Bibliographic record
Abstract
In the physiologically compromised elderly patient with an acetabular fracture, nonoperative treatment is associated with functional outcomes (as indicated by the Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] scores) similar to those seen in healthier patients who undergo open reduction and internal fixation, with similar mortality and lesser need for late conversion to total hip arthroplasty. Open reduction and internal fixation of displaced acetabular fractures in patients older than 60 years of age is an excellent option provided that the patient does not have risk factors for failure such as acetabular dome (roof) impaction, femoral-head impaction, or a posterior-wall component. Specific techniques to treat quadrilateral plate involvement and dome impaction are necessary to ensure a durable result. More limited operative approaches and percutaneous fixation have a role in this patient population to minimize the morbidity associated with more extensive exposures. The clinical and radiographic outcome of posterior-wall acetabular fractures that have associated comminution, marginal impaction, and/or femoral-head impaction fractures is predictably poor, with rapid onset of posttraumatic arthritis. Immediate total hip arthroplasty in this population is simple and has outcomes equivalent to those of total hip arthroplasty for coxarthrosis. Total hip arthroplasty should be considered for patients who are >=60 years of age and have posterior-wall acetabular fractures and perhaps even in younger patients when there are multiple injury factors that predict a poor outcome. The published clinical results of the use of acetabular reconstruction rings, bone graft, and revision arthroplasty techniques appear to be similar to the results of combined internal fixation and insertion of uncemented acetabular components. Surgeons should choose an operative plan that is appropriate to their particular training and skills, the patient's particular fracture, and hospital resources.
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".