Forearm-Based Ulnar Gutter versus Hand-Based Thermoplastic Splint for Pediatric Metacarpal Neck Fractures
Bibliographic record
Abstract
BACKGROUND: Use of a hand-based thermoplastic splint for treatment of isolated fifth metacarpal neck fractures in pediatric patients has not previously been studied in a randomized blinded trial. METHODS: The authors conducted a blinded, 1:1 allocation, two-arm parallel group, superiority design, randomized controlled trial in patients aged 16 years or younger with isolated fifth metacarpal neck fractures. Patients were immobilized for 3 weeks in a conventional forearm-based ulnar gutter or hand-based thermoplastic splint. Primary outcome was difference in active range of motion between splint groups. Secondary outcomes included fracture union, treatment adherence, grip strength, and patient-reported pain and functional outcomes. RESULTS: Between February of 2013 and August of 2014, 40 patients were enrolled in the trial. No differences were observed in baseline characteristics between groups. Mean range of motion was significantly better in the thermoplastic splint group compared with the ulnar gutter splint group at 3 weeks (p = 0.048). All patients had full range of motion at 12 weeks. Treatment adherence was 75 percent and 59 percent for ulnar gutter and thermoplastic splint groups, respectively (p = 0.46). Among ulnar gutter splint patients, decreased grip strength (injured versus noninjured) was observed at 3 and 6 weeks, and was significantly weaker compared with thermoplastic splint patients (p = 0.01). Reported pain scores were similar between groups. Patient-reported functional outcome scores were similar between groups at each time point. No nonunions were observed at 12 weeks. CONCLUSION: In pediatric patients, hand-based thermoplastic splints resulted in improved early range of motion and grip strength, with no increased pain, nonadherence, or complications compared with conventional ulnar gutter splints. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.
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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 | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 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".