• Lasse J Lapidus, Anastasios Charalampidis, Johanna Rundgren, and Anders Enocson.
• Karolinska Institutet, Department of Clinical Science and Education, Section of Orthopaedics, Stockholm Söder Hospital, Sweden. lasse.lapidus@sodersjukhuset.se
• J Orthop Trauma. 2013 Jul 1; 27 (7): 386-90; discussion 390-1.

ObjectiveTo 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.DesignProspective cohort study.SettingLevel II trauma center.PatientsA consecutive cohort of 382 hips in 379 patients who underwent internal fixation for a Garden I or II femoral neck fracture.InterventionThe 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 MeasuresReoperation 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.ResultsThe 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.ConclusionsPreoperative 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 EvidencePrognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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