External Fixation of Pertrochanteric Fractures

Sliding hip screw fixation is the most common surgical treatment for pertrochanteric fractures. Intramedullary hip screw fixation is another popular surgical option; however, for either sliding hip screw or intramedullary hip screw fixation, mechanical complications such as lag screw cut-out are frequent. Furthermore with these fixation techniques, the inability to restore previous hip anatomy is common. Recently, external fixation has been proposed as a suitable fixation technique for pertrochanteric fractures. The main advantages of external fixation include: minimally invasive, short operative time, limited blood loss, and maintenance of the reduction obtained at surgery. For these reasons, we evaluated the results of pertrochanteric fractures treated with external fixation after a minimum follow-up of 6 months. Ten consecutive female osteoporotic patients (age ≥ 65 years) with AO/OTA fracture type A 1 or A 2 were included in the study. Fractures were treated with Orthofix pertrochanteric fixator (OPF) with four hydroxyapatite (HA)-coated pins. The mean patient age was 82 ± 7 years. The mean operative time was 34 ± 5 min. Fixators were removed three months postoperatively. There was union in all fractures. No blood transfusions were required postoperatively. There was no pin-track infection. The mean pin-insertion torque was 1 962 ± 1 215 N/mm and the mean pin extraction torque was 2 784 ± 1 648 N/mm. These latter results indicated improved pin fixation over time (p < 0.0005). There was no significant change in fracture reduction over time since there were no differences between the femoral-neck-shaft angle at 6 months and postoperatively. This study demonstrates that external fixation is a reliable treatment option for osteoporotic pertrochanteric fractures.