The effect of intramedullary reaming on a diaphyseal bone defect of the tibia
Bibliographic record
Abstract
Objective: We prospectively evaluated clinical and radiographic outcomes in patients with displaced combined transverse-posterior wall acetabular fractures managed at our Institution over a period of seven years by posterolateral single approach, direct posterior wall and posterior column reduction and plating, and indirect reduction of anterior column controlled by fluoroscopic images with or without lag-screw fixation.The aim was to identify if the obtained intra-operative Matta radiographic roof-arc angles after wall reduction and fixation alters in the postoperative period when comparing posterior plating alone versus posterior plate and anterior column lag-screw fixation.Patients and methods: 35 skeletally mature patients (31 male and four female, with mean age of 39.9 years old [range, 23.3-66.7 y/o]) with combined transverse-posterior wall acetabular fractures surgically treated by a posterolateral single approach were enrolled in this prospective investigation.Nineteen patients had associated orthopaedic injuries.The first part of the acetabular fracture management was similar to all patients and consisted in anatomical reduction and fixation of the wall component followed by anatomical reduction of the transverse-posterior component and plating.The transverse-anterior component reduction was controlled by fluoroscopic images (anteroposterior (AP), iliac oblique, and obturator oblique views) and manual palpation through the greater sciatic notch.Fifteen patients had an additional lag-screw fixation from the posterior to the anterior columns with an extra-long smallfragment cortical screw.AP and Judet oblique radiographic views were taken at the end of the procedure and roof-arc angles were measured.Clinical results were assigned according to the grading system of Merle D'Aubigne and Postel as modified by Matta et al.Radiographic roof-arc angles were checked and compared between the two groups of patients to the same data collected both at the time of the surgical procedure and at three months postoperatively.Statistical analysis was done by either using chi-square (clinical outcome) and Mann-Whitney (roentgenographic outcome) tests, with a level of significance of ˛= 5%.Results: At final follow-up examination 18-84 months postoperatively (mean, 46.8 months), the clinical results were considered satisfactory in 31 (88.6%)patients (excellent in nine (25.7%) and good in 22 (62.9%)patients).There was no difference between patients with and without fixation of the transverse-anterior component of the acetabular fracture (p = 0.67).Radiographic roof-arc angles measured at three months postoperatively and at the last follow-up consultation did not changed significantly (p > 0.05).There was no statistically significant difference between patients treated with and without fixation of the anterior component of the transverse acetabular fracture in terms of medial displacement of the femoral head.Conclusion: associated transverse-posterior wall acetabular fractures can be managed by a single posterior approach.Direct reduction and fixation of the posterior wall and column components is an adequate option for these injuries.It is not necessary to fix the anterior column component of the transverse fracture.
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".