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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2001 April;52(2):81-6
Pertrochanteric fractures: minimally invasive surgical treatment with pertrochanteric axial external fixator and early rehabilitation
Background. To report our experience with an innovative surgical treatment for pertrochanteric fractures.
Methods. Fractures were treated with the Orthofix perthrochanteric axial external fixator (AEF) system+percutaneous pins (2-3 in the femoral neck-head and 2 in the subtrochanteric region). Since 1992, 248 patients have been treated; patient age ranged between 30 and 100 years.
Results. Healing time was three months, with an average follow-up of three years. Healing was excellent in 90% of cases; mild varus or valgus deformity was acceptable in 10%. Recovery of walking ability was excellent in 80%, fair in 10% and poor in 10%. Active and passive rehabilitation was initiated 24 hours after surgery; after radiograph and ultrasound control, weight bearing and walking was resumed on postoperative day 3 or 4 in patients with stable fractures and after day 30 in those with unstable fractures. Results were positive in 239 patients; complications developed in nine. In four patients (over age 80 with severe osteoporosis) bending and perforation of one femoral head plate occurred. After correction by loosening and tightening the pin and discontinuation of weight bearing for 30 days, healing progressed normally. In five patients septic necrosis of the femoral head developed from plate infection as a result of patient negligence.
Conclusion. Given the excellent results achieved so far, we will increasingly use the pertrochanteric AEF system because of the advantages it offers: 1) open treatment; 2) short operation time of 7 to 10 minutes; 3) treatment in advance age; 4) no need for transfusion; 5) optimum fractures stabilization; 6) removal in outpatient setting; 7) reduced costs. As the age of patients presenting with pertrochanteric fractures continues to rise, we believe this minimally invasive and simple procedure can be a life-saving technique in the management of pertrochanteric fractures.