Subcapital hip fractures: the Garden classification should be replaced, not collapsed.
Bibliographic record
Abstract
OBJECTIVES: To evaluate rater agreement for a simple 2-category classification of subcapital hip fractures versus the 4-category Garden classification and to determine the effect of clinician experience on the level of agreement. SETTING: Sunnybrook and Women's Health Sciences Centre, Toronto, a level 1 trauma centre. METHOD: Eleven raters, with varying levels of clinical experience (3 fellowship-trained orthopedic surgeons, 4 clinical fellows and 4 residents), classified 34 pairs of anteroposterior and lateral radiographs of patients with subcapital hip fractures according to whether the fracture was stable (the fragments move as a unit) or unstable (the fragments move independently), and according to Garden's original 4-category classification. The exercise was repeated 1 month later. The radiographs were obtained from a fracture database to represent a wide spectrum of injury severity. OUTCOME MEASURES: The level of agreement beyond chance, quantified by use of the SAV statistic of O'Connell and Dobson. RESULTS: The most experienced raters demonstrated almost perfect inter- and intrarater agreement with respect to stable and unstable fractures (SAV > 0.80). The raters demonstrated only fair agreement for the Garden classification (mean SAV 0.64). Even junior clinicians demonstrated substantial agreement regarding fracture stability, with much lower scores for the Garden classification. Collapsing the Garden classification responses into 2 categories (stages I and II v. III and IV) was not synonymous with rater categorization of stable versus unstable. CONCLUSION: The Garden classification for subcapital hip fractures is unreliable and should be abandoned in favour of categorizing fractures as stable versus unstable.
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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 | 0.010 | 0.049 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".