Background
Compound subtrochanteric fractures of the proximal femur caused by bullet injuries are a severe form of injury that are not common, and yet their management represents a major challenge. A specially designed external fixator can be used to treat these fractures, with avoidance of possible complications such as infection or nonunion. The author reviewed his experience with an external fixator in the management of this pattern of fractures.
Aim
A prospective evaluation was carried out of the result of treatment of bullet-caused subtrochanteric fractures by an external fixator.
Patients and methods
During the period between February 2011 and January 2012, eight male patients presented to the Kasr Al-Ainy School of Medicine and New Kasr Al-Ainy Teaching Hospital with compound subtrochanteric fractures of the femur caused by bullets. The patients were between 19 and 48 years of age (mean 33.5 years). All cases were primary fractures. They were followed prospectively after fixation of the fractures using a specially designed external fixator.
Results
The mean duration of healing was 20 weeks (range 18–26 weeks) according to the degree of comminution and soft tissue injury. Three patients developed pin-tract infection that resolved after removal of the frame. One patient developed shortening of about 2 cm. No deformity developed in any patient. No extra measures were needed. At the last follow-up, the results of all cases were scored as good (five cases) to excellent (three cases), with no fair or poor results.
Conclusion
An external fixator can be a reliable method to treat comminuted subtrochanteric fractures caused by bullet injuries.