Cerclage Breakage in Trochanteric Revision - High Risk for Hip Endoprosthesis?
Bibliographic record
Abstract
CASE REPORT KAZUISTIKAClinical examination did not reveal a shortening or mal-rotation of the right leg and further clinical examination was limited due to pain in the region of the greater trochanter.A slightly displaced fracture of the greater trochanter (Vancouver A1) was apparent on X-rays and therefore we initially agreed on a conservative treatment.However, osteosynthesis with a multifilament cerclage system (Dall Miles) was performed in January 2011 (Fig. 1b) since persistent pain and delayed union was present under the conservative attempt (Fig. 1a).Nonetheless, pain was persistent even 23 months after surgical management but cerclage breakage was evident for the first time on X-rays (Fig. 1c) whereas a CT-scan 7 month earlier was negative for any failure.A revision surgery of the hip was performed by the senior author (AMN) in January 2013 with removal of the destructed cerclage and the acetabular cup (Fig. 2).Noteworthy, the cerclage failure was not present adjacent to the clamp or opposite to the cutting site of the parallel cable (Fig. 3).In addition, cerclage fragments were found within the PE-surface inside the cup (Fig. 4) with several scratches on the bearing surface.The acetabular cup required a replacement by an acetabular revision ring due to a central acetabular defect.The residual greater trochanter shell was augmented with allograft (cancellous chips and demineralized bone matrix) after careful debridement.Fixation was performed by applying two multifilament cables and K-wires without the use of screws or grip plates in order to prevent damage of the fragile trochanteric fragments (Fig. 5a).
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.003 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".