Patient-Reported Outcome Measures in the Elderly: Do These Reflect Healing Post-Fragility Fracture of the Pelvis?
Bibliographic record
Abstract
Background and objective Fragility fractures of the pelvis (FFPs) have become increasingly common in the geriatric population. The prolonged healing process associated with current non-operative management of FFPs has a significant negative impact on patient mobility, independence, and quality of life (QoL). This study aimed to document functional outcomes and QoL measures in individuals with non-operatively treated FFPs and examine if a relationship exists between these parameters and healing status. Methods This was a prospective case series involving a cohort from a single level 1 trauma center. Fifty-three elderly patients (age ≥65 years) who, after a fall from less than 5 feet, sustained a non-operative FFP as diagnosed on X-ray between 2008 and 2019. Functional outcomes using Musculoskeletal Function Assessment (MFA) and QoL measures based on 36-Item Short Form Health Survey (SF-36) were collected over two years. Healing was assessed per available follow-up X-ray imaging by four orthopaedic surgeons. Results Health status and function did not improve in elderly patients with stable FFPs treated non-operatively from reported baseline levels, with many MFA and SF-36 categories demonstrating a steady decline out to approximately 24 months. Follow-up X-ray imaging was only available for a subset of these individuals (n = 35). Substantial agreement was found between all four surgeon raters (Fleiss Kappa = 0.65) with respect to their evaluation of healing status. Confirmation of bone healing on X-ray (level 3) was found for only seven individuals. There was no association found between any MFA or SF-36 category and healing status for patients with coincident reporting (n = 16). Conclusions Overall, patient function and QoL decrease post-stable FFP, with no relationship evident between these measures and healing status. Worsening patient-reported outcome measures (PROMs) regardless of healing status should prompt discussions and further investigations regarding the need for continued monitoring of non-operative FFPs post-injury.
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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 | 0.007 | 0.020 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 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 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".