Purpose: The study described a novel surgical treatment of Haraguchi type 1 posterior malleolar fracture in tri-malleolar fracture and patient outcomes at intermediate period follow-up. Methods: All patients from January 2015 to December 2017 with tri-malleolar fracture of which posterior malleolar fractures were Haraguchi type 1, were surgically treated in this prospective study. Lateral and medial malleolar fractures were managed by open reduction and internal fixation through dual incision approaches. 36 cases of Haraguchi type 1 posterior malleolar fractures were randomly performed by percutaneous posteroanterior screw fixation with the aid of medial exposure (group 1). And 40 cases were performed by percutaneous anteroposterior screw fixation (group 2). Clinical outcomes, radiographic outcomes and patient-reported outcomes were recorded. Results: Seventy-six patients with mean follow-up of 30 months were included. There were no significant differences in the mean operation time (81.0 ± 11.3 vs. 77.2 ± 12.4), ankle function at different periods of follow-up, range of motions and visual analog scale (VAS) at 24 months between the two groups ( p > 0.05). However, the rate of severe post-traumatic arthritis (Grade 2 and 3) and the rate of step-off rather than gap in radiological evaluation were lower in group 1 than that in group 2 ( p < 0.05). Conclusion: Using our surgical technique, more patients had good outcome with a lower rate of severe post-traumatic arthritis, compared with the group of percutaneous anteroposterior screw fixation. Percutaneous posteroanterior screw fixation can be a convenient and reliable alternative in treating Haraguchi type 1 posterior malleolar fracture.

Background: To investigate the effect of albumin infusion on cirrhotic patients admitted for acute gastrointestinal bleeding. Methods: Medical records of cirrhotic patients who admitted due to acute gastrointestinal bleeding through January 2009 to December 2018 were reviewed. Clinical data and the total amount of albumin and red blood cell used during hospitalization were recorded. For patients with rebleeding, the amount of albumin and red blood cell used before rebleeding was also documented. The primary outcome was the occurrence of rebleeding, and the second outcome was in-hospital mortality. Univariate and multivariate logistic analysis was performed to identify risk factors associated with rebleeding and in-hospital mortality. Results: A total of 1503 cirrhotic patients were included in the analysis. There were 146 episodes of in-patient rebleeding occurred, while 81 patients died. Overall, more red blood cells and albumin were prescribed to patients who suffered rebleeding. In terms of the amount before rebleeding, the red blood cell was higher in patients with rebleeding, but the albumin infusion was similar. In the multivariate model, the albumin infusion before rebleeding was an independent risk factor associated with rebleeding (adjusted OR for ≤40 g vs 0 g, 0.469 [0.269-0.793], p = 0.006; adjusted OR for > 40 g vs 0 g, 0.272 [0.115-0.576], p = 0.001). In Child-Pugh C class patients, the use of albumin more than 40 g during hospitalization associated with a lower risk of in-patient mortality (adjusted OR for > 40 g vs 0 g, 0.136 [0.019-0.741], p = 0.031). Conclusions: Albumin infusion was associated with a lower risk of rebleeding and in-hospital deaths in cirrhosis admitted for acute gastrointestinal bleeding.

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Objective: This study was performed to evaluate the safety and efficacy of a single cannulated iliac screw combined with reconstruction plate fixation for crescent pelvic fractures (Day type II). Method: Thirty adult patients (23 men, 7 women) with a mean age of 42.3 years (range, 22-81 years) were retrospectively reviewed. The time interval between the injury and the operation ranged from 3 to 14 days. The duration of screw insertion, the frequency of C-arm X-ray examination, and the intraoperative blood loss volume were recorded. The minimum followup was 12 months (mean, 29 months; range, 12-36 months). Radiographic evaluation was performed using the Matta and Tornetta criteria. Results: According to the Matta and Tornetta radiological criteria, the reduction was rated as excellent in 20 patients and good in 10 patients. Based on the Majeed functional evaluation at the follow-up appointment, the outcome was rated as excellent in 28 patients and good in 2 patients. Conclusion: This technique can restrict damage to the surrounding soft tissues, decrease complications, and promote good clinical results.

Background: To investigate the effect of albumin infusion on cirrhotic patients admitted for acute gastrointestinal bleeding. Methods: Medical records of cirrhotic patients who admitted due to acute gastrointestinal bleeding through January 2009 to December 2018 were systemically reviewed. Clinical data and the total amount of albumin and red blood cell used during hospitalization were recorded. For patients with rebleeding, the amount of albumin and red blood cell used before rebleeding was also documented. The primary outcome was the occurrence of rebleeding, and the second outcome was in-hospital mortality. Univariate and multivariate logistic analysis was performed to identify risk factors associated with rebleeding and in-hospital mortality. Results: A total of 2239 cirrhotic patients were included in the analysis. There were 245 episodes of in-patient rebleeding occurred, while 135 patients died. Overall, more red blood cells and albumin were prescribed to patients who suffered rebleeding. In terms of the amount before rebleeding, the red blood cell was higher in patients with rebleeding, but the albumin infusion was similar. In the multivariate model, the albumin infusion was an independent risk factor associated with rebleeding (adjusted OR for ≤40g, 0.385 [0.252-0.588], p<0.001; OR for >40g, 0.295 [0.169-0.514], p<0.001). The use of albumin more than 40g during hospitalization associated with a lower risk of in-patient mortality (adjusted OR for ≤40g, 0.730[0.375-1.423] , p=0.356; OR for >40g, 0.389 [0.180-0.838], p=0.016). Conclusions: Albumin infusion was associated with a lower risk of rebleeding and in-hospital deaths in cirrhosis admitted for acute gastrointestinal bleeding.