Internal Fixation of Garden I and II Femoral Neck Fractures

OBJECTIVE: To analyze factors influencing the reoperation rate due to fracture healing complications after internal fixation of Garden I and II femoral neck fractures with special reference to a new validated method assessing the preoperative posterior tilt on lateral radiographs. DESIGN: Prospective cohort study. SETTING: Level II trauma center. PATIENTS: A consecutive cohort of 382 hips in 379 patients who underwent internal fixation for a Garden I or II femoral neck fracture. INTERVENTION: The posterior tilt in preoperative radiographs was analyzed with a new validated method. A Cox regression analysis was used to evaluate factors associated with reoperation due to fracture healing complications. Age, gender, cognitive function, ASA classification, time to surgery, and the posterior tilt were tested as independent factors in the model. MAIN OUTCOME MEASURES: Reoperation rate due to fracture healing complications with a minimal follow-up of 5 years. Reoperation data were validated against the National Board of Health and Welfare's national registry using unique Swedish personal identification numbers. RESULTS: The overall reoperation rate was 19% (72 of 382 hips) and the reoperation rate due to fracture healing complications was 12% (45 of 382 hips). The posterior tilt had no influence on the risk for reoperation due to fracture healing complication, nor had the age, gender, cognitive function, ASA classification, or the time to surgery. CONCLUSIONS: Preoperative posterior tilt measurement on lateral radiographs cannot be used as a discriminator for fracture healing complications in Garden I and II femoral neck fractures. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.