ArticleFrontiers in surgery2026
Area-to-Length Ratio: a significant predictor of nonunion following intramedullary nailing of comminuted femoral shaft fractures.
Article in Frontiers in surgery, 2026. 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
Background: The relationship between fragment characteristics and nonunion risk in comminuted femoral shaft fractures remains controversial. This study aimed to investigate the relationship between radiographic fragment features and fracture union outcomes to assist clinical assessment. Patients and methods: A retrospective analysis was conducted on 91 femoral shaft fractures from 89 patients. Patient demographics, injury characteristics, and radiographic parameters-including fragment size, displacement, gap area, nail-to-canal diameter ratio, and ALR (gap area/major fragment length)-were analyzed. Univariate and multivariate logistic regression were used to identify independent risk factors for nonunion. Results: The overall nonunion rate was 16.5% (15/91). Univariate analysis revealed that a larger gap area (OR = 1.004, Conclusion: Traditional radiographic measures such as fragment length, width, Nail-to-canal ratio and absolute displacement did not show a significant association with healing outcome in our cohort. While the ALR is a significant predictor of nonunion in comminuted femoral shaft fractures, may assist in the early identification of cases at higher risk for nonunion, which could inform clinical vigilance regarding the potential need for more intensive management strategies.
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