Results of a compression pin alongwith trochanteric external fixation in management of high risk elderly intertrochanteric fractures

Background: External fixation is a well-known procedure for the management of intertrochanteric fractures in very elderly high-risk patients. A new compression pin that can be adapted to all fixators was designed to provide inter fragmentary compression. In the present study, its effects on the fracture stability and healing were evaluated. Materials and Methods: Thirty-one patients treated using compression pin and thirty-six patients treated using standard pins were evaluated retrospectively between January 2009 and July 2014. Patients were evaluated according to age, gender, duration of preoperative period, duration of operation time, American Society of Anesthesiologists (ASA) scores, and immediate postoperative and final femoral neck angle measurements. The stability of the fixation was evaluated by calculating the secondary varus angulation after weight bearing. Results: Thirty one patients (82.1 +/- 6.1 years old) comprised the compression pin group, and 36 patients (83.33 +/- 6.24 years old) comprised the standard pin group. From the time of weight bearing to healing time, 1.0 +/- 1.25 degrees (0-4) and 2.5 +/- 1.8 degrees (0-9) of secondary varus angulation in the compression pin and standard pin groups were measured, respectively (P = 0.000). With weight bearing, 2 of 31 (6%) and 9 of 36 (25%) patients in the compression and standard pin groups, respectively, had >4 degrees of secondary varus angulation. In the compression pin group, 13 fractures were unstable, but only 2 (15%) of them had >4 degrees of secondary varus angulation. In the standard pin group, 19 fractures were unstable, and 7 (37%) of them had >4 degrees of secondary varus angulation. Conclusions: Treatment of very elderly, high risk patients' with intertrochanteric fractures with external fixation is effective. Compression pin maintained stability better than standard pins after weight bearing, especially for unstable intertrochanteric fractures.