Journal of Orthopaedic Trauma最新文献

{"title":"Medial-Based Myofasciocutaneous Flap Above Knee Amputation.","authors":"Wei Wei Wu, Christopher Finkemeier","doi":"10.1097/BOT.0000000000002987","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002987","url":null,"abstract":"<p><strong>Summary: </strong>This is a case of a 62-year-old man with significant peripheral vascular disease who presented with chronic nonhealing full-thickness ulcerations along his right lower leg, now progressed to deep infection with systemic involvement. This review describes an above knee amputation with a medial-based myofasciocutaneous flap, which was chosen due to its dependency on the less-diseased vascular supply from the obturator artery. The anatomic dissection and myodesis technique are methodical and reproducible for all surgeons.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"39 8S","pages":"S15-S16"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033568","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}

{"title":"Outcomes of THA versus ORIF for Acetabular Fractures in Older Adults.","authors":"Priya Singh, Carolina Stocchi, Brocha Z Stern, Arthur Drouaud, Hulaimatu Jalloh, Jashvant Poeran, David Forsh","doi":"10.1097/BOT.0000000000003052","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003052","url":null,"abstract":"<p><strong>Objectives: </strong>To compare outcomes of total hip arthroplasty (THA) versus open reduction internal fixation (ORIF) for acetabular fractures in older adults using a large national database.</p><p><strong>Methods: </strong>Design: Retrospective cohort study using the Medicare Limited Data set.</p><p><strong>Setting: </strong>798 acute short-stay hospitals.</p><p><strong>Patient selection criteria: </strong>Fee-for-service Medicare beneficiaries aged 65+ who underwent inpatient ORIF or THA for acetabular fractures (OTA/AO 62) (without associated femoral fractures) from January 2013 to December 2020 were included.</p><p><strong>Outcome measures and comparisons: </strong>To minimize confounding, 1 THA patient was matched with up to 2 ORIF patients based on sociodemographic factors, comorbidities, and surgery year using a propensity score approach. Multivariable generalized linear models identified adjusted associations between surgery type and outcomes; adjusted odds ratios (ORs) or mean differences with 95% confidence intervals (CI) were reported.</p><p><strong>Results: </strong>Among 5,656 eligible procedures, the matched cohort included 2,879 patients (1,027 THA, mean age 78.6, 42.3% male; 1,852 ORIF, mean age 78.6, 42.4% male). THA (versus ORIF) patients had an increased odds of 30-day and 90-day hospital returns (30-day: OR=1.54, P<0.001; 90-day: OR=1.25, P=0.01) as well as 90-day and 1-year infection (90-day: OR=1.92, P<0.001; 1-year: OR=1.74, P<0.001). THA was also associated with higher odds of 90-day reoperation (OR=2.47, P<0.001) but not 1-year reoperation (OR=0.84, P=0.16). No significant associations were observed for hospital length of stay (P=0.42), discharge disposition (P=0.93), use of 90-day home health services (P=0.13), 90-day venous thromboembolism (P=0.75), or 1-year mortality (P=0.65).</p><p><strong>Conclusions: </strong>Patients who underwent THA for acetabular fractures were more likely to return to the hospital within 30 and 90 days post-surgery, have an infection in the year after surgery, and undergo a reoperation in the 90-day postoperative period compared to those who underwent ORIF. Further investigation of the mechanisms of the observed associations is necessary to understand which surgical approach provides optimal outcomes.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784528","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}

{"title":"Posterior Sternoclavicular Joint Dislocation and Reconstruction.","authors":"Charles C Lin, Allison Morgan, Michael Doran, Neha Jejurikar, Sehar Resad-Ferati, Danielle H Markus, Abhishek Ganta, Sanjit R Konda","doi":"10.1097/BOT.0000000000002986","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002986","url":null,"abstract":"<p><strong>Summary: </strong>This case presentation describes a technique for reconstruction of an acute posterior sternoclavicular joint dislocation. The patient was a 37 year-old female who sustained a left posterior sternoclavicular dislocation after a fall. A curvilinear incision was made directly over the sternoclavicular joint. After reduction, a semitendinosus allograft was used to reconstruct the sternoclavicular joint in a figure-of-8 fashion through drill holes in the manubrium and the proximal clavicle and secured with suture tape. Sternoclavicular reconstruction with semitendinosis allograft provides a reliable option with good clinical outcomes and low rates of recurrent instability.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"39 8S","pages":"S1-S2"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033515","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}

{"title":"Introduction.","authors":"Kyle J Jeray","doi":"10.1097/BOT.0000000000002991","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002991","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"39 8S","pages":"S1"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033612","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}

{"title":"Repair of Pediatric LC3 Pelvic Ring Injury.","authors":"Atticus Coscia, Erik Nakken, Michal Jandzinski, Aaron Perdue, Mark Hake, Jaimo Ahn","doi":"10.1097/BOT.0000000000002983","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002983","url":null,"abstract":"<p><strong>Summary: </strong>Lateral compression (LC) 3 pelvic ring injuries are high energy, complex patterns that may include a \"crescent fracture,\" which is an important consideration when determining the appropriate fixation tactic. This review discusses the reduction and fixation of a pediatric LC3 pelvic ring injury with particular focus on the open and percutaneous techniques for treatment of a crescent fracture.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"39 8S","pages":"S9-S10"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033521","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}

{"title":"Percutaneous anterior pelvic ring fixation in addition to percutaneous posterior pelvic ring fixation decreases postoperative pain and narcotic usage in hospital for LC1 and LC2 injuries.","authors":"Pranit Kumaran, Julian Wier, Joseph T Patterson, Jackson Lee, Geoffrey Marecek, Adam Lee, Joshua L Gary","doi":"10.1097/BOT.0000000000003050","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003050","url":null,"abstract":"<p><strong>Objectives: </strong>To compare postoperative pain and opioid requirements between LC1 and LC2 injuries treated with anterior and posterior fixation (AF+PF) vs. posterior fixation (PF) only.</p><p><strong>Methods: </strong>Design: Retrospective review of propensity matched cohorts for sex, age, LC1 vs. LC2, sacral fracture type, and preoperative visual analogue scores (VAS) were created in a 1:1 ratio.</p><p><strong>Setting: </strong>Level 1 Trauma Center and Academic Tertiary Care Hospital.</p><p><strong>Patient selection criteria: </strong>Adult patients with LC1 or LC2 (OTA/AO 61B2.1, 61B2.2) injuries treated surgically with PF or AF+PF between March 2019 through January 2024.</p><p><strong>Outcome measures and comparisons: </strong>VAS and morphine milligram equivalents (MMEs) were measured at 24 and 48 hours postoperatively, and 24 hours before discharge between the groups. Secondary outcomes included postoperative days to mobilization (DTM) and length of stay (LOS).</p><p><strong>Results: </strong>56 patients (28 AF+PF, mean age 49.4+16.9, 57.1% female, 28 PF, mean age 49.8+16.9, 53.6% female) were included. There were no differences between the groups for demographic data (all p > 0.78). AF+PF patients had lower VAS scores than PF patients 24 hours postoperatively (Difference in Mean (DIM): 2.18 cm (95%-confidence interval (95-CI): 0.9068 -3.4532), p=0.001), 48 hours postoperatively (DIM: 3.43 cm (95-CI: 2.11 to 4.75), p<0.001), and 24 hours before discharge (DIM: 2.68 (95%-CI: 1.31 to 4.04), p<0.001). AF+PF patients required lower MMEs 24 hours before discharge (DIM: 6.989 (95%-CI: 0.873 to 13.105), p=0.026). AF+PF patients also had shorter DTM (DIM: 3.21 (95-CI: 0.03 to 6.40), p=0.048). There were no differences in MMEs 24 hours postoperatively (DIM: 3.64 (95%-CI: -4.15 to 11.44), p=0.35), 48 hours postoperatively (DIM: 4.78 (9%-5CI: -3.12 to 12.67), p=0.23), or LOS (DIM: 1.96 (95%-CI: -2.03 to 5.95), p=0.33).</p><p><strong>Conclusions: </strong>Anterior and posterior fixation was associated with significantly decreased inpatient postoperative pain, pre-discharge narcotics use, and days to mobilization compared to posterior fixation alone. The combination of percutaneous anterior and posterior fixation for LC1 and LC2 pelvic ring injuries should be considered when the goals are maximizing pain control.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742301","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}

{"title":"The burden, management and treatment outcomes of gunshot-induced fractures of the forearm at a tertiary hospital in South Africa.","authors":"D Bruce-Brand, S Jakoet, M Van Heukelum, N le Roux, O Makhubalo, M Gerafa, M Burger, N Ferreira","doi":"10.1097/BOT.0000000000003049","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003049","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the burden, management and outcomes of gunshot-induced extra-articular forearm fractures at a tertiary institution in the Western Cape of South Africa.</p><p><strong>Methods: </strong>Design: Retrospective review.</p><p><strong>Setting: </strong>Single centre, Level 1 trauma centre.</p><p><strong>Patient selection criteria: </strong>Patients who presented with gunshot-induced extra-articular forearm fractures (OTA/AO 2R2 and/or 2U2) between January 2014 and December 2017 were included.</p><p><strong>Outcome measures and comparisons: </strong>Clinical examination and radiological review were used to assess for infection, neurovascular injury and union.</p><p><strong>Results: </strong>Ninety-six patients (94% male, mean age 29±11) were included with 45 radius, 36 ulna and 15 both bone fractures. Associated injuries were identified in 53 (55.2%) patients and included 36 (37.5%) patients who sustained more than one gunshot injury, 24 (25%) patients who had associated nerve injuries and three (3%) patients who sustained arterial injuries. A total of 51 patients (53.1%) were treated operatively, with a median time to surgery of four (IQR 2- 8) days. One patient presented with a fracture-related infection 2 weeks after external fixation. Of the patients who followed up beyond 12 weeks (n=53, 55.2%), union occurred in 92.5% (n=49 of 53), 49 of these were treated operatively and 4 non-operatively Isolated radius fractures were malunited in a shortened position in 29.2% (n=12 of 41) patients, 7 of which were treated operatively.</p><p><strong>Conclusions: </strong>Gunshot-induced forearm fractures had a low infection rate, even without formal wound debridement or bullet removal. Isolated radius fractures commonly healed in a shortened position, highlighting the need for strategies to preserve length during treatment.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742302","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}

{"title":"Arthroplasty versus fixation of femoral neck fractures in non-geriatric patients.","authors":"Kyle S Jamar, Kennedy J Ringelberg, Joshua A Parry","doi":"10.1097/BOT.0000000000003051","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003051","url":null,"abstract":"<p><strong>Objectives: </strong>To compare arthroplasty versus fixation of femoral neck fractures (FNFs) in non-geriatric patients.</p><p><strong>Methods: </strong>Design: Retrospective.</p><p><strong>Setting: </strong>Level one trauma center.</p><p><strong>Patients selection criteria: </strong>Adults with FNFs (OTA/AO 31-B) less than 65 years of age.</p><p><strong>Outcome measures and comparisons: </strong>Arthroplasty and fixation groups were compared in terms of major complications (nonunion, deep infection, etc.) and reoperations. Subgroup analysis of total hip arthroplasty (THA) versus fixation of displaced FNFs was performed using propensity score matching. Variables associated with complications after fixation were evaluated for.</p><p><strong>Results: </strong>Ninety-four patients were included; 47 received arthroplasty and 47 received fixation. The arthroplasty group was older (59.0 vs 40.0 years, p<0.0001), had more low-energy mechanisms (76.6% vs. 29.8%, p<0.0001), more displaced fractures (97.9% vs. 76.6%, p=0.003), and did not differ in proportion of males (61.7% vs. 70.2%, p=0.51), or follow-up duration (16.0 vs 10.6 months, p=0.08). The arthroplasty group was less likely to have a major complication (17.0% vs. 42.5%, p=0.01) or reoperation (12.8% vs. 31.9%, p=0.04). Patients treated with THA (n=19), compared to those with displaced fractures that were fixed (n=36), were older (61.0 vs. 37.5 years, p<0.0001), more likely to have low-energy injuries (63.1% vs. 25.0%, p=0.008), and less likely to have an ASA >2 (15.8% vs. 55.6%, p=0.008). After matching for these differences, there were 10 patients per group. The complication rate was lower in the THA group (0.0% vs. 50.0%, p=0.03) and the reoperation rate was similar (0.0% vs. 20.0%, p=0.47). Patients that had a complication after fracture fixation were more likely to have fracture comminution (70.0% vs. 22.2%, p=0.002), greater initial fracture displacement (14.5 vs. 6.7 mm; p=0.0002), and buttress plate fixation (20.0% vs. 0.0%; p=0.02).</p><p><strong>Conclusions: </strong>Arthroplasty, compared to fixation, resulted in fewer major complications and reoperations. Major complications after fixation were associated with initial fracture displacement and comminution.</p><p><strong>Level of evidence: </strong>3, retrospective comparison.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731875","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}

{"title":"Does Femoral Rotation More Closely Mirror the Contralateral Side or a Population Mean of 15 Degrees of Anteversion? A Radiologic Study of 219 Healthy Patients.","authors":"Megan L Anderson, Meera M Dhodapkar, Nicholas G Rhodes, Jaimo Ahn, Jennifer Tangtiphaiboontana, Krystin A Hidden, Brandon J Yuan","doi":"10.1097/BOT.0000000000003048","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003048","url":null,"abstract":"<p><strong>Objectives: </strong>To compare whether femoral version more closely mirrors the contralateral femur or a population norm estimate of 15° of anteversion.</p><p><strong>Design: </strong>Radiologic observational study.</p><p><strong>Setting: </strong>Level I Trauma Center.</p><p><strong>Patient selection criteria: </strong>Patients with no history of anatomy-altering femoral injury who underwent bilateral lower extremity CT scans.Outcome Measures and Comparisons: CTs were analyzed to measure femoral version on each side. The asymmetry in femoral version between left and right in each patient (interfemoral rotational variance [IRV]) was recorded. The difference of each femur's version from a proposed population mean of 15° of anteversion was also recorded.</p><p><strong>Results: </strong>219 patients with a mean femoral version of 14.9° ± 10.5° of anteversion were included. Mean IRV was 5.3°, compared to 8.2° of mean variation from the population norm of 15° of anteversion (p<0.001). Five percent of patients had IRV >15° compared to 15% that had femoral rotation > 15° from the population mean of 15° (p<0.001).</p><p><strong>Conclusions: </strong>In the setting of a comminuted diaphyseal femur fracture, knowledge of the appropriate target for restoration of rotational alignment is critical. This radiologic cohort study found that on average, femoral version more closely mirrors an individual patient's contralateral femur as opposed to a population norm of 15° of anteversion.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707774","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}

{"title":"Outcomes of nonunion repair for distal femur fracture nonunion.","authors":"Erika Roddy, Katrina Davis, Paul Wilson, Conor Kleweno, Robert P Dunbar, David Barei","doi":"10.1097/BOT.0000000000003047","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003047","url":null,"abstract":"<p><strong>Objectives: </strong>To report the outcomes aseptic distal femur nonunion repair and to identify factors associated with recalcitrant nonunion.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Single academic level 1 trauma center.</p><p><strong>Patient selection criteria: </strong>All skeletally mature patients undergoing repair of a presumed aseptic distal femur nonunion (AO/OTA 33A or 33C) between 2005-2023 were eligible for inclusion.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was the success of an initial nonunion repair attempt. Univariate and multivariable analysis was used to examine patient, injury, and treatment factors associated with recalcitrant nonunion.</p><p><strong>Results: </strong>One hundred and two patients were included. Their average age was 56 (SD 15) and 64 were female. Forty-seven patients had open fractures and 60 patients had high energy mechanisms. Fifty three fractures were AO/OTA type 33A, while 49 were type 33C. The rate of recalcitrant nonunion was 23%. Diagnosis of fracture related infection (FRI) after the index nonunion repair was associated with increased risk of recalcitrant nonunion (47% with FRI vs 18% without FRI, p=0.021). Nonunion repair with a nail plate combination was significantly associated with decreased risk of recalcitrant nonunion (0/27, 0%) compared to repair with plate alone (8/28, 29%), nail alone (4/10, 40%), or graft alone (9/25, 36%), p<0.001. Looking at dual-column fixation constructs as a whole (including nail + plate, plate + endosteal plate or medial strut, dual-plate), fixation with a dual column construct was again associated with a lower rate of recalcitrant nonunion (1/36, 3%) compared to nail alone (4/10, 40%), plate alone (8/28, 29%), or graft alone (9/25, 36%), p<0.001.</p><p><strong>Conclusions: </strong>Nearly one in four patients developed a recalcitrant nonunion after attempted nonunion repair. Fixation with a dual-column construct was associated with decreased risk of recalcitrant nonunion.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707775","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}