Application of the LEG NUI score to assess revision success in established distal femur non-unions

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2025-07-07 DOI:10.1016/j.jor.2025.07.001

Benedikt J. Braun, Carla Rau, Tanja Maisenbacher, Steven C. Herath, Mika FR. Rollmann, Maximilian M. Menger, Tina Histing, Marie Reumann

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引用次数: 0

Abstract

Background

The incidence of non-union following distal femur fractures is high. Management of persis-tent non-unions is challenging, often requiring multiple revision surgeries, thereby increasing patient morbidity and socioeconomic burden. Identifying patients at high risk for persistent non-union after revision is therefore crucial. The LEG NUI Score was originally developed to predict the need for early intervention following primary fixation of distal femur fractures. This study aimed to evaluate the LEG NUI Score's ability to predict the need for further revision surgery in a cohort of patients with established distal femur non-union undergoing their index revision procedure.

Patients and methods

45 patients with complete clinical data were identified from a non-union database. The LEG NUI Score was calculated for the index revision procedure and assessed in relation to the healing out-come of the revision treatment. Comparative statistics and test characteristics were assessed, as well as a receiver operator characteristic analysis was performed. Only patients with uneventful healing after the first treatment were considered healed for the score calculation. Patients requiring more than one surgery, including second step masquelet were considered non-healers.

Results

The union rate (healed non-unions) after the first non-union revision surgery was 55.5 %. 24.4 % of patients had an infected non-union. The average LEG NUI Score in patients with non-union healing was significantly lower than non-healing patients (3.36 ± 1.80 vs. 4.90 ± 1.21; p < 0.05). The AUC in the ROC Analysis was 0.755.

Discussion

The LEG NUI Score shows potential applicability in the setting of revision surgery for established distal femur non-unions. Calculating the score may help surgeons identifying patients at in-creased risk for requiring subsequent surgical procedures, thus warranting closer postoperative surveillance. Further validation in larger cohorts is required to fully elucidate its clinical utility in this context.

Level of evidence

Level III, Retrospective Cohort Study.

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应用LEG NUI评分评估股骨远端骨不连的翻修成功

背景：股骨远端骨折后骨不愈合的发生率很高。持续性骨不连的治疗具有挑战性，通常需要多次翻修手术，从而增加了患者的发病率和社会经济负担。因此，确定翻修后持续不愈合的高风险患者是至关重要的。LEG NUI评分最初用于预测股骨远端骨折初次固定后早期干预的需要。本研究旨在评估LEG NUI评分在确定股骨远端不连的患者中预测进一步翻修手术需要的能力，这些患者正在进行指数翻修手术。患者和方法从骨不连数据库中筛选了45例具有完整临床资料的患者。计算指数修订程序的LEG NUI评分，并评估修订治疗的愈合结果。比较统计和测试特性进行了评估，并进行了接收机操作员特性分析。只有第一次治疗后愈合平稳的患者才被认为愈合。需要一次以上手术（包括第二步口罩）的患者被认为无法治愈。结果首次骨不连翻修术后骨不连愈合率为55.5%。24.4%的患者存在感染性骨不连。愈合不愈合患者的LEG NUI评分平均值显著低于未愈合患者(3.36±1.80∶4.90±1.21；p & lt;0.05)。ROC分析的AUC为0.755。LEG NUI评分显示了股骨远端骨不连翻修手术的潜在适用性。计算评分可以帮助外科医生识别需要后续手术的风险增加的患者，从而保证更密切的术后监测。需要在更大的队列中进一步验证，以充分阐明其在这种情况下的临床应用。证据水平：III级，回顾性队列研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.