Objectives: We evaluated the results of osteosynthesis with external fixation for intertrochanteric hip fractures in elderly patients with a high anesthesia risk.
Methods: Fourteen ASA 4 patients (5 men, 9 women; mean age 75 years; range 65 to 81 years) with intertrochanteric hip fractures were treated with a unilateral external fixator under epidural anesthesia combined with mild sedation. According to the AO/OTA classification, six fractures were A1.2, seven fractures were A2.2, and one fracture was A3.1. All were closed fractures. The mean preoperative Singh index of the contralateral hip was 3.1 (range 3 to 5). Eleven patients received an AO tubular external fixator, and three patients received a unilateral external fixator. Final evaluations were made using the Parker-Palmer mobility score and Harris hip score. The mean follow up was 12 months (range 9 to 17 months).
Results: The mean operation time was 37 min (range 25 to 44 min), the mean fluoroscopy time was 1.5 min (1 to 2 min), and the mean hospital stay was seven days (5 to 15 days). None of the patients required blood transfusion. Bone union was obtained in all the patients in a mean of 4.1 months (3 to 5 months). The mean femoral shaft-neck angles in the early postoperative period and at the latest follow-up were 133 degrees (127 degrees to 139 degrees ) and 132 degrees (126 degrees to 138 degrees ), respectively. Five patients (35.7%) developed grade I pin-tract infection. Medial displacement of the distal fragment, limb shortening, or fixator failure were not seen. Three patients (21.4%) died within the first postoperative year due to associated diseases. The mean final Harris hip score was 61 (range 45 to 80) and the mean Parker-Palmer mobility score was 6.6 (range 5 to 8).
Conclusion: Osteosynthesis with an external fixator in elderly patients with a high anesthesia risk is a fast, minimally invasive procedure in the treatment of pertrochanteric fractures, resulting in fewer pre- and postoperative complications.