ORIGINAL ARTICLES

Conservative management of stable, minimally displaced pertrochanteric fractures: A case series

Matthew Mercouris¹, Schalk Klopper², Stefan Swanepoel¹, Sithombo Maqungo³, Maritz Laubscher⁴, Stephan Roche4, Ntambue Kauta¹

¹ Orthopaedic Surgery Department, Mitchell’s Plain Hospital, University of Cape Town, Cape Town, South Africa
²Orthopaedic Surgery Department, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
³Orthopaedic Surgery Department, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; Orthopaedic Research Unit, Division of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa; Division of Global Surgery, University of Cape Town, Cape Town, South Africa
⁴Orthopaedic Surgery Department, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; Orthopaedic Research Unit, Division of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa

Correspondence Address:
Dr. Matthew Mercouris
Orthopaedic Surgery Department, Mitchell’s Plain Hospital, University of Cape Town, 14 St. Johns Road, Unit 1B, Sea Point, Cape Town South Africa

Source of Support: None
Conflict of Interest: None

Background: Hip fractures are common, and account for significant morbidity and mortality. While surgical intervention remains the gold standard, nonoperative treatment protocols are seldom analysed and may be of value in select settings.

Objectives: We sought to review our conservatively treated pertrochanteric fractures and present a case series that outlined indications, treatment protocol and early outcomes.

Materials and Methods: A retrospective review of medical records and radiographic imaging of all patients who presented with stable pertrochanteric fractures and were treated nonoperatively, from September 2017 to February 2021, at a Level 2 District Hospital in South Africa.

Results: Of the 242 patients who were admitted with pertrochanteric fractures, 12 (4.9%) fractures were radiographically classified as AO 31A1.2 (stable, minimally displaced) and eligible for active nonoperative management. Within 6 weeks of injury, 10 (84%) of the patients who received active nonoperative treatment achieved union. Two patients (16%) failed the treatment protocol and required surgery, with one failing during the hospital phase of the treatment protocol and the other on follow up. In the group of united fractures, the neck shaft angle was on average within 3 degrees of the contralateral hip with a range of 0 to 5 degrees. At follow-up, two (16%) patients had a measurable shortening of 5 mm at union. There was no medical morbidity associated with this protocol.

Conclusion: In our case series, the active nonoperative management protocol, involving early mobilisation and serial radiographs, in select cases of stable pertrochanteric fractures yielded acceptable outcomes. This is of relevance in low-middle income countries with limited surgical capacity.