CEMENTING HIP FRACTURES AS THE STANDARD OF CARE: ESTABLISHING THE CONSENSUS IN CANADA?
Bibliographic record
Abstract
Despite the evidence supporting the use of cemented over non-cemented femoral stem fixation for treating hip fractures, there is still variation in its application. This paper looks at current trends in Canada using Canadian Joint Replacement Registry data and includes a national survey to understand the varied uptake in the use of cement for femoral stem fixation, aiming to discuss and explore ways to improve the quality of care for hip fracture patients. The Canadian Arthroplasty Society approved this national survey before the Canadian Orthopaedic Association endorsed it for distribution to its members. The survey was available online through Qualtrics, and the website link was distributed via email through the Canadian Orthopaedic Association to all orthopaedic surgeons across Canada. All survey responses remained anonymous. The survey was open for submissions between September and December of 2022. The survey was distributed to 1600 individuals and received 106 responses (response rate of 7%). Respondents’ location of practice varied; Ontario was the most common (40%), followed by Quebec (12.3%). Most respondents practiced in an academic community setting (52%). The number of respondents who reported using cement was roughly equal, with 53% responding ‘yes’ and 47% responding ‘no.’ 71% of respondents indicated that cemented femoral fixation was best practice, 27% indicated that both cemented/uncemented were acceptable, and 2% indicated that uncemented was best practice. Respondents cited various reasons for the selection of uncemented fixation, with the most common ones being less operative time (23%), cement disease concerns (11%), and surgeons’ comfort (10%). This Canadian study demonstrates equivalent use of cemented and cementless implants for femoral stem fixation despite solid evidence demonstrating improved clinical outcomes with cement. Some of the main reasons cited by respondents in favour of uncemented technique include operative time, surgical training, and concern about cement disease. Establishing clear position statements and clinical practice guidelines supporting cemented femoral stem fixation may be prudent to build universal consensus on this practice.
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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 | 0.072 | 0.149 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.007 | 0.016 |
| Science and technology studies | 0.011 | 0.010 |
| Scholarly communication | 0.012 | 0.007 |
| Open science | 0.008 | 0.008 |
| Research integrity | 0.005 | 0.008 |
| Insufficient payload (model declined to judge) | 0.003 | 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".