Revision arthroplasty versus open reduction and internal fixation in Vancouver type B2 and B3 periprosthetic femoral fractures: results from a matched pairs analysis of the registry for geriatric trauma of the DGU®
Bibliographic record
Abstract
BACKGROUND AND OBJECTIVES: Owing to a lack of evidence, the appropriate surgical treatment strategy for geriatric patients with Vancouver type B2 or B3 periprosthetic femoral fractures (PFFs) remains unclear. Data from a large international geriatric trauma registry were analyzed to investigate the medical care situation of such patients, as well as to examine the outcomes related to revision arthroplasty (RA) or open reduction and internal fixation (ORIF). MATERIALS AND METHODS: Datasets from the Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie [DGU]) (ATR-DGU) were analyzed. The ATR-DGU is a prospective, multicenter registry that provides information on geriatric trauma patients. All patients who underwent surgery for PFF were included in this analysis. The outcome parameters included the mortality rate during hospitalization and at the 120-day follow-up, as well as mobility, the EQ-5D-5 L score and the reoperation rate, and were analyzed in relation to RA versus ORIF in Vancouver type B2 or B3 PFF patients. RESULTS: A total of 607 patients with Vancouver type B2 or B3 PFF met the inclusion criteria. Among these patients, 420 underwent RA, and ORIF was performed in 187 patients. Regression analysis of the parameters collected during the acute phase revealed that after 2:1 matching, compared with the RA group, the ORIF group had significantly lower odds for full weight bearing allowed one day after surgery (OR: 0.49; p < 0.001); walking ability after seven days (OR: 0.56; p = 0.005); and the occurrence of nonsurgical complications (OR: 0.59; p = 0.012). The probability of death during follow-up and the EQ-5D-5 L score after seven and 120 days remained unaffected. CONCLUSIONS: The results of the present study support the estimate that ORIF represents a valid treatment alternative for Vancouver type B2 and B3 PFFs, as comparable midterm outcomes were demonstrated for each patient group. However, individualized decisions should always be made, especially for multimorbid geriatric patients, to reduce complications.
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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 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| 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".