External Fixation for Stable and Unstable Intertrochanteric Fractures in Patients Older Than 75 Years of Age: A Prospective Comparative Study

Abstract

External fixation for the treatment of Orthopaedic Trauma Association Types A2.2, A2.3, A3.1, A.3.2, and A.3.3 intertrochanteric fractures in the elderly was associated with prolonged union time, increased incidence of varus position of the fracture site, and inferior functional outcome. Therefore, it should be used with caution in the geriatric population with an unstable intertrochanteric fracture.

Outcomes of trochanteric external fixation for geriatric inter-trochanteric hip fractures

“…14 External fixation enhances fracture stability in stable trochanteric fractures by its tension band effect and in unstable trochanteric fractures it enhances load sharing by promoting callus formation. 1,24 In summary, our study shows that external fixators are appropriate for trochanteric fractures in geriatric, high-risk patients with multiple co-morbidities, as they can be applied under local anesthesia with sedation. They avoid delay in surgery and reduce the duration of the procedure and blood loss.…”

“…The ability to quickly apply external fixator using local anesthesia and its easy removal in the outpatient clinic makes it a worthy alternative in elderly, high-risk patients with trochanteric fractures compared to gold standard internal fixation techniques that may require general anesthesia. 1,11,25 Pin-track infection has been reported to be a common complication.…”

“…4e6 Operative goals for this patient cohort are restoration of anatomical alignment, stable fixation, achieving high union rates, minimizing blood loss, shortening operative time and early weight bearing. 1,7,8 Various methods of fixation are described for trochanteric fractures e sliding hip screw, compression plating, fixed angle blade-plate, intramedullary nailing and external fixation. 8e10 Internal fixation using a sliding hip screw is common; however the functional outcomes following sliding hip screw fixation in osteoporotic bone are not always satisfactory.…”

Evaluation of External Fixation Results in High-risk Older Patients with Intertrochanteric Femur Fractures

“…In high-risk patients (American Society of Anesthesiologists (ASA) 3 and 4), however, surgery with internal fixation can cause excessive stress. Consequently, external fixation is another option for treating these high-risk patients [4,5]. External fixation [6][7][8], is superior to plate osteosynthesis due to shorter operation and hospitalization times, no need for blood transfusions, and earlier mobilization.…”

Management of Pertrochanteric Fractures in Elderly High-Risk Patients with an External Fixation

“…Geriatric patients with these fractures usually have medical and surgical problems which make them unfit for prolonged anaesthesia and can cause excessive stress. External fixation performed under sedation and local anesthesia offers significant advantages in these patients in the form of minimal blood loss, minimal surgical trauma, minimal radiation exposure, preservation of fracture hematoma, a shorter hospital stay and early ambulation as compared to patients treated conservatively [32,44,49] . Varus collapse and shortening are the result of mechanical failure of fixation of unstable or severely osteoporotic intertrochanteric fractures.…”