External fixation of trochanteric fractures in elderly high-risk patients | ||
| The Egyptian Orthopaedic Journal | ||
| Volume 47, Issue 4, December 2012, Pages 386-392 PDF (243.32 K) | ||
| Author | ||
| Mohamad Osman Mohamad | ||
| Abstract | ||
| Background Although open reduction/internal fixation is the gold standard for treatment of trochanteric fractures, the treatment of these fractures in elderly high-risk patients is highly challenging because of the risks associated with anaesthesia and open surgery as a result of significant comorbid factors. Closed reduction/external fixation under sedation/local anaesthesia may be an attractive solution. Patients and methods Twenty elderly high-risk patients [ASA 3 (nine patients) and ASA 4 (11 patients)] were treated by external fixation (under sedation/local anaesthesia) for trochanteric femoral fractures. Postoperatively, early mobilization was started. Results The mean time for fixator application was 20 min with no intraoperative complications. Two patients died within the first postoperative month and thus were excluded from the study. After a mean follow-up period of 11 months, 11/18 (61.1%) patients returned to their prefracture mobility level. The mean time for union was 10.5 weeks. Fixators were removed after a mean of 13 weeks. Mild pin site problems occurred in 30/85 sites (35.3%) in 17 patients. Grade IV infection occurred in one, with removal of fixator at 7 weeks postoperatively. Initial knee and hip stiffness occurred in most patients while the fixator was in place. However, most patients nearly completely gained their preoperative range of motion of the hip and knee finally. There were no iatrogenic or neurovascular complications and no pin breaking or migration. Three mortalities (15%) occurred because of underlying medical diseases. Conclusion External fixation of trochanteric fractures may be a wise and viable option in high-risk geriatric patients, with major advantages: it is minimally invasive, can be performed under local anaesthesia, and involves less amount of blood loss, short operative time, shorter hospital stay, fast/good functional recovery and mobilization and reasonably minor complications. | ||
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