Periprosthetic fractures of the femur: the stability of the implant dictates the type of treatment
Bibliographic record
Abstract
The increasing incidence of complications after hip replacement surgery is a consequence of two main factors: the prolonged survival time in the general population and the increasing number of primary implants made worldwide in the last decades. Among the possible complications, periprosthetic femoral fractures represent a challenge for orthopaedic surgeons. In terms of treatment, it is crucial to distinguish between intraoperative (or perioperative) fractures and post-traumatic fractures. The former may be minor fractures that do not necessitate surgical treatment. Posttraumatic fractures usually require operative treatment and are associated both with predisposing factors such as osteolysis, osteopenia and aseptic loosening of the implant as well as with determining factors such as minor traumatic events. The incidence of intraoperative periprosthetic fractures in cementless total hip arthroplasty ranges from 1 to 20% and is higher in revision surgery [2, 6, 7, 8, 11, 15]. Lower rates are observed in cemented procedures where the need for a tight press fit is less. These fractures are usually located in the calcar region or directly in the trochanter, and they are often the consequence of excessive reaming with rasps and broaches during preparation of the medullary canal or, inadvertently, during insertion of the definitive stem. Although fixation of intraoperative fractures with wire cerclage or plates is effective, it is recommended to avoid such events through careful preoperative planning and optimal surgical technique. Regarding postoperative periprosthetic fractures, the incidence ranges between 1 and 4%, again with higher rates in revision surgery [2, 6, 10, 12]. These fractures are
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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 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| 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) | 0.005 | 0.001 |
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".