Article

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). INTERPRETATION:
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.

Langue : ANGLAIS