{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:50:24Z","timestamp":1787028624107,"version":"build-2736575974"},"reference-count":54,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2021,11,29]],"date-time":"2021-11-29T00:00:00Z","timestamp":1638144000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Our objective was to develop and validate a predictive model for non-union following a subtrochanteric fracture of the femur. Methods: Following institutional board approval, 316 consecutive patients presenting to our institution (84 non-unions) who fulfilled the inclusion criteria were retrospectively identified. To identify potential unadjusted associations with progression to non-union, simple logistic regression models were used, followed by a revised adjusted model of multiple logistic regression. Results: Having established the risk factors for non-union, the coefficients were used to produce a risk score for predicting non-union. To identify the high-risk patients in the early post-operative period, self-dynamisation was excluded. The revised scoring system was the sum of the following: diabetes (6); deep wound infection (35); simple or severe comminution (13); presence of an atypical fracture (14); lateral cortex gap size \u22655 mm (11), varus malreduction (5\u201310 degrees) (9); varus malreduction (&gt;10 degrees) (20). On the ROC (receiver operating characteristic) curve, the area under the curve (0.790) demonstrated very good discriminatory capability of the scoring system, with good calibration (Hosmer\u2013Lemeshow test; p = 0.291). Moreover, 5-fold cross validation confirmed good fit of the model and internal validity (accuracy 0.806; Kappa 0.416). The cut-point determined by Youden\u2019s formula was calculated as 18. Conclusion: This study demonstrates that the risk of non-union can be reliably estimated in patients presenting with a subtrochanteric fracture, from the immediate post-operative period. The resulting non-union risk score can be used not only to identify the high-risk patients early, offering them appropriate consultation and in some cases surgical intervention, but also informs surgeons of the modifiable surgery related factors that contribute to this risk.<\/jats:p>","DOI":"10.3390\/jcm10235632","type":"journal-article","created":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T22:01:11Z","timestamp":1638309671000},"page":"5632","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Development and Validation of a Post-Operative Non-Union Risk Score for Subtrochanteric Femur Fractures"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0905-1432","authenticated-orcid":false,"given":"Michalis","family":"Panteli","sequence":"first","affiliation":[{"name":"Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds LS2 9LU, UK"},{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9LU, UK"},{"name":"Leeds Orthopaedic & Trauma Sciences, Leeds General Infirmary, University of Leeds, Leeds LS2 9LU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4195-0403","authenticated-orcid":false,"given":"James S. H.","family":"Vun","sequence":"additional","affiliation":[{"name":"Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds LS2 9LU, UK"},{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9LU, UK"},{"name":"Leeds Orthopaedic & Trauma Sciences, Leeds General Infirmary, University of Leeds, Leeds LS2 9LU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"West","sequence":"additional","affiliation":[{"name":"Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7746-1268","authenticated-orcid":false,"given":"Anthony J.","family":"Howard","sequence":"additional","affiliation":[{"name":"Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds LS2 9LU, UK"},{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9LU, UK"},{"name":"Leeds Orthopaedic & Trauma Sciences, Leeds General Infirmary, University of Leeds, Leeds LS2 9LU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ippokratis","family":"Pountos","sequence":"additional","affiliation":[{"name":"Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds LS2 9LU, UK"},{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9LU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5205-7696","authenticated-orcid":false,"given":"Peter V.","family":"Giannoudis","sequence":"additional","affiliation":[{"name":"Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds LS2 9LU, UK"},{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9LU, UK"},{"name":"Leeds Orthopaedic & Trauma Sciences, Leeds General Infirmary, University of Leeds, Leeds LS2 9LU, UK"},{"name":"NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds LS2 9LU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1097\/00003086-199210000-00032","article-title":"Subtrochanteric fractures of the femur. 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