[Surgical results of pertrochanteric fractures. A 15-year study]

During the last 15 years new methods for the surgical treatment of pertrochanteric fractures have been developed [e.g. the dynamic hip screw (DHS) and the gamma-nail (GN)]. We report on the results obtained in 450 patients operated on between 1979 and 1984 (period I), from 1986 to 1989 (period II), and between 1991 and 1993 (period III); we reviewed the results with the intension of finding whether application of the new methods led to better results, shorter stay in hospital and fewer complications. The mean age of all patients was 79 years and was 4 years higher in period I to than in period III (77.5 +/- 9.2 vs 81.5 +/- 8.4). During period I, 65% of the fractures were stabilized using Ender rods, while during period III the DHS was used in nearly 60% and the GN, in 22%. The total hospital stay (department of surgery and geriatric hospital) decreased from 80.4 +/- 31.7 in period I to 66.6 +/- 24 days in period III (P < 0.001). Serious complications decreased by 80% during this time. During period I 86.2% of patients could be discharged home, as against 89.0% in period II and 94.7% during period III. The introduction of new operative techniques for the treatment of pertrochanteric fractures in the elderly was followed by a dramatic shortening of hospital stay, a reduced incidence of complications, early weight-bearing and an increased rate of discharge home.