Less invasive surgery using external fixator for the treatment of subtrochanteric femur fracture in a high-risk geriatric patient

Abstract

A 90-year-old female patient was admitted to our clinic complaining of pain in her left hip which occurred due to fall from a chair. Her medical history included memory loss and mental changes associated with Alzheimer's disease and depression. Patient’s cooperation and orientation were weak. Range of motion of the left hip was restricted and painful. Radiographs of the left hip demonstrated subtrochanteric comminuted fracture of femur. Laboratory tests revealed anemia and liver insufficiency. Departments of internal medicine and anesthesiology reported high risk for surgery. Surgery was performed under spinal anesthesia on radiolucent table and in supine position. Using fluoroscopy, subtrochanteric comminuted fracture of femur was reduced. Proximally, two Schanz screws were placed through femoral neck and head in axial plane, and distally, three Schanz screws were placed through femoral shaft in coronal plane. Finally, fixation of the screws was achieved with an external fixator which was made of carbon fiber rods. Patient was allowed to sit in the bed and move around with a wheelchair as of the day of surgery. No infection or loosening of fixator occurred.