ArticleJournal of the American Academy of Orthopaedic Surgeons. Global research & reviews2024
A Scoring System for Predicting Nonunion After Intramedullary Nailing of Femoral Shaft Fractures.
Article in Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.
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Who cites it
4 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Performance of prediction models for delayed union and nonunion after fracture: a systematic review and meta-analysis.BMC musculoskeletal disorders · 2026Pooled it
- Intramedullary Nailing of Femoral Shaft Fractures: Implications of Interlocking Screw Breakage.Cureus · 2026Article
- Body mass index, weight bearing, and delayed union after femoral shaft fracture nailing: a retrospective cohort study.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2026Article
- Of Mice and Men: Temporal Comparison of Femoral Shaft Fracture Healing After Intramedullary Nailing: Retrospective Observational Study of Modified Radiographic Union Scores for Tibia.The Journal of bone and joint surgery. American volume · 2025Observational
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionFemoral shaft nonunion negatively affects patient quality of life. Although multiple risk factors have been identified for femoral shaft nonunion after intramedullary nail (IMN) fixation, there is no quantitative model for predicting nonunion. STUDY DESCRIPTION: The study is a retrospective cohort study of patients with femoral shaft fractures treated at two level one trauma centers who were followed to fracture union or nonunion. Patient, injury, and surgical characteristics were analyzed to create a quantitative model for nonunion risk after intramedullary nailing.
methodsEight hundred one patients aged 18 years and older with femoral shaft fractures treated with reamed, locked IMNs were identified. Risk factors including demographics, comorbidities, surgical variables, and injury-related characteristics were evaluated. Multivariate analysis was conducted, and several variables were included in a scoring system to predict nonunion risk.
resultsThe overall nonunion rate was 7.62% (61/801). Multivariate analysis showed significant association among pulmonary injury (odds ratio [OR] = 2.19, P = 0.022), open fracture (OR=2.36, P = 0.02), current smoking (OR=3.05, P < 0.001), postoperative infection (OR=12.1, P = 0.007), AO/OTA fracture pattern type A or B (OR=0.43, P = 0.014), and percent cortical contact obtained intraoperatively ≥25% (OR=0.41, P = 0.021) and nonunion. The scoring system created to quantitatively stratify nonunion risk showed that a score of 3 or more yielded an OR of 6.38 for nonunion (c-statistic = 0.693, P < 0.0001).
conclusionsFemoral shaft nonunion risk is quantifiable based on several independent injury, patient, and surgical factors. This scoring system is an additional tool for clinical decision making when caring for patients with femoral shaft fractures treated with IMNs.
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