Indices Affecting Outcome of Neglected Femoral Neck Fractures After Valgus Intertrochanteric Osteotomy

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Abstract

Objectives:

To evaluate preoperative neck resorption and postoperative valgus orientation as predictors of union and functional outcome after valgus intertrochanteric osteotomy for treatment of neglected femoral neck fractures and nonunions.

Design:

Retrospective cohort study.

Setting:

Tertiary care center.

Patients/Participants:

Forty consecutive patients with neglected femoral neck fracture and nonunions were treated with valgus intertrochanteric osteotomy, and follow-up was available in 32 patients (average age, 43 years; range, 14–60 years; average nonunion duration, 6 ± 7 months; range, 1–36 months).

Intervention:

Valgus intertrochanteric osteotomy.

Main Outcome Measurements:

Clinical outcome was assessed with Harris hip score. Plain radiographs were evaluated for union, avascular necrosis, preoperative bone deficiency (neck resorption ratio), and postoperative femoral head fragment alignment (head-shaft angle).

Results:

Follow-up at 5 ± 3 years (range, 2–12 years) after surgery showed union in 29 patients (91%), and Harris hip score was 82 ± 13 points (range, 63–100 points). The 3 patients with persistent nonunion at the neck of femur had neck resorption ratio <0.52. Increased postoperative head-shaft angle was associated with lower follow-up Harris hip score; postoperative valgus alignment >15 degrees compared with the contralateral side was associated with poor functional outcome. The presence of avascular necrosis did not affect the outcome.

Conclusions:

Valgus intertrochanteric osteotomy resulted in union and satisfactory functional outcome in most patients who had neglected femoral neck fractures and nonunions. Preoperative neck resorption ratio <0.5 was a risk factor for nonunion, and excessive valgus alignment was a risk factor for poor functional outcome after osteotomy.

Level of Evidence:

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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