{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T08:43:22Z","timestamp":1769503402528,"version":"3.49.0"},"reference-count":26,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2022,6,24]],"date-time":"2022-06-24T00:00:00Z","timestamp":1656028800000},"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>Antegrade intramedullary (IM) nailing is the gold standard treatment for femoral shaft fractures; however, the non-union rate of infra-isthmal femoral shaft fractures is still high after antegrade IM nailing. This retrospective case\u2013control study aimed to determine the association between perioperative radiographic factors and the non-union of infra-isthmal femoral shaft fractures after antegrade IM nailing. Univariate and multivariate analyses were used to evaluate the radiographic risk factors of non-union. Ninety-three patients were included, with thirty-one non-unions and sixty-two matched controls between 2007 and 2017. All were regularly followed up for 2 years. Receiver operating characteristic analysis revealed that a ratio of the unfixed distal segment &gt; 32.5% was strongly predictive of postoperative non-union. The risk factors for non-union were AO\/OTA type B and C (odds ratio [OR]: 2.20), a smaller ratio of the distal fragment (OR: 4.05), a greater ratio of the unfixed distal segment (OR: 7.16), a higher ratio of IM canal diameter to nail size at the level of fracture (OR: 6.23), and fewer distal locking screws (OR: 2.31). The radiographic risk factors for non-union after antegrade IM nailing for infra-isthmal femoral shaft fractures were unstable fractures, shorter distal fragments, longer unfixed distal fragments, wider IM canal, and fewer distal locking screws. Surgeons must strive to avoid non-union with longer and larger nails and apply more distal locking screws, especially for unstable, wider IM canal, and shorter distal fragment fractures.<\/jats:p>","DOI":"10.3390\/jcm11133664","type":"journal-article","created":{"date-parts":[[2022,6,26]],"date-time":"2022-06-26T09:00:13Z","timestamp":1656234013000},"page":"3664","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Perioperative Radiographic Predictors of Non-Union in Infra-Isthmal Femoral Shaft Fractures after Antegrade Intramedullary Nailing: A Case\u2013Control Study"],"prefix":"10.3390","volume":"11","author":[{"given":"Wei-Cheng","family":"Hung","sequence":"first","affiliation":[{"name":"Department of Orthopedics, China Medical University Hospital, Taichung 404327, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chin-Jung","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, China Medical University Hospital, Taichung 404327, Taiwan"},{"name":"School of Chinese Medicine, China Medical University, Taichung 404333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abhishek","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, China Medical University Hospital, Taichung 404327, Taiwan"},{"name":"Anup Institute of Orthopedics and Rehabilitation, Patna 800020, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun-Hao","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, China Medical University Hospital, Taichung 404327, Taiwan"},{"name":"Department of Sports Medicine, College of Health Care, China Medical University, Taichung 406040, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao-Wei","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, China Medical University Hospital, Taichung 404327, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9480-8224","authenticated-orcid":false,"given":"Tsung-Li","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, China Medical University Hospital, Taichung 404327, Taiwan"},{"name":"Department of Sports Medicine, College of Health Care, China Medical University, Taichung 406040, Taiwan"},{"name":"Graduate Institute of Biomedical Sciences, China Medical University, Taichung 404333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.injury.2008.07.017","article-title":"National Data of 6409 Swedish Inpatients with Femoral Shaft Fractures: Stable Incidence Between 1998 and 2004","volume":"40","author":"Weiss","year":"2009","journal-title":"Injury"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e31","DOI":"10.2106\/JBJS.N.00314","article-title":"Estimating the Global Incidence of Femoral Fracture from Road Traffic Collisions: A Literature Review","volume":"97","author":"Meara","year":"2015","journal-title":"J. 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