The external fixator compared with the sliding hip screw for pertrochanteric fractures of the femur

Abstract

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.

Management of trochanteric fractures of the femur with external fixation in high-risk patients

“…Postoperative pain is minimal and easily controllable, making the nursing and mobilisation of these patients easier. Studies using new fixators (Orthofix Pertrochanteric Fixator) have also shown that external fixation can provide results that are similar to, or even better than, those obtained with conventional internal fixation techniques [13,14]. Despite these evident advantages, the external fixator has failed to become popular with most surgeons because of the significant reported complications in previous studies, infection being the most common.…”

“…Cases of deep infection that required pin removal or repositioning have been reported [5]. Vossinakis and Badras [14] reported that pintrack infection developed in 15 of their 50 patients (30%) treated with the Orthofix external fixator using standard pins. In a similar study, 18 of 41 patients (45%) had pintrack complications [4].…”

“…Fracture of the hip is a leading cause of death and disability in the elderly [4,14]. Treatment goals for these patients include early rehabilitation, restoration of anatomical alignment, and maintenance of the fracture reduction [2].…”

Outcomes of trochanteric external fixation for geriatric inter-trochanteric hip fractures

“…However a high prevalence of postoperative complications such as pin-loosening, infection, and mechanical failure of the fixator resulted in discontinuation of its use. 3,12 In the last decade, the advancement of external fixators and the introduction of new materials such as hydroxyapatite coated pins as well as better understanding of the mechanics of fracture healing in osteoporotic bone has prompted surgeons to reconsider external fixation as an alternative method for trochanteric fracture management. 13e16 The purpose of this study is to describe our outcomes of external fixation in management of trochanteric fractures in high-risk elderly patients.…”

The clinical outcomes of hemiarthroplasty and proximal femoral nail (PFN) fixation of unstable intertrochanteric femoral fractures in patients over 70 years old

“…Yaşlılarda oluşan kalça kı-rıklarının tedavisinde amaç, hastanın mümkün olan en kısa sürede hareket etmesini sağlayarak kırık öncesi yaşamına geri döndürmek ve hareketsizliğe bağlı ölümle sonuçlana-bilecek komplikasyonların gelişmesini önlemektir. [1][2][3] İnstabil IFK'nda yeterli redüksiyon ve rijid internal fiksasyon günümüzde halen en geçerli tedavi yöntemidir. Biyomekanik ve anatomik uyumluluğu nedeni ile son yıllarda proksimal femoral nail (çivi) (PFN) ortopedik cerrahlar tarafından gün geçtikçe kullanımı artan bir fiksasyon materyali olarak dikkat çekmektedir.…”