External fixation of intertrochanteric fractures of the femur

Abstract

External fixation was used in the treatment of 154 intertrochanteric fractures of the femur over a period of eight years. Good fixation and early ambulation was achieved in all cases. Blood loss was slight. There were 12 deaths due to medical causes unrelated to the surgical procedure. Deep pin-track infection occurred in six cases and late displacement of the fracture fragments in nine. The average time for union was 16 weeks. The technique is simple, quick and inexpensive, and causes minimal surgical trauma. All these features are particularly relevant where resources are limited.

Management of pertrochanteric fractures in high-risk patients with an external fixation

“…Shortening because of collapse and varisation of the femoral neck is a well-recognized complication of both internal and external fixation in unstable fractures or in the presence of severe osteoporosis [4,5,15]. However, although it also occurred in our study, it was not associated with implant failure or cut out.…”

“…Another well-described problem associated with external fixation in the femur is postoperative knee stiffness caused by fixation of the facia lata and vastus lateralis by the distal pins [2,4,13]. This problem was eliminated in our series with the use of the very short pertrochanteric fixator, which allowed the placement of the distal pins quite proximally in the femur.…”

“…Cases of deep infection that required pin removal or repositioning have been reported [4,7,10,13]. Although most authors do not comment on the incidence of superficial pin tract infection, it is common [1,7].…”

Management of trochanteric fractures of the femur with external fixation in high-risk patients

“…Despite these evident advantages, the external fixator has failed to become popular with most surgeons because of the significant reported complications in previous studies, infection being the most common. Cases of deep infection that required pin removal or repositioning have been reported [5]. Vossinakis and Badras [14] reported that pintrack infection developed in 15 of their 50 patients (30%) treated with the Orthofix external fixator using standard pins.…”

Treatment of intertrochanteric fractures of the femur with external fixation

“…Previous reports on external fixations showed short operating and hospitalization time, high fracture union rate and minimum blood loss 6,7,17,18 .…”