Open Reduction and Internal Fixation Compared With ORIF and Primary Subtalar Arthrodesis for Treatment of Sanders Type IV Calcaneal Fractures
Bibliographic record
Abstract
OBJECTIVES: To compare long-term health outcome of Sanders type IV calcaneal fractures treated with open reduction and internal fixation (ORIF) versus ORIF plus primary subtalar arthrodesis (PSTA). DESIGN: Randomized prospective multicenter trial. SETTING: Four Level 1 trauma hospitals in Canada. PATIENTS: Thirty-one patients with 31 Sanders IV displaced intraarticular calcaneal fractures. INTERVENTION: Seventeen patients were treated with a standard protocol involving a lateral approach for ORIF. Fourteen patients were treated with a standard protocol involving a lateral approach with ORIF + PSTA. MAIN OUTCOME MEASUREMENTS: Health outcomes were assessed with 4 validated instruments: (1) the Short Form 36 version 2 (SF-36), (2) the Musculoskeletal Functional Assessment Survey, (3) the American Orthopaedic Foot and Ankle Society's Ankle-Hindfoot Scale, and (4) the Visual Analogue Scale. RESULTS: From 2004 to 2011, 26 patients (26 displaced intraarticular calcaneal fractures) were followed for a minimum of 2 years (81% follow-up). No statistical difference was found between the results for ORIF compared with ORIF + PSTA: the mean SF-36 physical component scores were, respectively, 30.2 (SD = 11.4) and 37.8 (SD = 10.4) (P = 0.10); the mean Musculoskeletal Functional Assessment Survey scores were 44.2 (SD = 25.6) and 37.9 (SD = 21.5) (P = 0.50); the mean Ankle-Hindfoot Scale scores were 62.5 (SD = 19.6) and 65.8 (SD = 19.2), (P = 0.68); and the mean Visual Analogue Scale scores were 36.8 (SD = 34.7) and 36.0 (SD = 30.7) (P = 0.82). CONCLUSIONS: We were unable to demonstrate a significant difference between treating Sanders type IV fractures with either ORIF or ORIF + PSTA. It remains the choice of the surgeon and patient to take into account patient specific factors to determine treatment. However, ORIF + PSTA may be advantageous for both patients with Sanders type IV fractures and the health care system as patients heal quickly. Furthermore, ORIF + PSTA may prevent the need for late secondary subtalar fusion adding to increased costs and lost time from work. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".