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This study aimed to explore the factors influencing postoperative non-union of closed femoral shaft fractures and establish a predictive nomogram. Patients with closed femoral shaft fractures treated at Hebei Medical University Third Hospital between January 2015 and December 2021 were retrospectively enrolled. A total of 729 patients met the inclusion criteria; of them, those treated in 2015\u20132019 comprised the training cohort (n\u2009=\u2009617), while those treated in 2020\u20132021 comprised the external validation cohort (n\u2009=\u2009112). According to multivariate logistic regression analysis, complex fractures, bone defects, smoking, and postoperative infection were independent risk factors. Based on the factors, a predictive nomogram was constructed and validated. The C-indices in training and external validation cohorts were 0.818 and 0.781, respectively; and the C-index of internal validation via bootstrap resampling was 0.804. The Hosmer\u2013Lemeshow test showed good fit of the nomogram (<jats:italic>P<\/jats:italic>\u2009&gt;\u20090.05) consistent with the calibration plot results. The clinical effectiveness was best at a threshold probability of 0.10\u20130.40 in decision curve analysis. The risk prediction for patients with fractures using this nomogram may aid targeted prevention and rehabilitation programs.<\/jats:p>","DOI":"10.1038\/s41598-024-53356-x","type":"journal-article","created":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T17:02:35Z","timestamp":1707757355000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Development and validation of predictive nomogram for postoperative non-union of closed femoral shaft fracture"],"prefix":"10.1038","volume":"14","author":[{"given":"Wenjing","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuai","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shihang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luqin","family":"Di","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongzhi","family":"Lv","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,2,12]]},"reference":[{"key":"53356_CR1","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1007\/s00264-020-04492-2","volume":"44","author":"B Bouyer","year":"2020","unstructured":"Bouyer, B., Leroy, F., Rudant, J., Weill, A. & Coste, J. 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