Abstract

Twenty-eight unstable four-part intertrochanteric fractures in 27 elderly patients with severely osteoporotic femurs were treated by means of internal fixation (commonly the 130 or 95 A.O. blade plate) in combination with methylmethacrylate. Of the 28, ten patients with eleven fractures were recalled and reexamined; 12 had died; five were lost to followup (1 1/2-8 1/2 years) at the time of this review but sufficient documentation existed for their inclusion. There were no deep wound infections. We did not encounter any hypotension during surgery or as a result of the methylmethacrylate. One patient developed a pulmonary embolus 5 days postoperation and responded well to anticoagulant therapy. There were three failures; one femoral shaft fracture at the plate end, one nonunion, both requiring total hip replacemens, and the third failure was due to malreduction of fracture and was later revised. Where bone fragments were in contact, union occurred rapidly and the presence of cement did not interfere with bone union in any way. The patients were pain free and began full weight bearing the day after surgery.