Identification of risk factors and development of a high-performance predictive model for non-healing in elderly patients with intertrochanteric fractures post-internal fixation.

OBJECTIVE

To identify risk factors associated with non-healing in elderly patients with intertrochanteric femoral fractures treated with internal fixation and to develop a predictive model for non-union risk.

METHODS

We conducted a retrospective analysis of 889 elderly patients treated with internal fixation for intertrochanteric fractures at Wuxi Xishan People's Hospital from March 2021 to December 2024. Patients were classified into healing (n=806) and poor healing groups (n=83) based on radiographic evidence three months post-surgery. Univariate and multivariate logistic regression analyses were used to identify significant risk factors. A predictive model was developed and validated using receiver operating characteristic (ROC) analysis and the area under the curve (AUC).

RESULTS

Significant risk factors for poor healing included smoking history (Odds ratio [OR] 1.750, P=0.022), osteoporosis (OR 2.055, P=0.003), posterior or medial wall bone defects (OR 1.964, P=0.005), low postoperative albumin (OR 1.674, P=0.032), and early weight-bearing (OR 1.765, P=0.018). The use of proximal femoral nail antirotation (PFNA) significantly reduced the risk of poor-healing (OR 0.515, P=0.006). The combined predictive model achieved an AUC of 0.949, indicating high predictive value.

CONCLUSIONS

Our findings highlight key risk factors for non-healing in elderly patients post-internal fixation for intertrochanteric fractures. The developed predictive model, incorporating clinical, biochemical, and surgical factors, offers high accuracy and may help identify high-risk patients for targeted intervention.