Comparison of external Orthofix pertrochanteric fixator and internal proximal femoral nail antirotation fixation for intertrochanteric fractures in high-risk elderly patients

Background: Internal fixation methods, such as proximal femoral nail antirotation (PFNA), are the preferred treatment method for intertrochanteric fractures. However, less invasive external fixation methods, such as Orthofix pertrochanteric fixator (OPF), could provide similar clinical results as internal fixation with a reduced number of complications. A clinical trial on 243 high-risk patients has been performed to compare the effectiveness and occurrence of complications of the two surgical methods PFNA and OPF in elderly patients with intertrochanteric fractures. Methods: Two hundred forty-three elderly patients with high-risk comorbidities were diagnosed with intertrochanteric fractures, attributed to low-energy injuries like slipping and falling down at home. The patients were divided into two groups based on the method of internal fixation: 103 patients in group A were fixated with OPF and 140 patients in group B were treated with PFNA. Results: No significant differences between the two groups in terms of quality of fracture repositioning and Harris Hip Scores (HHS) were found. The operation time for group A (14.41 ± 2.10 min) was shorter than for group B (62.20 ± 5.60 min), (P < 0.05). No patients in group A required postoperative blood transfusion, while 110 patients in group B received it. The average length of the hospital stay in groups A and B was 4.10 ± 0.82 days and 5.63 ± 0.83 days, respectively, and there was no significant difference in postoperative complications between group A and B. Pin-tract infection occurred in nine cases in group A and nine patients with failed PFNA fixation achieved satisfactory recovery following bed rest. There were four deaths from unrelated causes in group A and 15 unrelated deaths in group B. Group A healing time of fractures (14.50 ± 1.09 days) was longer than for group B (12.84 ± 1.17 days). Conclusion: OPF is an effective fixation method for high-risk elderly patients with intertrochanteric fractures. OPF is notably simple to perform, with less bleeding, minimal radiation exposure, a much lower complication rate, a shorter hospital stay and satisfactory functional recovery compared to the internal fixation method of PFNA.