• Viju D Varghese, Palapattu R Boopalan, Vijay T K Titus, Anil T Oommen, and Thilak S Jepegnanam.
• Department of Orthopaedics, Christian Medical College, Vellore, India.
• J Orthop Trauma. 2014 Jul 1;28(7):410-6.

ObjectivesTo 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.DesignRetrospective cohort study.SettingTertiary care center.Patients/ParticipantsForty 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).InterventionValgus intertrochanteric osteotomy.Main Outcome MeasurementsClinical 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).ResultsFollow-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.ConclusionsValgus 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.Level Of EvidencePrognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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