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

Yousry, Ahmed H.; Chotai, Pranit N.; Ghazaly, Sherif A. El; Fayyad, Tamer A; Abdelgawad, Amr

doi:10.1016/j.jor.2015.05.019

Cited by 13 publications

(27 citation statements)

References 26 publications

(28 reference statements)

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“…One study has compared the use of external fixation in both stable and unstable intertrochanteric fractures 9 and 2 studies have compared 2 different techniques of external fixation for intertrochanteric fractures. 8,10 Despite the increase in studies regarding the use of external fixation as an alternative for intertrochanteric fractures in high-risk patients, [5][6][7][8][9][10][11][12][13][14][15][16][17] no published literature has analysed these studies in totality. Hence, this systemic review aims to pool together the studies to analyse the outcomes and complications of this procedure and compare it with other established treatment methods for intertrochanteric fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Fourteen patients suffered urinary tract infections, 8 patients had pneumonia, 7 patients had deep vein thrombosis, and 2 patients had pulmonary embolism. [5][6][7][8][9][10][11][12][13][14][15][16][17] One hundred and three patients suffered from pin tract complications, such as pin tract infections, that were resolved with oral antibiotics. [5][6][7][8][9][10][11][12][13][14][15][16][17] No case of osteomyelitis was noted, and no fixation washout had to be done.…”

Section: Complicationsmentioning

confidence: 99%

“…It can be performed under local or regional anaesthesia, for example, lumbar plexus block, and confers shorter operative times with less blood loss. However, publications thus far have been limited to small case series [5][6][7][8][9][10][11][12][13][14][15][16][17] and no published literature has attempted to analyse them in totality.…”

Section: Introductionmentioning

confidence: 99%

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Hip Fracture Management Using External Fixation—A Systematic Review

Chee

Foo

Hui

et al. 2020

Ann Acad Med Singap

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Introduction: Patients with significant comorbidities have high general anaesthetic risks and are often thought to be undesirable candidates for general anaesthesia and, therefore, surgery. External fixation uses local or regional anaesthesia, and allows patients with significant comorbidities to avoid the risks of general anaesthesia. It has been described to be successful in the management of high-risk patients with intertrochanteric fractures. However, published data have been derived from small case series, and no published literature has attempted to analyse them in totality. This review aims to pool together these case series, and to evaluate the outcomes and complications of external fixation when performed in high-risk patients with intertrochanteric fractures. Materials and Methods: The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRSIMA) guidelines. All studies that reported the outcomes of external fixation for intertrochanteric fractures of high-risk patients were included. Results: A total of 13 publications, involving 687 patients, were included in the review. All the studies reported postoperative radiological reduction and complete fracture healing with reduction of limb length discrepancy. One study using parallel placement of proximal fixation screws showed shorter operative duration as compared to convergent placement. Another study mentioned that there was no significant difference in mortality rates between patients with stable fractures and those with unstable fractures who underwent external fixation. All the studies reported a decrease in postoperative immobility, reduction in pain and improvement in clinical outcome hip scores. Conclusion: External fixation is promising and useful especially in the management of high-risk patients with intertrochanteric fractures. The procedure can help with radiological reduction of the fracture, reduction of limb length discrepancy, reduction of operative duration, decrease in postoperative immobility, reduction in pain and improvement in clinical outcome hip scores. The procedure is versatile and seems to be able to accommodate both stable and unstable fractures. However, unstable fractures may be associated with greater postoperative morbidity, and it may be worthwhile to prognosticate based on the stability of the patients’ fracture for better risk-benefit analysis preoperatively. Shorter operative times can also be achieved through parallel proximal pin placement, without impact on mortality or morbidity. Key words: External fixation; High risk; Intertrochanteric

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Section: Discussionmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

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Hip Fracture Management Using External Fixation—A Systematic Review

Chee

Foo

Hui

et al. 2020

Ann Acad Med Singap

View full text Add to dashboard Cite

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“…Sliding hip screws and intramedullary hip screws fixation are commonly used for the treatment of intertrochanteric fractures, although the reported high rates of fixation failures cannot be ignored 1345. For the treatment selection of the intertrochanteric fracture, age, general condition, comorbid diseases, bone quality, and fracture type should be taken into consideration 6.…”

Section: Discussionmentioning

confidence: 99%

Results of a compression pin alongwith trochanteric external fixation in management of high risk elderly intertrochanteric fractures

Arslan

Utkan

Koca

2016

IJOO

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Background:External fixation is a well-known procedure for the management of intertrochanteric fractures in very elderly high-risk patients. A new compression pin that can be adapted to all fixators was designed to provide inter fragmentary compression. In the present study, its effects on the fracture stability and healing were evaluated.Materials and Methods:Thirty-one patients treated using compression pin and thirty-six patients treated using standard pins were evaluated retrospectively between January 2009 and July 2014. Patients were evaluated according to age, gender, duration of preoperative period, duration of operation time, American Society of Anesthesiologists (ASA) scores, and immediate postoperative and final femoral neck angle measurements. The stability of the fixation was evaluated by calculating the secondary varus angulation after weight bearing.Results:Thirty one patients (82.1 ± 6.1 years old) comprised the compression pin group, and 36 patients (83.33 ± 6.24 years old) comprised the standard pin group. From the time of weight bearing to healing time, 1.0 ± 1.25° (0–4) and 2.5 ± 1.8° (0–9) of secondary varus angulation in the compression pin and standard pin groups were measured, respectively (P = 0.000). With weight bearing, 2 of 31 (6%) and 9 of 36 (25%) patients in the compression and standard pin groups, respectively, had >4° of secondary varus angulation. In the compression pin group, 13 fractures were unstable, but only 2 (15%) of them had >4° of secondary varus angulation. In the standard pin group, 19 fractures were unstable, and 7 (37%) of them had >4° of secondary varus angulation.Conclusions:Treatment of very elderly, high risk patients’ with intertrochanteric fractures with external fixation is effective. Compression pin maintained stability better than standard pins after weight bearing, especially for unstable intertrochanteric fractures.

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“…Surgical procedures play a major role in preventing bed-related complications and disability among the elderly [8]. The goals of surgery are to restore the anatomical alignment, maintain fracture reduction, and allow early rehabilitation [9]. Mobilization and full weight bearing as soon as possible are equally important after surgery [10].…”

Section: Introductionmentioning

confidence: 99%

Computer-assisted preoperative planning improves the learning curve of PFNA-II in the treatment of intertrochanteric femoral fractures

Wang

Kun

Qiang

et al. 2020

BMC Musculoskelet Disord

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Background: Intertrochanteric femoral fractures are prevalent among the elderly, and usually demands surgical treatments. Proximal femoral nail antirotation Asian version (PFNA-II) is widely used for intertrochanteric fracture treatment. The computer-assisted preoperative planning (CAPP) system has the potential to reduce the difficulty of PFNA-II in the treatment of intertrochanteric fractures. The aim of the study was to investigate and compare the learning curves of PFNA-II treatment with CAPP and conventional preoperational planning methods for intertrochanteric femoral fractures.Methods: A total of 125 patients with intertrochanteric fracture who were treated with PFNA-II between March 2012 and June 2015 were retrospectively analyzed. Patients who underwent surgery with CAPP procedure by a junior surgeon were regarded as group A (n = 53); patients who underwent the conventional surgery by another junior surgeon were regarded as group B (n = 72). Each group was divided into three subgroups (case 1-20, case 21-40, case 41-53 or case 41-72). Results:The average operation time of group A was 45.00(42.00, 50.00) minutes, and in group B was 55.00 (50.00, 60.00) minutes (P < 0.01). Average radiation frequency and blood loss were 13.02 ± 2.32, 160.00 (140.00, 170.00) ml and 20. 92 ± 3.27, 250.00 (195.00, 279.50) ml, respectively, with significant differences (P < 0.01). The learning curve of the surgical procedure in group A was steeper than that in group B. There were no significant differences in patient reported outcomes, hospital stay and complication rate between the two groups. Significant differences were observed between group A and B in Harris score at last follow-up in the AO/OTA type 31-A2 intertrochanteric fracture (P < 0.05).Conclusion: Compared with conventional preoperative planning methods, CAPP system significantly reduced operation time, radiation frequency and blood loss, thus reshaped the learning curve of PFNA-II treatment with lower learning difficulty.

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

Cited by 13 publications

References 26 publications

Hip Fracture Management Using External Fixation—A Systematic Review

Hip Fracture Management Using External Fixation—A Systematic Review

Results of a compression pin alongwith trochanteric external fixation in management of high risk elderly intertrochanteric fractures

Computer-assisted preoperative planning improves the learning curve of PFNA-II in the treatment of intertrochanteric femoral fractures

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