P001: Do all toddler’s fractures need to be managed by orthopaedic surgeons?
Bibliographic record
Abstract
Introduction: There is increasing evidence that emergency room physicians or primary care physicians can definitively manage many uncomplicated paediatric fractures without orthopaedic follow-up. This strategy leads to a reduction in radiation exposure and decreased costs to patient families and the healthcare system without impacting patient outcomes. The aim of this study was to determine whether patients who sustained a toddler’s fracture of the tibia required orthopaedic surgeon follow-up. Methods: A retrospective analysis including patients who presented to the Hospital for Sick Children (SickKids) for management of toddlers’ fractures between Jan 2009 and Dec 2014 was performed. Results: 186 patients (115 males, 72 females) with an average age of 2.00 (range 0.2-3.9) were included in the study. The mean number of clinic visits including initial consultation in the emergency department was 2.00 (±1.0). The mean number of radiology department appointments was 2.76 (±1.1) where patients received a mean number of 5.86 (±2.6) radiographs. Complications were minimal and no patient developed a non-union nor re-fractured. All patients achieved clinical and radiographic union. To date, no patient has returned to clinic or undergone surgery for concerns regarding leg length inequality or malalignment. Conclusion: Our series supports reduced clinical follow-up of patients with a toddler’s fracture of the tibia. If the diagnosis can be made on the initial radiographs, emergency room physicians or primary care providers can definitively manage these patients with appropriate immobilization that can be removed by the parents between 3-4 weeks after the injury. A fracture clinic follow-up is only necessary if the diagnosis cannot be made on the initial radiographs. Our toddler’s fracture pathway will reduce patient radiation exposure and reduce costs incurred by the healthcare system and patients’ families without jeopardizing patient outcomes.
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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 | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 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) | 0.011 | 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".