title: A new measurement for posterior tilt predicts reoperation in undisplaced femoral neck fractures: 113 consecutive patients treated by internal fixation and followed for 1 year.
abstract: OBJECTIVE
  Preoperative posterior tilt in undisplaced (Garden I-II) femoral neck fractures is thought to influence rates of reoperation. However, an exact method for its measurement has not yet been presented. We designed a new measurement for posterior tilt on preoperative lateral radiographs and investigated its association with later reoperation.
  
  
  METHODS
  A consecutive series of 113 patients, > or = 60 years of age with undisplaced (Garden I-II) femoral neck fractures treated with two parallel implants, was assessed regarding patient characteristics, radiographs, and rate of reoperation within the first year. In a subgroup of 50 randomly selected patients, reliability tests for measurement of posterior tilt were performed.
  
  
  RESULTS
  Intra- and interclass coefficients for the new measurement were > or = 0.94. 23% (26/113) of patients were reoperated and increased posterior tilt was an accurate predictor of failure (p = 0.002). 14/25 of posteriorly tilted fractures > or = 20 degrees were reoperated, as compared to 12/88 of fractures with less tilt (p < 0.001). In multiple logistic regression analysis including sex, age, ASA score, cognitive function, new mobility score, time from admission to operation, surgeon's expertise, postoperative reduction, and implant positioning, a preoperative posterior tilt of > or = 20 degrees was the only significant predictor of reoperation (p < 0.001).
  
  
  CONCLUSIONS
  The new measurement for posterior tilt appears to be reliable and able to predict reoperation in patients with undisplaced (Garden I-II) femoral neck fractures.
authors.affiliation: Department of Orthopaedic Surgery, Hvidovre University Hospital, Copenhagen, Denmark. hpalm@dadlnet.dk
authors.forename: Henrik
authors.initials: H
authors.lastname: Palm
authors.forename: Kasper
authors.initials: K
authors.lastname: Gosvig
authors.forename: Michael
authors.initials: M
authors.lastname: Krasheninnikoff
authors.forename: Steffen
authors.initials: S
authors.lastname: Jacobsen
authors.forename: Peter
authors.initials: P
authors.lastname: Gebuhr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005265:Femoral Neck Fractures / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D011187:Posture; D011237:Predictive Value of Tests; D011379:Prognosis; D011859:Radiography; D012086:Reoperation; D015203:Reproducibility of Results; D016896:Treatment Outcome