reduction quality, lessens the incidence of complications and, compared with posteromedial ORIF, does not affect the functional recovery of the ankle joint.
{"title":"Application of the posterolateral approach in the surgical treatment of ankle fractures","authors":"Heng Zhang, Yue Wang, Zhiliang Guo, Minhui Zhang, Ruojie Bi","doi":"10.1016/j.injury.2026.113021","DOIUrl":"10.1016/j.injury.2026.113021","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to compare the efficacy of the posterolateral and posteromedial approaches in the surgical treatment of trimalleolar ankle fractures involving the posterior malleolus.</div></div><div><h3>Methods</h3><div>A total of 120 patients with trimalleolar ankle fractures (Haraguchi type II posterior malleolar fractures confirmed by computed tomography scans involving >30% of the tibial articular surface) admitted to our hospital were separated into two subgroups according to different intervention methods. The posterolateral approach subgroup had 60 patients (finally, 58 patients were included), and the posteromedial approach subgroup had 60 patients (finally, 57 patients were included). Open reduction and internal fixation (ORIF) were conducted in all patients, addressing the fibula through the same posterolateral incision or through a separate lateral incision in the posteromedial group. The general operation, fracture healing and complication rate of the two subgroups were compared.</div></div><div><h3>Results</h3><div>The operation time, intraoperative bleeding, incision length and postoperative hospitalisation time of the posterolateral approach subgroup were significantly shorter than those of the posteromedial approach subgroup. The fracture healing time in the posterolateral approach subgroup was significantly shorter than that in the posteromedial approach subgroup, and the complication rate was significantly less than that in the posteromedial approach subgroup. At a mean follow-up of 14.3 months (range: 12–18 months), there was no notable distinction in the excellent and good rates for the posterolateral approach subgroup (94.83%) and the posteromedial approach subgroup (87.72%).</div></div><div><h3>Conclusion</h3><div>The posterolateral approach for the treatment of trimalleolar ankle fractures shortens the operation time, promotes fracture healing through improved visualisation and reduction quality, lessens the incidence of complications and, compared with posteromedial ORIF, does not affect the functional recovery of the ankle joint.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113021"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146032472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-09DOI: 10.1016/j.injury.2026.113017
Simple Sibi Joseph , Layth Al-Jarrah , Mohamed H. Ahmed , Ayman El-Menyar , Naushad Ahmad Khan , Husham Abdelrahman , Rafael Consunji , Yassir Abdulrahman , Sandro Rizoli , Hassan Al-Thani
Background
Although road traffic injuries (RTIs) pose a significant public health burden in the Gulf Cooperation Council countries (GCC), the true extent of motorcycle crash injuries (MCCIs) remains unclear because of limited published data from this region. Emerging evidence suggests that MCCIs are on the rise because of the growing use of motorcycles for transport and delivery services, even though road safety overall has improved. We sought to review regional evidence on MCCIs' patterns, key risk factors, and temporal trends to inform policy interventions and research priorities for effective prevention.
Methods
A scoping review was conducted in accordance with the PRISMA-ScR guidelines. Articles on GCC MCCIs published from July 2008 to October 2025, examining injury patterns, mortality, and safety practices, were included in the review. Search was conducted across PubMed, Scopus, Google Scholar, and grey literature sources. The GCC consists of six countries: Saudi Arabia (KSA), Qatar, Kuwait, the United Arab Emirates (UAE), Bahrain, and Oman.
Results
Of 1344 studies identified, 9 met the inclusion criteria and were analyzed. The GCC has seen an increase in the number of motorcycles registered, resulting in higher MCC rates over time. During the COVID-19 pandemic, these rates surged again as the delivery sector grew. MCCI victims were mainly young males (mean age of 29 years). Extremity injuries were the most frequent (two-thirds), followed by head injuries (20–41%), often associated with poor helmet use compliance (range 13–17%). Delivery riders represented a high-risk subgroup, reflecting occupational exposure, fatigue, and time pressure. Despite advances in trauma care, geographic gaps persist. Helmet use non-compliance, alcohol use, and inadequate documentation remain significant risk factors. Extremity injuries were the most common in the GCC.
Conclusion
MCCIs in the GCC are on the rise with high rates of extremity and head trauma. Poor helmet use compliance is a significant factor. Therefore, we suggest strengthening helmet use laws and safety standards, increasing community efforts, and establishing motorcycle lanes with lower speed limits. Protection for riders at work should be enhanced. Road infrastructure and robust data systems also need improvement.
{"title":"Scoping review on motorcycle crashes patterns, risk factors, and potential in setting policy priorities in the gulf cooperation council countries (GCC)","authors":"Simple Sibi Joseph , Layth Al-Jarrah , Mohamed H. Ahmed , Ayman El-Menyar , Naushad Ahmad Khan , Husham Abdelrahman , Rafael Consunji , Yassir Abdulrahman , Sandro Rizoli , Hassan Al-Thani","doi":"10.1016/j.injury.2026.113017","DOIUrl":"10.1016/j.injury.2026.113017","url":null,"abstract":"<div><h3>Background</h3><div>Although road traffic injuries (RTIs) pose a significant public health burden in the Gulf Cooperation Council countries (GCC), the true extent of motorcycle crash injuries (MCCIs) remains unclear because of limited published data from this region. Emerging evidence suggests that MCCIs are on the rise because of the growing use of motorcycles for transport and delivery services, even though road safety overall has improved. We sought to review regional evidence on MCCIs' patterns, key risk factors, and temporal trends to inform policy interventions and research priorities for effective prevention.</div></div><div><h3>Methods</h3><div>A scoping review was conducted in accordance with the PRISMA-ScR guidelines. Articles on GCC MCCIs published from July 2008 to October 2025, examining injury patterns, mortality, and safety practices, were included in the review. Search was conducted across PubMed, Scopus, Google Scholar, and grey literature sources. The GCC consists of six countries: Saudi Arabia (KSA), Qatar, Kuwait, the United Arab Emirates (UAE), Bahrain, and Oman.</div></div><div><h3>Results</h3><div>Of 1344 studies identified, 9 met the inclusion criteria and were analyzed. The GCC has seen an increase in the number of motorcycles registered, resulting in higher MCC rates over time. During the COVID-19 pandemic, these rates surged again as the delivery sector grew. MCCI victims were mainly young males (mean age of 29 years). Extremity injuries were the most frequent (two-thirds), followed by head injuries (20–41%), often associated with poor helmet use compliance (range 13–17%). Delivery riders represented a high-risk subgroup, reflecting occupational exposure, fatigue, and time pressure. Despite advances in trauma care, geographic gaps persist. Helmet use non-compliance, alcohol use, and inadequate documentation remain significant risk factors. Extremity injuries were the most common in the GCC.</div></div><div><h3>Conclusion</h3><div>MCCIs in the GCC are on the rise with high rates of extremity and head trauma. Poor helmet use compliance is a significant factor. Therefore, we suggest strengthening helmet use laws and safety standards, increasing community efforts, and establishing motorcycle lanes with lower speed limits. Protection for riders at work should be enhanced. Road infrastructure and robust data systems also need improvement.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113017"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-09DOI: 10.1016/j.injury.2026.113022
Hans-Joachim Riesner , Jason DePhillips , Amber R. Witt , Jonathan M. Mahoney , Brandon S. Bucklen
Objectives
To biomechanically compare triangular osteosynthesis (TOS) and a minimally invasive triangular spinopelvic stabilization (TMSS) technique for Type IV fragility fractures of the pelvis (FFP) in a cadaveric model.
Methods
Six fresh-frozen lumbopelvic specimens (L3–pelvis; mean age 61.5 ± 11.5 yrs) with simulated Type IV U-shaped sacral fractures were sequentially instrumented with TOS (bilateral iliosacral screws + lumbopelvic fixation) and TMSS (bilateral iliac screws with transverse connecting rod + lumbopelvic fixation). Constructs were cyclically loaded (200–430 N; 25,000 cycles or 1 cm axial displacement) to simulate postoperative single-leg stance loading. Fracture displacement was quantified using a motion capture system.
Results
All but one TOS specimen completed 25,000 cycles. Bone mineral density had no effect on displacement. TMSS showed lower maximum fracture displacement (6.05 mm) than TOS (12.12 mm; p= 0.071). Displacement after 1000 cycles averaged 56% (TOS) and 62% (TMSS) of the maximum.
Conclusions
TMSS provided comparable or improved stability versus TOS and, with its minimally invasive design, may offer a viable alternative for FFP Type IV treatment. Further clinical validation is warranted.
{"title":"Biomechanical comparison of triangular osteosynthesis and triangular minimally invasive spinopelvic stabilization technique for pelvic fragility fractures","authors":"Hans-Joachim Riesner , Jason DePhillips , Amber R. Witt , Jonathan M. Mahoney , Brandon S. Bucklen","doi":"10.1016/j.injury.2026.113022","DOIUrl":"10.1016/j.injury.2026.113022","url":null,"abstract":"<div><h3>Objectives</h3><div>To biomechanically compare triangular osteosynthesis (TOS) and a minimally invasive triangular spinopelvic stabilization (TMSS) technique for Type IV fragility fractures of the pelvis (FFP) in a cadaveric model.</div></div><div><h3>Methods</h3><div>Six fresh-frozen lumbopelvic specimens (L3–pelvis; mean age 61.5 ± 11.5 yrs) with simulated Type IV U-shaped sacral fractures were sequentially instrumented with TOS (bilateral iliosacral screws + lumbopelvic fixation) and TMSS (bilateral iliac screws with transverse connecting rod + lumbopelvic fixation). Constructs were cyclically loaded (200–430 N; 25,000 cycles or 1 cm axial displacement) to simulate postoperative single-leg stance loading. Fracture displacement was quantified using a motion capture system.</div></div><div><h3>Results</h3><div>All but one TOS specimen completed 25,000 cycles. Bone mineral density had no effect on displacement. TMSS showed lower maximum fracture displacement (6.05 mm) than TOS (12.12 mm; <em>p</em>= 0.071). Displacement after 1000 cycles averaged 56% (TOS) and 62% (TMSS) of the maximum.</div></div><div><h3>Conclusions</h3><div>TMSS provided comparable or improved stability versus TOS and, with its minimally invasive design, may offer a viable alternative for FFP Type IV treatment. Further clinical validation is warranted.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113022"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-22DOI: 10.1016/j.injury.2026.113055
Adam M. Gordon , Faisal R. Elali , Gabriel A. Lama , Matthew L. Magruder , Kevin K. Kang
Introduction
Multiple sclerosis (MS) is a chronic neurological condition characterized by muscle spasticity, which may influence the outcomes of hip arthroplasty procedures, particularly in patients undergoing total hip arthroplasty (THA) or hemiarthroplasty for femoral neck fractures. It is unclear whether implant complications and revision rates differ between these two surgical approaches in patients with MS. The aim of this study was to compare patient demographics and 2-year implant complications in patients with MS undergoing THA versus hemiarthroplasty for femoral neck fractures.
Methods
A retrospective analysis was performed using a nationwide claims database (2010–2022). MS patients who did not have dementia who underwent THA or hemiarthroplasty for femoral neck fractures were identified. Two-year implant complications, including hip dislocations, aseptic loosenings, periprosthetic joint infections (PJIs), periprosthetic fractures, and all-cause revisions, were compared between the two groups using multivariable logistic regressions while controlling for age, sex, comorbidities, and overall Elixhauser Comorbidity Index (ECI).
Results
A total of 2018 patients with MS (604 THA and 1414 hemiarthroplasty) were included. Patients had no difference in overall comorbidity burden (ECI 7.47 vs. 6.93, p = 0.015). At 2 years, THA was associated with significantly higher rates of aseptic loosenings (OR: 4.17, p = 0.001) and all-cause revisions (OR: 3.04, p < 0.0001). Patients undergoing THA also showed trends toward higher rates of hip dislocations (OR: 1.53, p = 0.087) and PJIs (OR: 1.73, p = 0.059) compared to hemiarthroplasty.
Conclusions
Patients with MS undergoing THA for femoral neck fractures are associated with a higher risk for implant complications, including aseptic loosening and all-cause revisions, compared to those undergoing hemiarthroplasty. Surgeons should consider these outcomes when selecting the appropriate surgical option for patients with MS who do not have dementia with femoral neck fractures.
简介：多发性硬化症（MS）是一种以肌肉痉挛为特征的慢性神经系统疾病，它可能影响髋关节置换术的结果，特别是在股骨颈骨折患者接受全髋关节置换术（THA）或半髋关节置换术时。目前尚不清楚这两种手术方式对MS患者的植入物并发症和翻修率是否有差异。本研究的目的是比较患者人口统计学和2年植入物并发症，MS患者接受THA和股骨颈骨折半关节置换术。方法：使用全国索赔数据库（2010-2022）进行回顾性分析。没有痴呆的多发性硬化症患者因股骨颈骨折接受了THA或半关节置换术。在控制年龄、性别、合共病和Elixhauser总体合共病指数（ECI）的情况下，采用多变量logistic回归比较两组患者两年的假体并发症，包括髋关节脱位、无菌性松动、假体周围关节感染（PJIs）、假体周围骨折和全因修复。结果：共纳入2018例MS患者（604例THA和1414例半关节置换术）。患者的总体合并症负担无差异（ECI为7.47 vs. 6.93, p = 0.015）。2年时，THA与无菌松动率（OR: 4.17, p = 0.001）和全因修正率（OR: 3.04, p < 0.0001）显著升高相关。与半关节置换术相比，接受THA的患者髋关节脱位（OR: 1.53, p = 0.087）和PJIs （OR: 1.73, p = 0.059）的发生率也更高。结论：与接受半关节置换术的患者相比，接受THA治疗股骨颈骨折的MS患者发生植入物并发症的风险更高，包括无菌性松动和全因修复。外科医生在为没有痴呆伴股骨颈骨折的多发性硬化症患者选择合适的手术方案时应考虑这些结果。
{"title":"Comparison of patient demographics and implant complications in patients with multiple sclerosis undergoing total hip arthroplasty versus hemiarthroplasty for femoral neck fractures","authors":"Adam M. Gordon , Faisal R. Elali , Gabriel A. Lama , Matthew L. Magruder , Kevin K. Kang","doi":"10.1016/j.injury.2026.113055","DOIUrl":"10.1016/j.injury.2026.113055","url":null,"abstract":"<div><h3>Introduction</h3><div>Multiple sclerosis (MS) is a chronic neurological condition characterized by muscle spasticity, which may influence the outcomes of hip arthroplasty procedures, particularly in patients undergoing total hip arthroplasty (THA) or hemiarthroplasty for femoral neck fractures. It is unclear whether implant complications and revision rates differ between these two surgical approaches in patients with MS. The aim of this study was to compare patient demographics and 2-year implant complications in patients with MS undergoing THA versus hemiarthroplasty for femoral neck fractures.</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed using a nationwide claims database (2010–2022). MS patients who did not have dementia who underwent THA or hemiarthroplasty for femoral neck fractures were identified. Two-year implant complications, including hip dislocations, aseptic loosenings, periprosthetic joint infections (PJIs), periprosthetic fractures, and all-cause revisions, were compared between the two groups using multivariable logistic regressions while controlling for age, sex, comorbidities, and overall Elixhauser Comorbidity Index (ECI).</div></div><div><h3>Results</h3><div>A total of 2018 patients with MS (604 THA and 1414 hemiarthroplasty) were included. Patients had no difference in overall comorbidity burden (ECI 7.47 vs. 6.93, <em>p</em> = 0.015). At 2 years, THA was associated with significantly higher rates of aseptic loosenings (OR: 4.17, <em>p</em> = 0.001) and all-cause revisions (OR: 3.04, <em>p</em> < 0.0001). Patients undergoing THA also showed trends toward higher rates of hip dislocations (OR: 1.53, <em>p</em> = 0.087) and PJIs (OR: 1.73, <em>p</em> = 0.059) compared to hemiarthroplasty.</div></div><div><h3>Conclusions</h3><div>Patients with MS undergoing THA for femoral neck fractures are associated with a higher risk for implant complications, including aseptic loosening and all-cause revisions, compared to those undergoing hemiarthroplasty. Surgeons should consider these outcomes when selecting the appropriate surgical option for patients with MS who do not have dementia with femoral neck fractures.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113055"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146115272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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