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. 2024 Jan 1;35(1):20-26.
doi: 10.52312/jdrs.2024.975. Epub 2023 Oct 31.

A prediction model for osteonecrosis of femoral head after internal fixation with multiple cannulated compression screws for adult femoral neck fractures

Zhang Jin, Luo Chen, Dafeng Wang, Yayun Ye, Jiaxing Fu, Zhifan Yang, Baoqiang He  1
Affiliations

A prediction model for osteonecrosis of femoral head after internal fixation with multiple cannulated compression screws for adult femoral neck fractures

Zhang Jin et al. Jt Dis Relat Surg. .

Abstract

Objectives: This study aims to investigate the high-risk factors for osteonecrosis of the femoral head (ONFH) after internal fixation with multiple cannulated compression screws for adult femoral neck fractures and to construct a prediction model.

Patients and methods: Between from January 2012 and December 2020, a total of 268 patients (138 males, 130 females; mean age: 53±10 years; range, 23 to 70 years) with ONFH who had complete follow-up data were included. Closed reduction in combination with open reduction were performed. All patients received internal fixation with multiple cannulated compression screws and were assigned to ONFH and non-ONFH groups. Logistic regression model was utilized to identify independent risk factors for postoperative ONFH, followed by constructing a nomogram prediction model. The predictive ability of the model was evaluated by receiver operating characteristic curve, Hosmer-Lemeshow test, and calibration curve.

Results: Multivariate analysis revealed that older age (odds ratio [OR]: 2.307, 95% confidence interval [CI]: 1.295-4.108], Charlson Comorbidity Index (CCI) ≥2 (OR: 2.214, 95% CI: 1.035-4.739), fracture displacement (OR: 2.426, 95% CI: 1.122-5.247), unsatisfactory reduction (OR: 2.629, 95% CI: 1.275-5.423), postoperative removal of internal fixation implant (OR: 2.200, 95% CI: 1.051-4.604) were independent risk factors for postoperative ONFH (p<0.05). The nomogram prediction model constructed based on these clinical characteristics showed high predictive value (AUC=0.807) and consistency (p>0.05).

Conclusion: Age, comorbidity index, fracture type, reduction quality and postoperative removal of internal fixation implant are of utmost importance for postoperative ONFH in patients with femoral neck fractures. The established nomogram prediction model can accurately predict the occurrence of postoperative ONFH.

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Conflict of interest statement

Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Figures

Figure 1
Figure 1. Nomogram model for predicting postoperative ONFH. ONFH: Osteonecrosis of the femoral head.
Figure 2
Figure 2. Nomogram prediction model for risk stratification of postoperative ONFH. ONFH: Osteonecrosis of the femoral head.
Figure 3
Figure 3. ROC curve of nomogram model for predicting postoperative ONFH. ROC: Receiver operating characteristic; ONFH: Osteonecrosis of the femoral head.
Figure 4
Figure 4. Calibration curve of nomogram model for predicting postoperative ONFH. ONFH: Osteonecrosis of the femoral head.
See this image and copyright information in PMC

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