When would orthopaedic surgeons perform arthroplasty for a femoral neck fracture in an older adult?
Bibliographic record
Abstract
PURPOSE: Minimally displaced femoral neck fractures (FNFs) in older adults have traditionally been managed with internal fixation (IF). However, emerging evidence suggests arthroplasty may provide better outcomes. We sought to determine surgeons' current practice patterns and determine which patient and fracture characteristics lead them to prefer arthroplasty. METHODS: We developed a survey to assess the influence of fracture and patient characteristics on orthopaedic surgeons' choice to treat FNFs in older adults with arthroplasty. We electronically distributed the survey to members of professional associations and our research network. RESULTS: Among 155 orthopaedic surgeons (response rate 25%), 74% agreed that deciding between IF and arthroplasty is difficult for certain minimally displaced FNFs cases and 36% reported performing arthroplasty for at least half of minimally displaced FNFs. Surgeons reported they would perform arthroplasty for a minimally displaced FNF with posterior tilt of 20° (69%) or 30° (94%), varus angulation (88%), or a neck-shaft angle > 160° (70%). Age (83%), mobility (76%), and osteoporosis (62%) influenced surgeons' treatment preferences. Preference for arthroplasty was significantly associated with annual volume of minimally displaced FNFs (p = 0.033), but not years in practice (p = 0.065). Seventy-nine per cent agreed that a randomized trial is needed to determine the best clinical practice for minimally displaced FNFs. CONCLUSIONS: In contrast to existing guidelines and practice trends, over one-third of orthopaedic surgeons who responded to the questionnaire would routinely treat minimally displaced FNFs with arthroplasty. The variation between surgeon's current practices demonstrates the need for a high-quality randomized trial.
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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 | 0.002 | 0.015 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".