Author/Authors :
Siavashi, Babak Department of Orthopedics - Sina Hospital - School of Medicine - Tehran University of Medical Sciences - Tehran, Iran , Heshmati, Mohammad Department of Orthopedics - Sina Hospital - School of Medicine - Tehran University of Medical Sciences - Tehran, Iran , Golbakhsh, Mohammadreza Department of Orthopedics - Sina Hospital - School of Medicine - Tehran University of Medical Sciences - Tehran, Iran , Shafiei, Hosein Department of Orthopedics - Sina Hospital - School of Medicine - Tehran University of Medical Sciences - Tehran, Iran , Mahdavi, Farhad Department of Orthopedics - Sina Hospital - School of Medicine - Tehran University of Medical Sciences - Tehran, Iran , Sadeghi, Mohammadreza Department of Orthopedics - Sina Hospital - School of Medicine - Tehran University of Medical Sciences - Tehran, Iran , Yousefifar, Yeganeh Department of Orthopedics - Sina Hospital - School of Medicine - Tehran University of Medical Sciences - Tehran, Iran , Baghbani, Salar Department of Orthopedics - Sina Hospital - School of Medicine - Tehran University of Medical Sciences - Tehran, Iran , Bozorgmanesh, Mohammadreza Department of Orthopedics - Vali-e-Asr Hospital - School of Medicine - Arak University of Medical Sciences - Arak, Iran
Abstract :
Background: The aim of this study was to develop a prognostic model to identify a subgroup of high-risk patients for non-healing after femoral neck fracture fixation among young adults. The model was implemented by presenting graphically as a nomogram that could be easily used in every day clinical cases.
Methods: Data on a total of 129 patients were included in the current study. The mean [standard deviation (SD)] age of the participants was 42 (13) years and 28% of the patients were women. Harrell’s C statistic was used as a measure of discrimination predictive power. We calculated the Nam-D’Agostino χ2 to examine calibration for prediction models.
Results: Approximately, 83% of fractures united uneventfully, with avascular necrosis (AVN), fixation nonhealing, non-union, infection, arthroplasty, and death being observed. Body mass index (BMI) and head acetabular trabecular angle (HATA) were inversely associated with the risk of all-cause nonhealing. The final model showed excellent discriminatory power [Harrell’s C statistic: 0.820, 95% confidence interval (CI) (0.680-0.960)] and it was well-calibrated [Nam-D’Agostino χ2: 10.1, (P = 0.3456)]. A nomogram developed by incorporating significant predictors modelled without discretizing continuous variables.
Conclusion: Using readily available clinical and radiological data, we developed a parsimonious, simple, accurate yardstick to measure the 5-year risk of nonhealing after femoral neck fractures among young adults. In order to add ease-of-use and to promote its integration into clinical practice, the prognostic model was demonstrated visually as a statistic nomogram.
