Mortality After Periprosthetic Fracture of the Femur
Bibliographic record
Abstract
BACKGROUND: Management of periprosthetic femoral fractures is often complex, and few studies have documented its associated mortality. METHODS: We retrospectively identified from our trauma and surgical registries 106 patients who underwent surgery for a periprosthetic femoral fracture. We then identified a contemporaneous age and sex-matched control cohort of 309 patients who had a hip fracture (femoral neck or intertrochanteric) and 311 patients who underwent primary hip or knee replacement. Mortality at one year was identified with use of the Social Security database. RESULTS: Twelve (11%) of 106 patients died within one year following surgical treatment of a periprosthetic fracture. During the same follow-up period, fifty-one (16.5%) of 309 patients died following surgery for a hip fracture and nine (2.9%) of 311 patients died following primary joint replacement. The mortality rate after a periprosthetic femoral fracture was significantly higher (p < 0.0001) compared with that for matched patients who had undergone primary joint replacement, and it was similar to the mortality rate after a hip fracture. For periprosthetic fractures, a delay of greater than two days from admission to the time of surgery was associated with an increased mortality rate at one year (p < 0.0007). Forty-nine patients underwent revision arthroplasty for the treatment of a Vancouver type-B periprosthetic fracture, and six (12%) died. In contrast, twenty-four patients with a Vancouver type-B periprosthetic fracture were treated with open reduction and internal fixation and eight (33%) died. The difference was significant (p < 0.03). CONCLUSIONS: The mortality rate within one year following surgical treatment of periprosthetic femoral fractures is high and is similar to that after treatment for hip fractures. Because revision arthroplasty for the treatment of type-B periprosthetic fractures was associated with a one-year mortality rate that was significantly less than that after surgical treatment with open reduction and internal fixation, in instances when either treatment option is feasible, revision arthroplasty may be the preferred option.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".