Research On The Safety Assessment Of Intertrochanteric Fractures In High-risk Elder Patients Treated By External Fixation

Objective: To study the safeties of external fixator in the treatment of high-risk elderly patients with stable and unstable intertrochanteric fractures.Methods: Retrospective analysis was conducted in 50 patients aged over 70 years who were treated with the external fixation device during the period of May 2013 to May 2017.There were 24 males and 26 females with an average age of(77.34±5.95)years.All patients were treated with external fixator,and the type of fracture is classified according to Orthopedic Trauma Association classification systemand divided into two groups,group A(stable)and group B(unstable).There were 27 cases in group A and 23 cases in group B.According to the American association of anesthesiologists(ASA)classification,ASA III in 35 cases and ASA ? in 15 cases.Postoperative Harris' s score and complications were compared and analyzed.Results: All patients were successfully followed up at mean time of(23.44 ±9.33)months(range12 to 42).The total average operative time was(18.8±3.5)minutes,and the average operative time was(16.22±1.55)minutes in group A,which was lower than(21.91±2.59)minutes in group B.The total average fracture healing time was(11.08±3.14)weeks,and the average fracture healing time was(9.7±1.71)weeks in group A,which was less than(12.7±3.67)weeks in group B.The total last follow-up for neck stem angle was(127.01±4.74)°,and the last follow-up for neck stem angle was(128.31±3.31)°in group A,which was higher than(125.47±5.7)°in group B.The above differences were statistically significant(P<0.01).At the last follow-up,hip function was assessed according to the Harris scoring criteria of hip joint: excellent in 26 cases,good in 17 cases,acceptable in 7 cases,and the total excellent and good rate is 86%;excellent in 16 cases,good in 8 cases,acceptable in 3cases,and the total excellent and good rate is 88.9% in group A;excellent in 10 cases,good in 9cases,acceptable in 4 cases,and the total excellent and good rate is 82.6% in group B,and the difference was statistically significant(P<0.01).There was pin tract infection in 5 cases including pin loosening in 2 cases and delayed union in 1 case,with a complication rate of 12%(6/50).Conclusion: Therefore,external fixator is a feasible surgical method for the treatment of femoral trochanteric fractures in elder patients with high risk.There are more advantages in the treatment of stable intertrochanteric fractures than those for unstable fractures regarding shorter operative time,earlier full weight bearing and shorter fracture healing time.