Construction of a nomogram prediction model using risk factors for tibial tuberosity avulsion fractures in adolescents
10.3760/cma.j.cn115530-20241216-00485
- VernacularTitle:青少年胫骨结节撕脱骨折的危险因素分析及列线图预测模型构建研究
- Author:
Tao QIAN
1
;
Yao LIU
1
;
Jun WEN
1
;
Yicong LIU
1
;
Cong LIU
1
;
Bingqing MAO
1
;
Yunfang ZHEN
1
Author Information
1. 苏州大学附属儿童医院骨科，苏州 215000
- Publication Type:Journal Article
- Keywords:
Tibial fractures;
Risk factors;
Nomograms;
Adolescents;
Tuberosity avulsion;
Prediction model
- From:
Chinese Journal of Orthopaedic Trauma
2025;27(9):789-797
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the risk factors for tibial tuberosity avulsion fractures (TTAF) in adolescents and develop a clinically applicable nomogram prediction model for rapid risk assessment and identification of high-risk populations.Methods:A retrospective study was conducted to analyze the data of 58 adolescent patients (61 sides) who had been treated for TTAF at Department of Orthopaedics, Children's Hospital of Soochow University between January 2018 and October 2024. There were 57 males and 1 female, with an age of 14.0 (13.0, 14.0) years, designated as the observation group. The control group enrolled another contemporary 52 patients who, matched with age and gender, had a clear history of trauma and clinical symptoms of knee injury but no bone continuity destruction of the knee joint by the final imaging examination. They were 50 males and 2 females, with an age of 13.5 (12.0, 15.0) years. Baseline characteristics, pre-injury physical activity profiles, and imaging-derived anatomical parameters were compared between the 2 groups. Variables with P<0.05 in the univariate analysis were included in a multivariable logistic regression model to identify independent risk factors for adolescent TTAF, based on which a nomogram prediction model was developed and internally validated using bootstrapping (1,000 resamples). Results:Multivariable logistic regression analysis identified the following independent risk factors for adolescent TTAF: short-term high-frequency exercise ( OR=5.653, 95% CI: 1.068 to 29.918, P=0.042), a large body mass index (BMI) ( OR=1.445, 95% CI: 1.197 to 1.743, P<0.001), a large posterior tibial slope (PTS) ( OR=1.637, 95% CI: 1.140 to 2.353, P=0.008), and an increased tibial tubercle-trochlear groove (TT-TG) distance ( OR=1.227, 95% CI: 1.021 to 1.474, P=0.029). The area under the receiver operating characteristic curve (AUC) was 0.927 for the model incorporating CT-derived variables and 0.907 for the model excluding CT variables. Decision curve analysis (DCA) and calibration curves demonstrated favorable clinical utility and alignment between predicted and observed outcomes in both models. Conclusions:Short-term high-frequency exercise, a large body mass index, a large PTS, and an increased TT-TG distance are risk factors for adolescent TTAF. The established prediction model is suitable for rapid clinical assessment and demonstrates good predictive capability.
