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

Abstract

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.

Intramedullary versus extramedullary internal fixation for unstable intertrochanteric fracture, a meta-analysis

“… 2 The internal fixations are usually considered as prior options for treatments that can enable the patient to have postoperative early mobilization, good functional recovery and less complications. 3 , 4 With the time of invention and promotion internal fixation devices, the diversity of devices brings orthopedic surgeons more choices, such as intramedullary fixation (IF) (e.g. gamma nail, PFNA) or extramedullary fixation (EF) (e.g.…”

Hip Fracture Management Using External Fixation—A Systematic Review

“…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.…”

“…20,21 Another noteworthy finding is that the incorporation of a compression pin in the external fixation device has reduced the rates of complications compared to the use of standard pins solely. 10 In the study done by Arslan et al, the compression pin allowed for the additional step of fracture compression and fragment stabilization intraoperatively. Patients who had a compression pin included were noted to have significantly lower rates of varus deformity and limb length discrepancy postoperatively.…”

“…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.…”

“…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.…”