Intramedullary Versus Extramedullary Fixation for Subtrochanteric Femur Fractures
Bibliographic record
Abstract
OBJECTIVES: Both intramedullary and extramedullary internal fixation has been advocated for the treatment of subtrochanteric femur fractures. Is there clinical evidence to recommend one method of internal fixation over the other? DATA SOURCES: A search of MEDLINE (1950 to June 2007), CINAHL (1982 to June 2007), and EMBASE (1980 to June 2007) was performed. Results were limited to English language studies. References from eligible studies were reviewed to identify additional studies. STUDY SELECTION: Studies were selected for review based on the following criteria: comparison and observational studies examining the use of intramedullary and/or extramedullary implants for the fixation of subtrochanteric femur fractures, inclusion of intertrochanteric hip fractures with subtrochanteric extension, exclusion of pure intertrochanteric and intracapsular hip fractures, and exclusion of pathologic fractures. DATA EXTRACTION: The following outcomes were extracted from eligible studies: operative time, operative blood loss, intraoperative complications, postoperative medical complications, number of patients transfused, wound complications, failure of fixation, rate of nonunion, length of hospital stay, and functional recovery. DATA SYNTHESIS: Three level I and 9 level IV studies were identified and used in the systematic review of outcomes for intramedullary and extramedullary fixation for subtrochanteric fractures. Three level I studies were used to calculate a pooled relative risk for failure of fixation with a 95% confidence interval. An analysis of heterogeneity between pooled studies was conducted. CONCLUSIONS: There is grade B evidence that operative time is reduced and that fixation failure is reduced with the use of intramedullary implants for subtrochanteric fractures. Future studies should perform subgroup analysis according to the type of population sampled (ie, young versus elderly) and subtrochanteric fracture type.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".