LONG VERSUS SHORT INTRAMEDULLARY NAILS FOR TROCHANTERIC HIP FRACTURES: A SECONDARY ANALYSIS OF THE INSITE TRIAL
Bibliographic record
Abstract
We aimed to use data from a recent randomized controlled trial (RCT) comparing the sliding hip screw vs. intramedullary nailing for trochanteric fractures to examine complication rates between those managed with a short vs. long nail. This is a secondary analysis using one arm of an RCT that included ambulatory patients ³18 years with AO type 31-A1 or 31-A2 trochanteric fractures. We examined differences in fracture-related (femoral shaft fracture, implant failure, surgical site infection, nonunion, limb shortening, and pain) and medical adverse events (AE, organ failure, respiratory distress, stroke, deep vein thrombosis [DVT] gastrointestinal upset, pneumonia, myocardial infarction, sepsis, or urinary tract infection [UTI]), and readmission between those managed with a short vs. long IMN. We used logistic regression to examine the independent association between nail length and outcomes. We included 412 trochanteric fracture patients managed with an IMN. Of these, 339 (82.2%) received a short (170mm-200mm) nail, while 73 (17.7%) received a long (260mm-460 mm) nail. Patients managed with a short nail were more likely to be admitted from an institution (vs. home), while those managed with a long nail were more likely to have comorbidities, and more complex fracture types. Patients in the long nail group had higher rates of fracture-related AE (12.3%) vs. the short IMN group (3.5%). Specifically, the unadjusted rates of surgical site infection (SSI) and pain were significantly higher in the long group (SSI: 5.5%, pain: 2.7%) compared to the short group (SSI: 0.3%, pain: 0.0%). Similarly, patients in the long group were more likely to develop DVT (Long: 2.7%; Short: 0.3%), and readmitted to the hospital (Long: 28.8%; short: 20.7%). Following covariable adjustment, long nails remained independently associated with a higher odds of fracture-related AE (5.11, 1.96-13.33) compared to short nails. We found no association between the odds of readmission and nail length following covariable adjustment (1.00, 0.52-1.94). Our analyses revealed that trochanteric fracture patients managed with long IMN nails (260mm-460mm) may have a higher odds of fracture-related AE compared to short nails (170mm to 200mm). Future research is required to validate these findings with larger event rates, and further optimize IMN for trochanteric fracture patients.
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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 | 0.001 |
| 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 | 0.000 | 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".