ABSTRACT

Objective:

We evaluated the results of osteosynthesis with external fixation for intertrochanteric hip fractures in elderly patients with a high anesthesia risk.

Material and Methods:

Sixty-eight patients with closed intertrochanteric femur fractures (48 women, 20 men, mean age: 77 years; range between 65-84 years) were treated with an unilateral external fixator under epidural anesthesia combined with mild sedation. According to AO/OTA classification A1.1, A1.2, A1.3 and A2.1 types were accepted as stabil, (Group 1), A2.2, A2.3, A3.1, A3.2 and A3.3 type fractures (Group 2) were accepted as unstabil fracture types. In first group there were 39 patients and in the second group there was 29 patients. The mean follow up was 12 months (9 to 18). In all patients, an AO tubular external fixator was used. Operation time, hospitalization period, healing time, complication rate and postoperative activity level were evaluated. Statistical evaluation was done by Mann-Whitney U-test.

Results:

The mean operation time was 24 minutes (17-60) in the firstgroup and 38 minutes (26-70) in the second group (p<0.001). The mean hospitalization duration was 4 days (2-10) in the first group and 7 days (3-13) in the second group (p<0.001). The mean time for the union of the fracture was 11.64 (9-17) weeks in the first group and 13.9 weeks (11-18) in the second group (p<0.001). While 8 patients had superficial and 3 patients had deep infection in the first group, in the second group there were 10 patients with superficial and 4 with deep infection. In the second group, varus deformity was observed in 5 patients. The mean Barthel daily activity score was calculated as 14.2 (9-18) in the first group and 11.4 (4-14) in the second group (p<0.01). There was no statistically significant difference in the mortality ratios between two groups.

Conclusion:

Since fixation by external fixators for intertrochanteric femur fractures is minimally invasive, causes less bleeding and preserves soft tissues and bones, it is one of the preferred methods for the treatment of elderly patients with a high anesthesia risk. Nevertheless, for the intertrochanteric femur fractures that are unstable according to the AO classification, the union time is longer, union in the varus position is more often and the complication ratio is higher. Therefore it should be used for chosen cases among geriatric patients.