Notice bibliographique
Résumé
Commentary In their meta-analysis of randomized controlled trials, McKee et al. offer a welcome and thorough analysis of the controversial topic of displaced midshaft clavicular fractures. McKee was the lead investigator on a prospective randomized clinical trial by the Canadian Orthopaedic Trauma Society (COTS) study that was published in January 2007 in JBJS and that is included in this analysis1. Since the publication of that study, it has been my observation that some surgeons have used the results of that study—specifically, that, overall, patients have improved function at all time periods of analysis—to justify the overutilization of internal fixation of displaced clavicular fractures. This manuscript thoroughly evaluates the six prospective randomized trials that are available for analysis. The summation of the data indicates, as McKee et al. note, that approximately 75% of all patients with a nonoperatively treated, 100% displaced midshaft clavicular fracture will have essentially normal motion, with full fracture union, normal strength, and normal outcome scores of the upper extremity, and that there is an overall minimal difference in function between operative and nonoperative groups as measured with use of Disabilities of the Arm, Shoulder and Hand (DASH) and Constant scores. Approximately 15% of patients with nonoperatively treated fractures will have a nonunion and 10% will have a symptomatic malunion. It is not surprising that there is essentially no difference in the functional outcomes scores with use of the DASH or the Constant score for these two cohorts of patients. If 75% of nonoperatively treated patients heal with few or no symptoms, this large percentage will blunt any effects of the two treatment groups when considered on the whole. This manuscript can be utilized to give patients with a 100% displaced midshaft clavicular fracture the reasonable advice that they have a 75% chance of having no residual symptoms and normal shoulder function. We need to be able to better predict which patients are at risk of developing a nonunion and/or symptomatic malunion after this injury. In their 2007 paper, McKee et al. found that patients with a “droopy” shoulder may be the ones most likely to be at risk of developing symptoms from a midshaft clavicular fracture. Hopefully, further work will help define the patients who would truly benefit from early surgical intervention. McKee is to be congratulated for his part in the initial study and for his clear view of this timely topic.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».