简介：AbstractPurpose:Posterior fracture-dislocation of shoulder is an infrequent traumatic event; however, most orthopaedic surgeons may face the challenge of treating it. The aim of this study is to review and summarise systematically the current principles of the management of this complex injury, and create a treatment algorithm.Methods:Both PubMed and Scopus Databases were systematically searched for the terms "posterior shoulder fracture-dislocation" or "posterior glenohumeral fracture-dislocation" or "posterior glenoid fracture-dislocation" for articles written in English and published in the last decade.Results:A total of 900 articles were identified, of which 13 were retained for analysis. A total of 153 patients (161 shoulders) were identified. These patients were treated either with open reduction and internal fixation, modified McLaughlin procedure, allograft/autograft humeral head reconstruction or shoulder arthroplasty. The mean age was 40.15 years. The mean postoperative Constant score in cases treated by open reduction and internal fixation was 86.45, whereas by bone graft was 84.18. Further, the mean postoperative Constant score was between 79.6 and 67.1 in those that were managed by modified McLaughlin and arthroplasty procedure, respectively.Conclusion:The management of posterior shoulder fracture-dislocation may be challenging, and the best surgical option depends on many variables such as the chronicity of the injury, the presence of a fracture at the level of the surgical neck or tuberosities and the extend of the Hill-Sachs lesion if any. A treatment algorithm is proposed, based on the current literature in an effort to create a consensus for these injuries. For the acute shoulder fracture-dislocations, an open reduction should be performed. For the chronic fracture/dislocations in the elderly low-demand patients, conservative treatment should be performed. For the rest of the patients, depending on the severity of the Hill-Sachs lesion different surgical options are available such as the McLaughlin technique, the use of an allograft, osteotomy or arthroplasty.

简介：AbstractBackground:Our aim was to evaluate the sensitivity and specificity of the automated computer-based Alberta Stroke Program Early CT Score (e-ASPECTS) for acute stroke patients and compare the result with physicians at different levels.Methods:In our center, e-ASPECTS and 9 physicians at different levels retrospectively and blindly assessed baseline computed tomography (CT) images of 55 patients. Sensitivity, specificity, receiver-operating characteristic curves, Bland-Altman plots with mean score error, and Matthews correlation coefficients were calculated. Comparisons were made between the scores by physicians and e-ASPECTS with diffusion-weighted imaging (DWI) being the ground truth. Two methods for clustered data were used to estimate sensitivity and specificity in the region-based analysis.Results:In total, 1100 (55 patients × 20 regions per patient) ASPECTS regions were scored. In the region-based analysis, sensitivity of e-ASPECTS was better than junior doctors and residents (0.576 vs 0.165 and 0.111, p < 0.05) but inferior to senior doctors (0.576 vs 0.617). Specificity was lower than junior doctors and residents (0.883 vs 0.971 and 0.914) but higher than senior doctors (0.883 vs 0.809, p < 0.05). E-ASPECTS had the best Matthews correlation coefficient of 0.529, compared to senior doctors, junior doctors, and residents (0.463, 0.251, and 0.087, respectively).Conclusions:e-ASPECTS showed a similar performance to that of senior physicians in the assessment of brain CT of acute ischemic stroke patients with the Alberta Stroke Program Early CT score method.