Fractures of the Great Toe Proximal Phalanx: A Case Series and Review of the Literature
Bibliographic record
Abstract
Phalangeal fractures are the most common fractures seen in the foot, especially in the great toe. Acceptable angulations for fractures of the proximal phalanx are not known. To determine practice trends, a retrospective review of consecutive patients treated at a single institution from January 2011 to August 2014 was performed. All patients were skeletally mature with fractures to the diaphysis of the proximal phalanx with or without intra-articular extension. Outcomes from the medical record review included the type of treatment, radiographic alignment, and visual analog pain scores. Of the 12 patients reviewed, 4 sustained crush injuries and 8 sustained axial load injuries. Statistical analysis was done using Student’s t test for a normally distributed population. Nine of the 12 fractures were treated with manipulation, 7 were closed reduction and percutaneous pinning (CRPP), and 2 were isolated closed reduction without internal fixation. Two of the 9 patients with CRPP required additional surgery. The comparison between the sagittal plane angulation in the closed reduction cohort was 25 degrees compared with 42 degrees in the CRPP cohort (P=0.02). The final sagittal plane angulation comparison was not significant 12 versus 15 degrees (P=0.55). In the transverse plane, no statistical difference was seen between the 2 cohorts with an initial angulation of 8 degrees in the closed reduction cohort versus 13 degrees in the CRPP cohort (P=0.45). The final transverse angulation was symmetric with a mean of 4 degrees in each cohort (P=0.91). The patients in this review were more likely to be treated with operative intervention when initial angulation had a mean of 42 degrees in the sagittal plane. Patients with initial mean angulation of 25 degrees were more likely to be treated with a closed reduction. Final sagittal plane angulations of 12 to 15 degrees were associated with good outcomes. This series may help surgeons and patients in their shared decision making when faced with shaft fractures of the proximal phalanx. Level of Evidence: Level IV—retrospective cohort study.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.008 | 0.008 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.002 |
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".