الفهرس 
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Abstract
Twenty patients with intertrochanteric fracture in high risk patients where operated in orthopedic department, El-Menufiya University Hospital and Orthopedic Department, El-Menshawy general hospital in the period between march 2011 and September 2012,this include the follow up period which ranged from 6 to 9 monthes.
Of those patients, 6 were males and 14 females. Their mean age was 68.1 years (range 50-85 years). Fractures were classified according to the system proposed by Evans. 4 fractures were type II, 4 were type IV, 12 were type V . 18 fractures were due to low energy trauma and 2 were due to high energy trauma. 12 fractures affected the left side and 8 affected the right.
The patients were operated on after an average of 8.6 days (range 2-
17 days) after trauma. Anaesthesia was chosen according to the patient’s condition .Operations were performed under spinal anaesthesia in 16<patients, general anaesthesia in 2 and local anaesthesia in 2.
All of the patients were allowed to sit in bed on the 1st postoperative day. 15 patients were allowed to start partial weight bearing within the first week post-operatively while it was delayed after the first week in 5. All patients were discharged from hospital when the general condition permitted.
The mean hospitalization time post-operatively was 3 days (range 2-
4 days). Patients were followed up every 4 weeks until the external fixator was removed. When union was proved the external fixator was removed in the out-patient clinic. Following the removal of the device,
patients were followed up at 1-month interval. The mean follow-up time was 7.5 months. Final assessment was performed according to Kyle,(1980).
A specially designed unilateral uniplaner external fixator was used in this study. C-arm was used for the closed reduction of the fracture and insertion of the Schanz screws into their proper position. The first Schanz screw with a diameter of 6 mm is introduced gradually under bidirectional fluoroscopic guidance into the femoral neck from the base of the greater trochanter across the fracture site at an angle of 125-130o with the femoral shaft and approximately in the center of the femoral head and in both antero-posterior and lateral views. The tip of the Schanz is stopped 0.5-1 cm from the articular surface of the head. The external fixator clamp is applied to the inserted Schanz screw, then using the same implantation technique of the first screw, a second proximal Schanz is inserted into the femoral neck through the clamp of the external fixator. Then two 6 mm diameter Schanz screws are inserted, through the clamp of the external fixator, into the proximal part of the femoral diaphysis at a right angle to the femoral shaft. The final position of the Shcanz screws as well as reduction are checked by image intensifier in both antero-posterior and lateral views. Finally, the external fixator clamp is tightened by Allen wrench and thus rigid fixation is obtained at the fracture site.