In a prospective, randomised study we have compared the pertrochanteric external fixator (PF) with the sliding hip screw (SHS) in 100 consecutive patients who were allocated randomly to the two methods of treatment. Details of the patients and the patterns of fracture were similar in both groups. Follow-up was for six months. Use of the PF was associated with significantly less blood loss, a shorter operating time, reduced postoperative pain, shorter hospitalisation (p < 0.001), earlier mobilisation (p < 0.001) and a reduced rate of mechanical complications (p < 0.01). Superficial infection was significantly more common with the PF (p < 0.01), but without long-term adverse consequences. There were no differences in the healing of the fracture, mortality or final functional outcome. Our results indicate that the external fixator is an effective and safe device for treating pertrochanteric fractures and should be considered as a useful alternative to conventional fixation with the sliding hip screw.

Otoacoustic emissions measurement (especially of DP OAEs) proved more sensitive than PTA in revealing minor cochlear dysfunction after gentamicin exposure. They should be used for monitoring patients receiving ototoxic factors such as aminoglycosides.

In a prospective, randomised study we have compared the pertrochanteric external fixator (PF) with the sliding hip screw (SHS) in 100 consecutive patients who were allocated randomly to the two methods of treatment. Details of the patients and the patterns of fracture were similar in both groups. Follow-up was for six months.Use of the PF was associated with significantly less blood loss, a shorter operating time, reduced postoperative pain, shorter hospitalisation (p < 0.001), earlier mobilisation (p < 0.001) and a reduced rate of mechanical complications (p < 0.01). Superficial infection was significantly more common with the PF (p < 0.01), but without long-term adverse consequences. There were no differences in the healing of the fracture, mortality or final functional outcome. Our results indicate that the external fixator is an effective and safe device for treating pertrochanteric fractures and should be considered as a useful alternative to conventional fixation with the sliding hip screw. J Bone Joint Surg [Br] 2002;84-B:23-9. Received 9 January 2001; Accepted after revision 7 June 2001External fixation was introduced for the management of pertrochanteric fractures in the 1950s at about the same time as the first sliding internal fixation devices.

In 44 surgical high-risk patients (ASA grade 3 or 4) pertrochanteric fractures were treated with a newly developed external fixator; all fractures healed within 14 weeks. Seven patients had a superficial pin tract infection and in 12 patients the fracture united with a shortening of 18 (5-30) mm. No implant failures or limitation of knee movements were recorded. Nine patients died during the first 6 months. The "pertrochanteric fixator" is a valuable alternative for treating highrisk, elderly patients.Résumé Chez 44 patients présentant des problèmes médicaux majeurs (ASA grade 3 ou 4) nous avons utilisé un nouveau "fixateur trochantérien". Toutes les fractures ont consolidé en 14 semaines. Les complications à noter ont été l'infection superficielle des fiches (7 patients) et le raccourcissement du membre inférieur de 18 (5-30)mm (12 patients). Il n'y a pas eu de complications liées au matériel (rupture ou lâchage des fiches) ni de limitation de mobilité du genou. La mortalité observée a été 21% en 6 mois. Le "fixateur trochantérien" est une alternative valable pour des patients âgés à risque opératoire très élevé.

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