Operative Versus Nonoperative Treatment of Stress-Positive Lateral Compression Type 1 Pelvic Ring Injuries: A Multicenter Retrospective Propensity-Matched Analysis
Bibliographic record
Abstract
OBJECTIVES: To compare outcomes of operative versus nonoperative management of stress-positive lateral compression type 1 (LC1) pelvic ring injuries. DESIGN: Multicenter retrospective study. SETTING: Eight level 1 trauma centers. PATIENTS SELECTION CRITERIA: Patients with minimally displaced stress-positive LC1 pelvic ring injuries (OTA/AO 61B2) treated with acute operative (≤3 days) versus nonoperative management. OUTCOME MEASURES AND COMPARISONS: Propensity matching was used to compare operative versus nonoperative groups in terms of hospital length of stay (LOS), maximum feet ambulated while hospitalized, discharge to home versus a facility, unassisted ambulation at last follow-up, and mortality. RESULTS: There were 224 patients included: 139 operative and 85 nonoperative. Operative versus nonoperative patients were similar in terms of age (47.0 vs. 59.0, P = 0.06), female gender (61.2% vs. 68.2%, P = 0.32), and follow-up duration (159 vs. 122 days, P = 0.05), and were more likely to have complete sacral fractures (63.3% vs. 35.3%; P =<0.0001), and less likely to be injured in ground-level falls (17.3% vs. 32.9%; P = 0.007) and to have baseline-assisted ambulation (5.8% vs. 16.4%; P = 0.008). After matching for these differences, operative versus nonoperative patients (77 vs. 77) had a lower mortality rate (5.2% vs. 15.6%, P = 0.04), and were similar in terms of follow-up duration (134 vs. 122 days, P = 0.39), max feet ambulated while hospitalized (16.5 vs. 50.0 feet, P = 0.55), hospital length of stay (5.0 vs. 5.0 days, P = 0.39), discharging to home (68.8% vs. 71.4%, P = 0.72), and unassisted ambulation at last follow-up (76.6% vs. 62.3%, P = 0.05). Mortality was associated with older age (72 vs. 48 years, P = 0.0002), a higher CCI (3.0 vs. 1.0, P = 0.003), assisted ambulation at baseline (29.4% vs. 8.2%, P = 0.02), and ground-level falls (64.7% vs. 19.8%, P = 0.0002). CONCLUSIONS: On matched analysis, operative versus nonoperative management was associated with a lower mortality rate. Mortality was associated with fragility fracture characteristics suggesting that this is an at-risk population. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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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 | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| 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".