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Type: Journal article
Title: Indices affecting outcome of neglected femoral neck fractures after valgus intertrochanteric osteotomy
Author: Varghese, V.
Ramasamy, B.
Titus, V.
Oommen, A.
Jepegnanam, T.
Citation: Journal of Orthopaedic Trauma, 2014; 28(7):410-416
Publisher: Lippincott Williams & Wilkins
Issue Date: 2014
ISSN: 0890-5339
Statement of
Viju D. Varghese, Palapattu R. Boopalan, Vijay T.K. Titus, Anil T. Oommen, and Thilak S. Jepegnanam
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 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 6 3 years (range, 2–12 years) after surgery showed union in 29 patients (91%), and Harris hip score was 82 6 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.
Keywords: Hip; valgus osteotomy; nonunion femoral neck; functional outcome
Rights: © 2013 Lippincott Williams & Wilkins
DOI: 10.1097/BOT.0000000000000030
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