ArticleBMC musculoskeletal disorders2025
Development and validation of a nomogram model for predicting postoperative nonunion in femoral shaft fractures.
Article in BMC musculoskeletal disorders, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo identify independent risk factors for nonunion following femoral shaft fracture surgery and develop a clinically applicable nomogram model for personalized risk prediction.
methodsA retrospective cohort study included 804 patients with femoral shaft fractures treated at Xijing Hospital (2014-2020). Patients were divided into development (n = 561) and validation (n = 243) cohorts. Variables were screened via LASSO regression, and a nomogram was constructed using multivariate logistic regression. Model performance was assessed using ROC curves, calibration plots, Hosmer-Lemeshow tests, and decision curve analysis (DCA).
resultsFive independent predictors of nonunion were identified: smoking. (OR = 3.094, 95% CI:1.790-5.350), high-energy injury (OR = 2.454, 95% CI:1.167-5.159), multiple injuries (OR = 2.897, 95% CI:1.580-5.312), internal fixation method (OR = 1), and fixation failure (OR = 3.437, 95% CI:1.51'. 9-7.778). The nomogram demonstrated excellent discrimination. (AUC = 0.828 in development, 0.835 in validation cohorts) and calibration (Hosmer-Lemeshow P = 0.463 and P = 0.858, respectively). DCA confirmed clinical utility at threshold probabilities > 15%.
conclusionThis nomogram provides a practical tool for predicting nonunion risk in femoral shaft fractures, enabling early intervention for high-risk patients.
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