A Trial of Fracture Fixation in the Operative Management of Hip Fractures
Why this work is in the frame
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Bibliographic record
Abstract
Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw<br/>versus cancellous screws on the risk of reoperation and other key outcomes.<br/>Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients<br/>aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries.<br/>Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw<br/>with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws.<br/>Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment<br/>groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing,<br/>relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was<br/>registered with ClinicalTrials.gov, number NCT00761813.<br/>Findings Between March 3, 2008, and March 31, 2014, we randomly assigned 1108 patients to receive a sliding hip<br/>screw (n=557) or cancellous screws (n=551). Reoperations within 24 months did not differ by type of surgical fixation<br/>in those included in the primary analysis: 107 (20%) of 542 patients in the sliding hip screw group versus 117 (22%)<br/>of 537 patients in the cancellous screws group (hazard ratio [HR] 0·83, 95% CI 0·63–1·09; p=0·18). Avascular<br/>necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9%] vs<br/>28 patients [5%]; HR 1·91, 1·06–3·44; p=0·0319). However, no significant difference was found between the number<br/>of medically related adverse events between groups (p=0·82; appendix); these events included pulmonary embolism<br/>(two patients [Interpretation In terms of reoperation rates the sliding hip screw shows no advantage, but some groups of patients<br/>(smokers and those with displaced or base of neck fractures) might do better with a sliding hip screw than with<br/>cancellous screws.
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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 | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| 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 it