Successful Treatment of a Challenging Periprosthetic Femoral Fracture on a Premenopausal Patient with a Long History of Immunosuppression : Case Report
Bibliographic record
Abstract
While immunosuppression provides relief and care in patients with rheumatic arthritis, the prolonged usage of steroids has been known to cause various and serious complications. While in older patients it is common to find those with a long history of immunosuppression, younger patients also suffer from its prolonged complications. We present a 38 year old heavily immunocompromised female patient with excellent compliance on which we operated on multiple occasions and have treated from 2019 to 2022. The patient was originally diagnosed with rheumatoid arthritis at age 7, and has been receiving high dose immunosuppressive medication. The patient received bilateral total hip arthroplasty during 2009 and 2013, and a Total Knee Arthroplasty (TKE) in 2011. Over the course of her postoperative recovery, she suffered from multiple cases of periprosthetic fractures. In October 2019, the patient again presented with spontaneous pain in her right thigh. She was then diagnosed with a Vancouver C type periprosthetic fracture on the right femur, and was referred and admitted to our level one Trauma Center in Szeged, Hungary. After multiple trials, the patient received a Locking Compression Plate (LCP) type Proximal Femoral Hook Plate (PFHP) with cable fixation, attachments and a bone allograft to reinforce stability and neutralize stress on the fractured area. Multiple and repetitive challenges can be expected in treating bony fractures of weight bearing lower limbs for heavily immunocompromised patients. The patient, despite her young age, had the osteological biology of a elderly patient, requiring us to take into consideration not only surgical components but biological components as well. With a multidisciplinary approach from osteological, biological, and surgical fields, successful results may be acquired even in these challenging cases.
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.005 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
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".