Provisional fixation of unstable femoral neck basicervical fractures: A web-based survey and biomechanical assessment using a sliding hip screw construct
Bibliographic record
Abstract
Objectives: Many hip fractures are considered rotationally unstable, especially during lag screw insertion. To counteract this instability, multiple provisional fixation constructs have been used to maintain the fracture reduction. This study aimed to compare the methods of provisional fixation biomechanically in ba sicervical femoral neck fractures. Methods: A web-based survey was sent by e-mail to members of three orthopedic assocations with questions concerning used techniques for provisional fixation of unstable basicervical femoral neck fractures and these results were used to guide our biomechanical assessment. Twenty, fourth-generation composite proximal femurs were osteotomized in the basicervical region to simulate a basicervical fracture. These fractures were anatomically reduced and one of the four provisional fixation constructs was applied. A sliding hip screw was then inserted with a torque limiter to the appropriate depth. The amount of fracture displacement during screw insertion was collected and analyzed. Results: Of the 142 respondents, 79.6% apply some form of provisional fixation. Derotational screw was the most commonly used provisional fixation (43.4%), followed by one superior Kirschner wire (K-wire) (39.8%). Biomechanically, the single derotation screw construct showed significantly less displacement (0.92 mm) than the one superior K-wire construct (3.09 mm). No other significant differences in fracture displacement were found between the groups. Conclusion: This study highlights that the majority of surgeons apply a form of provisional fixation during the surgical management of unstable basicervical femoral neck fractures. We have shown biomechanically that the single derotation screw had superior rotational stability when compared to the one superior K-wire.
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How this classification was reachedexpand
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 | 0.009 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| 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 teacher head, 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".