Management of pertrochanteric fractures in the elderly patients with an external fixation

One hundred patients above 80 years of age (mean age 88.20 years) with 101 fractures in the area of the trochanters were managed with an external fixation (Orthofix pertrochanteric fixator, OPF) from October 1995 to March 2000. Osteosynthesis was performed under radiology control and especially after a satisfactory closed reduction had been obtained. Accompanying diseases, duration of surgery, the transfused blood units, duration of hospitalization, complications, walking ability, time to union and mortality rate were recorded pre-operatively and post-operatively for a year. The results were: fast operation time (19.6 min at average), minimal blood loss (no blood transfusion was needed for 85 patients whereas for the remaining 15 patients 29 blood units were administrated due to a pre-existing anemia and not to compensate blood loss during surgery) and short duration of post-operative hospitalization (5.27 days at average). The main complications that were recorded were sore wounds in 15%, inflammation in the entrance of the screws in 9%, and aseptic loosening of the femoral screws/loss of reduction in varus >10 degree in 8%. These complications did not prevent the union of the fracture to a satisfactory level (13.91 weeks at average). There were no revisions. Within the first post-operative semester, the majority of the patients (57.69%) returned to the walking condition they had before the fracture. Post-operative mortality during the first month was 15% whereas during the first post-operative semester the rate increased by 7%. Due to the design of the device, the method is simple, fast, does not derange the patients and requires short time of hospitalization. These advantages are especially useful for the treatment of elderly patients with aggravated general condition.