External Fixation of Intertrochanteric Fractures in High-Risk Patients: A Case Series Demonstrating Safety and Early Ambulation
Christos T.Christoforidis *
Orthopedic Clinic-Thriasio General Hospital, Athens, Greece.
Claudio D’Agostino
Clinica Ortopedica e Traumatologica I - Istituto Ortopedico Rizzoli, Bologna, Italy.
Sotirios M.Sokorelos
Orthopedic Clinic-General Hospital of Rhodes, Greece.
Marios Klonaris
Orthopedic Clinic-General Hospital of Rhodes, Greece.
Michail V.Sokorelos
Orthopedic Clinic-General Hospital of Rhodes, Greece.
*Author to whom correspondence should be addressed.
Abstract
Hip intertrochanteric fractures are associated with significant morbidity and a substantial mortality risk, with a 15% to 30% death rate in the first year following the fracture. The standard treatment for these fractures is internal fixation, typically using devices such as the dynamic hip screw, intramedullary nails, or a proximal femoral plate. This study aimed to evaluate the clinical outcomes, including intraoperative blood loss, postoperative hip functionality, radiological results and complications in high-risk patients with intertrochanteric fractures treated with external fixation of the hip. This study strictly follows the ethical guidelines established by the National Orthopaedic Association. Twenty-two high-risk patients, classified by the anaesthetist as American Society of Anesthesiologists (ASA) grade 3 or 4 and considered unsuitable for conventional fracture fixation, were treated with hip external fixation at a single centre by the same surgeon from 2020 to 2023. The study group included 10 men and 12 women. All patients received regional anaesthesia, including a femoral nerve block (FNB) and lateral femoral cutaneous nerve block (LFCNB). The functional outcome was assessed using the Harris Hip Score, with an average score of 82.5 points, ranging from 60 to 98. Of the 22 total patients, 14 had excellent or satisfactory results, 5 had fair results, and 3 had poor outcomes. The overall complication rate was 31.5%. Two patients (9%) experienced pin tract infections, which were treated with antibiotics. Pin loosening occurred in one patient (4.5%), and varus malunion was observed in two patients (9%). The use of this external fixator device for treating trochanteric fractures is a safe, reliable, and minimally invasive alternative for managing intertrochanteric femoral fractures, particularly in elderly high-risk patients. However, larger studies with longer follow-up periods are necessary, as our series is limited by a small patient sample and a short follow-up duration.
Keywords: Hip intertrochanteric fractures, high-risk patients, femoral nerve block, lateral femoral cutaneous nerve block, fixator device