Study: Nomogram is used for predicting Reoperation following
Researchers aimed to evaluate risk factors and develop a nomogram for reoperation after internal fixation of nondisplaced femoral neck fractures (FNFs) in elderly patients.

A retrospective study involving a total of 255 elderly patients who underwent closed reduction and internal fixation with cannulated screw system for nondisplaced FNFs was conducted. 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.

Results:
--Analysis showed that among the 255 patients, 28 underwent reoperation due to osteonecrosis of the femoral head, mechanical failure or nonunion.

--All of the 28 patients underwent conversion surgery to arthroplasty.

--The multivariate logistic regression analysis demonstrated that preoperative posterior tilt angle more than 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 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.

Conclusively, this analysis showed researchers 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.

Source: https://josr-online.biomedcentral.com/articles/10.1186/s13018-021-02697-8
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