title: Indices affecting outcome of neglected femoral neck fractures after valgus intertrochanteric osteotomy.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  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).
  
  
  METHODS
  Valgus intertrochanteric osteotomy.
  
  
  METHODS
  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.
  
  
  METHODS
  Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics, Christian Medical College, Vellore, India.
authors.forename: Viju D
authors.initials: VD
authors.lastname: Varghese
authors.forename: Palapattu R
authors.initials: PR
authors.lastname: Boopalan
authors.forename: Vijay T K
authors.initials: VT
authors.lastname: Titus
authors.forename: Anil T
authors.initials: AT
authors.lastname: Oommen
authors.forename: Thilak S
authors.initials: TS
authors.lastname: Jepegnanam
mesh_terms: D000293:Adolescent; D000328:Adult; D017760:Bone Malalignment; D001862:Bone Resorption; D015331:Cohort Studies; D005260:Female; D005265:Femoral Neck Fractures / Q000503:physiopathology / Q000601:surgery*; D005269:Femur / Q000601:surgery*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects*; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult