Minimally invasive treatment for intertrochanteric fractures of the femur in high-risk patients / 中国微创外科杂志

ABSTRACT

Objective To evaluate the clinical effectiveness of minimally invasive external fixation in the treatment of intertrochanteric fractures of the femur in high-risk patients. Methods By using a monolateral external fixator with oblique pin-insertion, we treated 77 consecutive elderly patients (mean age, 71.3) with intertrochanteric fractures of the femur associated with at least one kind of severe systemic diseases from June 1996 to June 2004. Fractures included 70 cases of anterograde intertrochanteric fracture (According to the Evans classification, there were 5 cases of type Ⅰ fracture, 11 cases of type Ⅱ, 34 type ⅢA, 9 type ⅢB, and 11 type Ⅳ.) and 7 cases of retrograde intertrochanteric fracture. A total of 8 patients were combined with multiple injuries. Results A follow-up was made for 5~60 months (mean, 24.3 months). Complete bone union was achieved in all the patients within a period of 8~20 weeks (mean, 12 weeks). Postoperatively, no non-union or coxa vara occurred. According to the Harris hip scores, 49 patients were classified as “excellent” results, 21 as “good”, and 7 as “poor” (all of which were fatal cases), the “excellent-and-good” rate being 91%. Conclusions Minimally invasive external fixation is an alternative to open internal fixation in the management of intertrochanteric fractures in high-risk elderly patients, especially suitable to those with multiple injuries.