title: Treatment of intertrochanteric fractures in elderly highrisk patients: dynamic hip screw vs. external fixation.
abstract: BACKGROUND
  Although the use of a dynamic hip screw (DHS) is considered to be the preferred treatment for intertrochanteric fractures, the external fixation device could produce clinical outcomes comparable to the outcomes obtained with conventional treatment. Furthermore, because external fixation is minimally invasive, we expected a lower rate of morbidity. Therefore, we compared the two treatments in a clinical trial of elderly patients with intertrochanteric fracture.
  
  
  METHODS
  60 elderly high-risk patients with an average age of 78 years were treated for intertrochanteric fracture, resulting from a low energy trauma. Patients were randomly divided in two groups regarding to treatment. In Group A the patients were treated with DHS, while in Group B were treated with external fixator.
  
  
  RESULTS
  The fixator was well accepted and no patient had significant difficulties while sitting or lying. The average intraoperative time was 73 min in Group A and 15 min in Group B (p<0.05). 27 patients of Group A need blood transfusion postoperatively and none in Group B (p<0.05). The mean duration of hospitalization in Group A and Group B was 8.4 and 2.2 days, respectively (p<0.05). 9 of patients Group B had pin-track infection grade 2 that all were treated by oral antibiotics. There were no differences in comorbidities, quality of reduction, screw cut out, bed sore and HHS between the two groups.
  
  
  CONCLUSIONS
  Treatment with external fixator is an effective treatment for intertrochanteric fractures in elderly highrisk patients. The advantages include quick and simple application, minimal blood loss, less radiation exposure, adequate fixation, pain reduction, early discharge from hospital, low costs and favourable functional outcomes.
authors: Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors: G H
authors: GH
authors: Kazemian
authors: Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors: A R
authors: AR
authors: Manafi
authors: Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address: faridehnajafi1@gmail.com.
authors: F
authors: F
authors: Najafi
authors: Faculty of Medicine, Isfahan University of Medical Sciences, Esfahan, Iran.
authors: M A
authors: MA
authors: Najafi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000379:methods*; D001803:Blood Transfusion; D001863:Bone Screws; D003362:Cost-Benefit Analysis; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D017102:Fracture Healing; D006620:Hip Fractures / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D018579:Patient Selection; D011183:Postoperative Complications / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Dynamic hip screw; External fixator; Harris Hip Score; Intertrochanteric fractures