Beware the Boxer's Fracture Imposter: Where Does the Metaphysis End and the Diaphysis Begin?
Bibliographic record
Abstract
Introduction: Fractures of the fifth metacarpal are a common injury. In children, they are often stable and heal uneventfully, including after closed reduction. Fractures of the metacarpal diaphysis, conversely, tend to be unstable and may require surgical intervention. It is unclear at what point fractures of the fifth metacarpal fracture should be considered unstable. We identify the location at which a fifth metacarpal fracture is at risk for surgical intervention. Methods: A two-year retrospective cohort analysis of all children (age ≤18) with fifth metacarpal fractures presenting to a Pediatric Plastic Surgery clinic was performed. Clinical and radiographical data were acquired from electronic medical records. Fracture location and fracture angulation were measured, descriptive statistics were performed, and multivariable logistic regression was used to identify predictors for surgery. Results: Ninety-eight patients met criteria for review. Mean patient age was 14.0 years (SD 2.2), and 95% were male. Forty-two (44.2%) patients underwent closed reduction, and 12 (12.2%) patients were recommended for surgery. Increased fracture angulation on initial lateral radiograph (OR: 1.08 (1.03-1.14 95% CI), p = 0.006) and more proximal fractures (OR: 0.92 (0.86-0.98 95% CI), p = 0.008) were identified as independent predictors for surgery. Fractures occurring proximal to 70% of metacarpal length resulted in accurate detection of those requiring surgery with 72.4% sensitivity, 75.3% specificity, 95.5% and 27.6% negative and positive predictive value, respectively. Conclusions: In pediatric fifth metacarpal fractures, increased fracture angulation and those occurring proximal to 70% of the metacarpal length were independent predictors for surgery.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".