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ABSTRACT: Conservative treatment in intertrochanteric fractures of the high risk patient carries a high rate of mortality and morbidity, In the present study external fixation of the fracture was performed under local or light generai anaesthesia. This is a safe procedure and permits immediate full weight bearing.
Intertrochanteric fracture of the hip in the elderly presents a serious medical problem and often a terminal one. The fact that there is a steady increase in longevity of nonna! population may explain recent reports on the increasing number of patients with hip fractures.1,2
Medically, many of these patients are in a poor general condition, and with severe associated diseases, and carry a poor prognosis following the fracture of the hip.1,3-8 They have a high mortality rate either when treated surgically5,6" or conservatively, 2^-7 y although in many studies the nonoperative treatment reflects selection of this treatment for the high risk patient.3,7,8,10
The benefit of surgery and subsequent early mobilization are well recognized7,11-'3 but it is interesting that early mobilization without surgery is still practiced in certain places and it carries a mortality rate similar to the surgically treated patient. However. the rehabilitation of the conservatively treated patient is a very difficult task and is an enormous burden on the nursing staff and on the physical therapy team. In addition, the functional results are inferior. (Personal communication. Pillar T. 1981).
In the study presented, we focus on the treatment of the controversial group of high risk patient with intertrochanteric fractures, with the use of external fixation. This carried a minimal operative risk, eased the nursing care and permitted immediate full weight bearing and rehabilitation.
Clinical Material
Among some 65 patients treated for intertrochanteric fractures in Haifa Medical Center (Rothschild) and Poria Hospital . i 1 were classified as high operative risk (Table 1). Anaesthesia, either general or regional, was contraindicated by the anaesthesiologist and the internist in most cases.
The patient's ages ranged from 65 to 94 years. Over 81% were older than 80 years old. Nine were female and two were male. Most of the patients had more than one severe associated disease (Table 2). All but one patient, who received two weeks conservative treatment elsewhere, were operated on within 24 hours after sustaining the...