Bibliographic record
Abstract
Sir:FigureWe appreciate the comments by Drs. Nikkhah, Rodrigues, Saleh, and Jeffers regarding our article, “Comparison of Trapeziectomy and Trapeziectomy with Ligament Reconstruction and Tendon Interposition: A Systematic Literature Review” (Plast Reconstr Surg. 2011;128:199–207). Our systematic review and meta-analysis attempted to answer the crucial question of whether trapeziectomy and ligament reconstruction and tendon interposition is superior to trapeziectomy alone for a number of clinically important outcomes. The meta-analysis component of this systematic review has shown that in terms of the specific outcomes of tip and key pinch strength, there was no difference in the two procedures. We are confident of the veracity of this conclusion, as the pooled results had enough power to answer this question. Although we found no difference between the two techniques regarding the other outcomes (i.e., grip strength, pain, adverse events, and function), we have concerns that type II error may be at play here. In other words, there may be a difference but even the pooling of the data did not have enough power to “tell us the truth.” For these variables, the results were inconclusive. Quality of life and cost-effectiveness remain largely unknown, as previous investigators did not pay particular attention to these very important outcomes.1,2 Dr. Nikkhah and colleagues state that they prefer trapeziectomy with ligament reconstruction and tendon interposition because it maintains thumb height. Although maintenance of trapezial height is theoretically important, it has been shown to not be associated with postoperative subjective and objective outcomes, particularly strength outcomes. The impact of marginal or greater decrease in trapezial height with trapeziectomy alone remains questionable. In general, this systematic review questions the general acceptance of trapeziectomy with ligament reconstruction and tendon interposition as a definitive solution to the osteoarthritis of the carpometacarpal joint of the thumb. To find the definitive answer, we need to compare the two procedures side-by-side in a methodologically sound randomized controlled trial with a large sample size with unbiased assessors in which the following outcomes are measured: quality of life, pain control, cost-effectiveness, grip strength, radial and palmar abduction, and adverse events. The time horizon for measuring the outcomes should be decided by a panel of expert hand surgeons and should include an early, intermediate, and long-term follow-up.3,4 We agree with Dr. Nikkhah and colleagues that it would also be appropriate to compare the two procedures in different patient groups. Such a definitive study will require contribution of multiple centers to achieve the necessary sample size with adequate power to address this clinical question. Failure to do so will lead to additional multiple smaller studies in the future with inadequate power, thus wasting resources and possibly preventing future patients from undergoing the most effective procedure. Achilleas Thoma, M.D., M.Sc. Yu Kit Li, B.H.Sc. Colin White, M.D. Teegan A. Ignacy, B.Sc. McMaster University, Hamilton, Ontario, Canada
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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 | 0.003 | 0.044 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.003 | 0.005 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.012 | 0.017 |
| Insufficient payload (model declined to judge) | 0.076 | 0.046 |
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".