Development and Validation of a Post-Operative Non-Union Risk Score for Subtrochanteric Femur Fractures.

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Biostatistics

Background:

• Subtrochanteric femur fractures pose a significant risk of non-union.
• Developing a reliable predictive model is crucial for patient management.

Purpose of the Study:

• To develop and validate a predictive model for non-union following subtrochanteric femur fractures.
• To create a risk score for early identification of high-risk patients.

Main Methods:

• Retrospective analysis of 316 patients with subtrochanteric femur fractures.
• Logistic regression models were used to identify risk factors.
• A revised scoring system was developed based on identified risk factors.

Main Results:

• A novel risk score was developed, incorporating factors like diabetes, deep wound infection, fracture comminution, atypical fracture, lateral cortex gap, and malreduction.
• The scoring system demonstrated very good discriminatory capability (AUC = 0.790) and good calibration.
• Cross-validation confirmed the model's good fit and internal validity (accuracy = 0.806).

Conclusions:

• The developed non-union risk score reliably estimates non-union risk in the early post-operative period.
• The score aids in identifying high-risk patients for prompt consultation and potential surgical intervention.
• The model highlights modifiable, surgery-related factors contributing to non-union risk.