Internal fixation of unstable intertrochanteric fractures and post-op erative complications in elderly patients

Objective To discuss how to select proper internal fixation devices for unstable in tertrochanteric fractures in the elderly and analyze the causes of post-operative complications.Methods To retrospectively review a series of 65patients treated with i nternal fixation using contemporary techniques for unstable intertrochanteric frac-tures between March 1995and October2002in our department.Results The average follow-up was 36.2month s(range:12to 82months).Excellent and good functional resu lts were obtained in 53patients(81.5%).The main complications were varus malunion(5cases),failure of internal fixation(3cases)and eliciting pre-existing disease s(2cases).Conclusions In order to reduce the mortality and morbidity and improve functional end results,the un-stable intertrochanteric fracture in the elderly should be treated by early operation and use of internal fix ation appara-tus.One of the most important factors in this regard is selection of a prop er fixation device according to fracture type and physical status of the specific p atient.Proximal femoral nail or dyn amic hip screw is the choice of treatm ent for such fractures.External fixation a nd multiple screws or pins are not recommended.An anatomic reduction,im plant placement in the biomechanically id eal position and well-scheduled reh abilitation program are also important for ex-cellent functional results.[