Osteoporotic Pertrochanteric Fractures Can Be Successfully Treated with External Fixation

Abstract

H ip fractures are the most severe of all fragility fractures. It has been calculated that more deaths are caused by hip fractures than by other common severe diseases such as cancer of the stomach or the pancreas1. Furthermore, regardless of the quality of surgical treatment, hip fractures remain a major cause of disability. The economic implications are clear. In the United States, hip fracture management already costs approximately $13.8 billion per year2. In Europe, the average acute hospital cost is approximately €25,000 per fracture and the total care cost is as much as 2.5 times higher3. Approximately 200,000 pertrochanteric fractures (AO/OTA fracture type A1 and A2) per annum occur in the United States alone4. It has been calculated by the United States Census Bureau that, by the year 2020, the average life expectancy will be eighty-two years for women and seventy-four years for men5. This longer life expectancy will be associated with a dramatic increase in the number of pertrochanteric fractures. The functional results of treatment of pertrochanteric fractures are often unsatisfactory. The mortality rate has been reported to be 18% in the first year following operative treatment6. The results are influenced by the inability of the implant to remain well fixed in osteoporotic bone during the time required for fracture-healing. Implant failure and loss of reduction, which often lead to fracture malunion, are frequent complications of osteoporotic pertrochanteric fractures. Because fracture stability is crucial for bone repair, poor bone quality remains a concern that must be given priority when the type of implant is being chosen7. The primary aim of surgical treatment is to obtain good fracture reduction and to maintain this reduction until sufficient stability is provided by the fracture callus. If stable …