Nail Plafond Angle: A Novel Technique to Evaluate for Intraoperative Coronal Malalignment in Tibia Fractures
Bibliographic record
Abstract
Objective: Orthopedic management of distal tibia fractures presents a difficult challenge with high rates of malignment. Intramedullary nailing demonstrates coronal malalignment rates of 5% to 30%. This malignment has been associated with decreased satisfaction with outcomes. This stresses the importance of obtaining appropriate intraoperative nail alignment. This article helps address the rate of coronal plane malreduction during intramedullary nailing of distal tibial shaft fractures. This novel fluoroscopic technique analyzes the intraoperative angle between the distal end of the tibial nail and the tibial plafond [the nail plafond angle (NPA)]. Materials and Methods: Retrospective review study of 100 subjects with distal tibia fractures at a single level 1 trauma center. Coronal nail alignment was measured on intraoperative fluoroscopic films utilizing the NPA. This measurement was then compared with full-length film alignment postoperatively analyzing for overall malreduction and correlation between the measurements. All measurements were completed by at least 2 orthopedic trained physicians. Results: Coronal alignment was compared, and there was a strong correlation between the measured varus and valgus angulation using the intraoperative technique and the full-length postoperative films ( R = 0.74). The overall coronal malalignment while utilizing the NPA technique was 8% (8/100 patients). Discussion: The overall malalignment utilizing the NPA intraoperatively was 8%, which is substantially lower than the generally accepted literature malreduction rate of distal tibia fractures treated with intramedullary fixation. This novel technique could be added to the armamentarium of tools to assist in preventing the malreduction of distal tibia shaft fractures.
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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 | 0.001 | 0.000 |
| 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 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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".