Safety and reliability of external fixation for basicervical and intertrochanteric fractures in high-risk elderly patients

Abstract

Forty elderly patients with basicervical and pertrochanteric fractures were managed with uniplanar AO external fixator under regional anaesthetic block of the femoral nerve and lateral cutaneous nerve of the thigh from April 2003 to March 2006. The mean age of the patients was 67.9 +/- 5.5 years. External fixator application was performed under radiological control after closed reduction had been obtained. Comorbid factors, duration of surgery, duration of hospitalisation, complications, walking ability, time to union and mortality rate were recorded. Patients were followed up for a mean period of 12 +/- 4.5 months. Superficial pin tract infection occurred in 13 patients, healing in varus >10 degrees and with shortening >2 cm occurred in six patients, and one patient suffered a spontaneous ipsilateral femoral neck fracture after removal of the fixator. The mean time for union was 10.4 +/- 1.2 weeks. Rapid union rate and minor complications obtained in the present study are comparable to those obtained with standard internal fixation techniques. Minimal intraoperative blood loss, short operative time and early patient mobilisation are advantages signifying uniplanar external fixator application under regional anaesthetic block to be a viable option in treatment of basicervical and pertrochanteric fractures in high-risk elderly patients.

Treatment of intertrochanteric fractures of the femur with external fixation

“…The mean time to achieve union in the present study is 14 weeks±2 for unstable fractures(group A),and 18 weeks±2 for( group B) unstable fractures, this is similar to other studies 6,11 ,but it is longer than shalaby 10 etal study(10±1.2 weeks) and Gudemez 8 etal study.…”

“…The mean hospitalization time in the present study is 3days ,range from2 to 5 days, this similar to shabby 10 etal group(3±0.9 days) while it was less than those recorded by kourtzis 11 etal(7.2 days).…”

“…With the development of compression hip screw and gamma nail, internal fixation of intertrochanteric fractures remain the gold standard treatment 4,10 ,but the morbidity and mortality rate are high in elderly patients with significant co-morbid factors an in those with multiple fracture.…”

“…Under anesthesia, usually spinal or short period of general anesthesia or even local anesthesia with narcotic analgesic support, orthopedic table, under carm control, gentle reduction to the affected limb started with the limb held in slight internal rotation and 15-20 degrees of abduction 6,10,18 .…”

Basicervical Fracture of Neck Femur Treated With DHS And Derotation Screw- A Prospective Study of 30 Cases

“…Other authors like Kuokkanen (1991) [2] found the average age to be 72 years in the Basicervical fractures which he treated with various methods. Saarenpaa et al (2002) [3], Su et al (2006) [4], Boghdady et al (2007) [5], Massoud et al (2010) [6] reported the average age to be 79 years, 67.9 years, 75years(M) and 78 years(F), 68.9 years respectively. The male : female ratio being 3:1.…”