A Web-Based Dynamic Nomogram to Calculate the Risk of Nonhealing after Femoral Neck Fracture Fixation among Young Adults: Bench to bedside Translational Research

Babak Siavashi; Mohammad Heshmati; Mohammadreza Golbakhsh; Seyed Hosein Shafiei; Farhad Mahdavi; Mohammadreza Sadeghi; Yeganeh Yousefifar; Salar Baghbani; Mohammadreza Bozorgmanesh

doi:10.18502/jost.v7i3.8104

Babak Siavashi Associate Professor, Department of Orthopedics, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Mohammad Heshmati Resident, Department of Orthopedics, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Mohammadreza Golbakhsh Associate Professor, Department of Orthopedics, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Seyed Hosein Shafiei Assistant Professor, Department of Orthopedics, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Farhad Mahdavi Resident, Department of Orthopedics, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Mohammadreza Sadeghi Resident, Department of Orthopedics, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Yeganeh Yousefifar Resident, Department of Orthopedics, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Salar Baghbani Resident, Department of Orthopedics, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Mohammadreza Bozorgmanesh Assistant Professor, Department of Orthopedics, Vali-e-Asr Hospital, School of Medicine, Arak University of Medical Sciences, Arak, Iran

DOI: https://doi.org/10.18502/jost.v7i3.8104

Keywords: Femoral Neck Fracture; Nomograms; Risk

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 χ 2 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 χ 2 : 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.