Sainio Heini, Rämö Lasse, Reito Aleksi, Silvasti-Lundell Marja, Lindahl Jan
Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Centre for Musculoskeletal Diseases, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Bone Jt Open. 2023 Aug 15;4(8):584-593. doi: 10.1302/2633-1462.48.BJO-2023-0077.R1.
Several previously identified patient-, injury-, and treatment-related factors are associated with the development of nonunion in distal femur fractures. However, the predictive value of these factors is not well defined. We aimed to assess the predictive ability of previously identified risk factors in the development of nonunion leading to secondary surgery in distal femur fractures.
We conducted a retrospective cohort study of adult patients with traumatic distal femur fracture treated with lateral locking plate between 2009 and 2018. The patients who underwent secondary surgery due to fracture healing problem or plate failure were considered having nonunion. Background knowledge of risk factors of distal femur fracture nonunion based on previous literature was used to form an initial set of variables. A logistic regression model was used with previously identified patient- and injury-related variables (age, sex, BMI, diabetes, smoking, periprosthetic fracture, open fracture, trauma energy, fracture zone length, fracture comminution, medial side comminution) in the first analysis and with treatment-related variables (different surgeon-controlled factors, e.g. plate length, screw placement, and proximal fixation) in the second analysis to predict the nonunion leading to secondary surgery in distal femur fractures.
We were able to include 299 fractures in 291 patients. Altogether, 31/299 fractures (10%) developed nonunion. In the first analysis, pseudo-R was 0.27 and area under the receiver operating characteristic curve (AUC) was 0.81. BMI was the most important variable in the prediction. In the second analysis, pseudo-R was 0.06 and AUC was 0.67. Plate length was the most important variable in the prediction.
The model including patient- and injury-related factors had moderate fit and predictive ability in the prediction of distal femur fracture nonunion leading to secondary surgery. BMI was the most important variable in prediction of nonunion. Surgeon-controlled factors had a minor role in prediction of nonunion.
先前确定的几个与患者、损伤及治疗相关的因素与股骨远端骨折不愈合的发生有关。然而，这些因素的预测价值尚未明确界定。我们旨在评估先前确定的危险因素对股骨远端骨折不愈合导致二次手术的预测能力。
我们对2009年至2018年间接受外侧锁定钢板治疗的成年创伤性股骨远端骨折患者进行了一项回顾性队列研究。因骨折愈合问题或钢板失效而接受二次手术的患者被视为发生了骨折不愈合。基于先前文献中股骨远端骨折不愈合危险因素的背景知识，形成了一组初始变量。在第一次分析中，使用逻辑回归模型纳入先前确定的与患者和损伤相关的变量（年龄、性别、体重指数、糖尿病、吸烟、假体周围骨折、开放性骨折、创伤能量、骨折区域长度、骨折粉碎程度、内侧粉碎程度），在第二次分析中纳入与治疗相关的变量（不同的外科医生控制因素，如钢板长度、螺钉置入和近端固定），以预测股骨远端骨折不愈合导致二次手术的情况。
我们纳入了291例患者的299处骨折。总共有31/299处骨折（10%）发生了不愈合。在第一次分析中，伪R为0.27，受试者工作特征曲线下面积（AUC）为0.81。体重指数是预测中最重要的变量。在第二次分析中，伪R为0.06，AUC为0.67。钢板长度是预测中最重要的变量。
包含患者和损伤相关因素的模型在预测导致二次手术的股骨远端骨折不愈合方面具有中等拟合度和预测能力。体重指数是预测不愈合的最重要变量。外科医生控制的因素在不愈合的预测中作用较小。
