Abstract
ObjectiveWe aimed to evaluate risk factors and develop a nomogram for reoperation after internal fixation of nondisplaced femoral neck fractures (FNFs) in elderly patients.MethodsWe conducted a retrospective study involving a total of 255 elderly patients who underwent closed reduction and internal fixation with cannulated screw system for nondisplaced FNFs between January 2016 and January 2019. We collected data on demographics, preoperative radiological parameters, surgery, serum biochemical markers, and postoperative rehabilitation. In addition, we performed univariate and multivariate logistic regression analyses to determine independent risk factors for reoperation, and then developed a nomogram to assess the risks of reoperation. Besides, discriminative ability, calibration, and clinical usefulness of the nomogram were evaluated using the concordance index (C-index), the receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA), respectively. We employed bootstrap method to validate the performance of the developed nomogram.ResultsOur analysis showed that among the 255 patients, 28 (11.0%) underwent reoperation due to osteonecrosis of the femoral head (14 cases), mechanical failure (8 cases) or nonunion (6 cases). All of the 28 patients underwent conversion surgery to arthroplasty. The multivariate logistic regression analysis demonstrated that preoperative posterior tilt angle ≥ 20°, Pauwel’s III type, younger patients, preoperative elevated levels of alkaline phosphatase (ALP), preoperative hypoalbuminemia, and early postoperative weight-bearing were independent risk factors for reoperation. In addition, the C-index and the bootstrap value of the developed nomogram was 0.850 (95% CI = 0.803–0.913) and 0.811, respectively. Besides, the calibration curve showed good consistency between the actual diagnosed reoperation and the predicted probability, while the DCA indicated that the nomogram was clinically valuable.ConclusionsOur analysis showed we successfully developed and validated a nomogram for personalized prediction of reoperation after internal fixation of nondisplaced FNFs in elderly patients. This model would help in individualized evaluation of the need for reoperation and inform strategies aimed at eliminating the need for the reoperation.
Highlights
MethodsWe conducted a retrospective study involving a total of 255 elderly patients who underwent closed reduction and internal fixation with cannulated screw system for nondisplaced Femoral neck fractures (FNF) between January 2016 and January 2019
Femoral neck fractures (FNFs) are common in geriatric population, accounting for 48 to 54% of hip fractures and 3.6% of the total fractures in adults [1]
This model would help in individualized evaluation of the need for reoperation and inform strategies aimed at eliminating the need for the reoperation
Summary
Patients This study collected data from elder patients with nondisplaced FNFs and who underwent surgical treatment between January 2016 and January 2019. All the patients underwent closed reduction and internal fixation with cannulated screw system. The patients were treated with closed reduction and internal fixation using a cannulated screw system and with a follow-up time ≥ 24 months. We collected data on patient demographics, radiological parameters, surgery, serum biochemical markers, as well as postoperative rehabilitation. The demographic data included gender, age, injured side, smoking status, alcohol consumption, preoperative functional status, cerebrovascular disease, hypertension, diabetes mellitus, Charlson’s weighted index of comorbidities (WIC), chronic kidney disease, and chronic obstructive pulmonary diseases (COPD). The Charlson’s WIC is the most commonly used method in the evaluation of the severity of comorbidities in elderly patients It is calculated based on the patient’s medical history, Fig. 1 Patient selection flowchart. Information on postoperative rehabilitation included interval to weight-bearing. A corrected C-index was calculated through bootstrapping (1000 resamples) to evaluate the accuracy of the nomogram
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