A POPULATION REVIEW OF 5207 CALCANEOUS FRACTURES: CURRENT PRACTICE AND TREATMENT COMPLICATIONS
Bibliographic record
Abstract
5207 patients treated for a calcaneous fracture in Ontario between 1993–1999 were identified from population datasets and were reviewed to evaluate regional practice variation and complication rates for operatively and non-operatively managed calcaneous fractures. There was considerable geographic variation in treatment. Individuals in some parts of Ontario were almost eight times more likely to receive operative treatment than others. The majority of calcaneous fractures in Ontario are treated non-operatively, however the large observed practice variation suggests that there is disagreement among treating clinicians. Primary subtalar fusion has a high risk of post-operative infection and should therefore be considered very cautiously. The purpose of this study was to evaluate regional practice variation and complication rates for operatively and non-operatively managed calcaneous fractures. The majority of calcaneous fractures in Ontario are treated non-operatively, however the large observed practice variation suggests that there is disagreement among treating clinicians. Primary subtalar fusion has a high risk of post-operative infection and should therefore be considered very cautiously. Given the observed regional variation in management of calcaneous fractures more work needs to be done to address this issue. 5207 fractures of the calcaneous in Ontario between 1993–1999were identified from population datasets. Regional variations in treatment and complication rates were computed. Multiple linear regression was used to identify factors associated with complications. There was considerable geographic variation in treatment. Individuals in some parts of Ontario were almost eight times more likely to receive operative treatment than others. General surgeons or general practitioners definitively treated 30% of patients (almost all closed). Overall rate of complications was low, however there was a 13.4 percent infection rate following immediate subtalar fusion. Infection was 5.3% following ORIF and 0.6% following closed treatment. Infection risk was increased in multiple trauma patients and those with open fractures. Subsequent subtalar fusion rates (within the study period) were higher in multiple trauma patients, but were not associated with treatment (open or closed). Amputation was 22.5 times more likely following open calcaneous fractures but the overall amputation rate was only 0.17%. No relationship between surgeon experience and the rate of complications following operative treatment was identified.
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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 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.006 | 0.018 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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".