Recommendations for Early Surgical Intervention in Adolescents With Salter-Harris II (SH2) Distal Radius Fractures
Bibliographic record
Abstract
INTRODUCTION: Nonsurgical management is the standard of care for most distal radius fractures involving the epiphyseal plate. However, because of the lack of remodeling potential in adolescents, nonanatomic reduction can result in a symptomatic malunion necessitating late complex surgical correction. Guidelines outlining optimal management strategies for SH2 distal radius fractures in the adolescent population are needed. METHODS: This study is a retrospective review of isolated SH2 distal radius fractures from two, large, regional, referral pediatric ACS trauma level 1 hospitals between 2017 and 2020 in patients aged 9 to 18 years. Patients were identified by Current Procedural Terminology coding associated with their fracture management. Demographics, timing and type of treatment, and fracture displacement at relevant time points were recorded. Bivariate analysis was used to identify predictors of decision for acute surgery and/or correlates with the need for malunion correction. A Classification and Regression Tree model was fit to identify predictors of surgeon decision making for acute surgical intervention. RESULTS: Sixty (11%) of 556 patients underwent acute surgical intervention following closed reduction. Seventeen cases (3%) were done to correct late malunion. A Classification and Regression Tree model correctly classified the decision for acute surgery in 77% of patients using sagittal translation post reduction of ≥35% followed by age at injury of ≥12 years. The decision for acute surgery included older patients (median age 13.8 vs. 12.6 years, P < 0.001), with greater coronal (11.6% vs. 0%, P < 0.001) translation, sagittal (30% vs. 0%, P < 0.001) translation and increased dorsal tilt (5.2° vs. 0°, P < 0.001). CONCLUSION: Decision for acute surgical intervention of SH2 distal radius fractures is done most often with persistent deformity of sagittal translation ≥35% in patients ≥12 years following closed reduction at the time of injury. Additional parameters are identified as associated with the decision for acute surgery and progression to symptomatic malunion.
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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 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.002 |
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".