Treatment of perinail refracture following surgery of proximal femoral fracture
Bibliographic record
Abstract
Objective To investigate the treatment of perinail refracture after surgery of proximal femoral fracture. Methods From January 2010 to January 2015, we treated perinail fractures in 31 patients who had undergone surgery for proximal femoral fracture. They were 11 men and 20 women, with an average age of 75.6 years (range, from 24 to 87 years). On average, their refracture occurred 9.4 months after primary fixation (range, from 3 to 60 months). With reference to the Vancouver classification of peri-prosthestic refractures in the proximal femur and the position and bone quality of perinail refractures, we tried to classify the perinail fractures and chose different treatment protocols accordingly. In our cohort, 6 were type A, 5 type B, 15 type C, and 5 type D. Type A cases were treated conservatively, and types B and C cases with locking compression plate or less invasive stabilization system. In one case of type D, dynamic hip screws were implanted to fixate the femoral neck fracture after removal of the original intramedullary nail, and hip replacement was conducted in the other 4 after removal of the original intramedullary nail. Results The operation time averaged 2.1 hours (range, from 1.6 to 3.0 hours) and intraoperative bleeding 600 mL (range, from 150 to 800 mL) in this cohort. Of them, 27 were followed up for an average of 15 months (range, from 12 to 24 months), giving a follow-up rate of 87.1% (27/31). Six type A fractures obtained bone union after protected weight-bearing walking for 12 weeks. All the 16 fractures of types B and C healed after an average period of 4.2 months (range, from 3 to 6 months). Of the 5 type D fractures, one obtained bone union 12 weeks after change into dynamic hip screwing and 4 had fine functional recovery after hip replacement. No infection, nonunion, or implants failure occurred. Conclusions We have set an exploratory classification system for the perinail refractures at the proximal femur with reference to the Vancouver classification of peri-prosthestic refractures. Our classification can provide effective guidance for the treatment of perinail refracture after surgery of proximal femoral fracture. Key words: Hip fractures; Fractures fixation, internal; Bone nails; Refracture; Classification
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 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".