INTRODUCTION: The goal of this study was to report and evaluate the place of external fixation in the treatment of trochanteric fractures in patients with high unacceptable operative risk to withstand conventional osteosynthesis. MATERIAL AND METHODS: From January 1990 to December 1991 (2 years period), 42 patients, 13 males and 29 female, mean age 84.1 years, suffering from trochanteric fracture and considered preoperatively as "poor medical status" were treated by external fixation and immediate mobilisation. The average operative time was 18 minutes and no blood transfusion was necessary per or post-operatively. The mean hospital stay was 19 days. RESULTS: All patients were followed up for 6 months post-operatively. During this time 8 patients (19 per cent) died due to medical problems unrelated to the fracture. All fractures united in an acceptable position at an average time of 10.4 weeks with no loss of reduction, no pin breakage, no deep infection. All hips were painless. COMPLICATIONS: proximal pin migration occurred in 3 patients (7 per cent) due to fracture impaction and superficial pin tract infection in 16 (38 per cent) with no further consequence. DISCUSSION: External fixation in trochanteric fractures has been applied since 1957 with good results. This series confirms the advantages of the method in patients with a high operative risk; these are short operative time, minimal blood loss, early mobilisation and acceptable morbidity and mortality rates, considering the old and senile age group with poor medical condition, not allowing conventional treatment. The minor complications such as superficial pin tract infection and proximal pin migration are easily controlled.
INTRODUCTION: The goal of this study was to report and evaluate the place of external fixation in the treatment of trochanteric fractures in patients with high unacceptable operative risk to withstand conventional osteosynthesis. MATERIAL AND METHODS: From January 1990 to December 1991 (2 years period), 42 patients, 13 males and 29 female, mean age 84.1 years, suffering from trochanteric fracture and considered preoperatively as "poor medical status" were treated by external fixation and immediate mobilisation. The average operative time was 18 minutes and no blood transfusion was necessary per or post-operatively. The mean hospital stay was 19 days. RESULTS: All patients were followed up for 6 months post-operatively. During this time 8 patients (19 per cent) died due to medical problems unrelated to the fracture. All fractures united in an acceptable position at an average time of 10.4 weeks with no loss of reduction, no pin breakage, no deep infection. All hips were painless. COMPLICATIONS: proximal pin migration occurred in 3 patients (7 per cent) due to fracture impaction and superficial pintract infection in 16 (38 per cent) with no further consequence. DISCUSSION: External fixation in trochanteric fractures has been applied since 1957 with good results. This series confirms the advantages of the method in patients with a high operative risk; these are short operative time, minimal blood loss, early mobilisation and acceptable morbidity and mortality rates, considering the old and senile age group with poor medical condition, not allowing conventional treatment. The minor complications such as superficial pintract infection and proximal pin migration are easily controlled.
Authors: Marios D Vekris; Marios G Lykissas; Gregory Manoudis; Alexandros N Mavrodontidis; Christos D Papageorgiou; Anastasios V Korompilias; Ioannis P Kostas-Agnantis; Alexandros E Beris Journal: J Orthop Surg Res Date: 2011-09-22 Impact factor: 2.359