External fixation of select intertrochanteric fractures with single hip screw

Since 1994, external fixation using a long hip screw was used for osteosynthesis of trochanteric fractures in 41 patients (27 women and 14 men) 76 to 94 years of age (mean age, 85 years) to minimize the risks associated with an open surgical procedure and general or long lasting spinal anesthesia. The patients were operated on under short duration spinal anesthesia, and intraoperative blood transfusion was not required in any patient. The hip screw was inserted on a guide pin within a protective sleeve in such a way as to achieve impaction at the fracture site as compression was applied in 35 patients. The hip screw was left free for sliding and dynamization in six patients. Diaphyseal distraction by the fixator was used in three of nine unstable fractures to correct varus deformity. The range of times to apply the external fixator was 20 to 45 minutes (mean, 35 minutes). The mean hospital stay was 6 days (range, 3-12 days) and the time to fracture union was 12 weeks (range, 11-13 weeks). Five patients died within 3 months. There were no nonunions or deep infections, but in 18 patients superficial skin reactions were seen around the pins and the screw. No material failure occurred. The method is thought to offer easy and safe stabilization of these fractures with the exception of temporary skin problems, which do not create a major problem.