Implant-Related Complications and Mortality After Use of Short or Long Gamma Nail for Intertrochanteric and Subtrochanteric Fractures
Why this work is in the frame
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Bibliographic record
Abstract
BACKGROUND: The purpose of this study was to evaluate the rates of implant-related complications and mortality after treatment of an intertrochanteric or subtrochanteric fracture with a short or long Gamma nail. METHODS: Between September 1998 and August 2003, 644 patients at 2 centers treated with a long or short Gamma nail for a hip fracture were prospectively enrolled in this study. These patients were followed until they reached 1 of the study end points, which included death, a reoperation directly related to the Gamma nail, or the end date of the study. RESULTS: The average age (and standard deviation) of the patients included in the study was 81.3 ± 8.6 years at the time of the operation, and 28.3% of the patients were male. The rate of implant-related complications was 9.9%. The most common complications included peri-implant fracture (4.2%), proximal lateral thigh discomfort requiring extraction of the implant (2.0%), and lag-screw cutout (1.1%). Interestingly, more than half (56%) of the 27 peri-implant fractures occurred >1.5 years after the index operation. The median time from the operation to death was 2.9 years (range, 0 to 17.1 years). The 30-day mortality rate after treatment was 9.5%. Patients with American Society of Anesthesiologists (ASA) class-3 or 4 physical status had a significantly higher risk of mortality than ASA class-1 patients. CONCLUSIONS: Gamma nails are effective in the treatment of intertrochanteric and subtrochanteric fractures. However, 9.8% of patients had complications requiring additional surgery. The most common serious complications include peri-implant fracture and lag-screw cutout. Several peri-implant fractures occurred long after the index procedure. Patients had a high rate of mortality (27%) after 1 year, and higher preoperative ASA class was found to be a predictor of increased risk of mortality. Therefore, clinicians must carefully consider patients' preoperative comorbidities when counselling patients on the risks of surgery. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| 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 | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 it