External fixation of intertrochanteric femur fractures in elderly patients: Functional outcome

Background: Intertrochanteric fractures are common extra capsular fractures of the proximal femur at the level of the greater and lesser trochanters, most commonly occurring in the elderly after falls. The treatment of this femoral fracture is a rapid, safe, and minimally invasive procedure for elderly patients with external fixation and high anesthetic risk. Objective: Evaluate the result of the external fixation devices in treatment of closed intertrochanteric femur fracture in elderly patients with high anesthetic risk. Method: The study was conducted at the Department of Orthopaedic Surgery, Al-Kadhemia Teaching Hospital, between April 2014 and July 2017, and examined 30 cases of intertrochanteric fractures with high risk of anesthesia. The patients included 18 women and 12 men, 11 right-sided fractures and 19 left-sided fractures, and their ages ranged from 65 to 85 years. All fractures were fixed with an external fixator under general anesthesia (8 cases), neuraxial anesthesia (15 cases), epidural anesthesia (5 cases), and local anesthesia (2 cases). Results: The average duration of the operation was 35 minutes (25-50 minutes), and no blood transfusion was required in any case. The remaining 28 patients did not die immediately after four months. Most patients had excellent and good results according to the Judet functional score. The most common complications were pin tract infection and deep vein thrombosis. The use of an external fixator significantly reduces blood loss, shortens the operation time, eliminates the need for surgical incisions other than the slotted incision for the insertion of the pins, reduces postoperative pain, and shortens hospital stay. Conclusion: For elderly patients with high anesthetic risk, external fixation of intertrochanteric fractures is a rapid, safe, and minimally invasive procedure with few preoperative and postoperative complications.