الفهرس 
-Angles of the upper end of the femurOnly 14 pages are availabe for public view
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Abstract
Twenty patients with intertrochanteric fracture in high risk patients where operated upon in the orthopedic department, Al-Menoufia University Hospital in the period between January 2014 and January 2015 with a follow up period which ranged from 6 to 9 months. Of those patients, 6 were males and 14 females. Their mean age was 67.5 years (range 50-85 years). Fractures were classified according to the system proposed by Evans 60% of fracture were stable and 40% were unstable. 19 fractures were due to low energy trauma and one was due to high energy trauma. Ten fractures affected the left side and 10 affected the right.The patients were operated on after an average of 8.5 days (range 3-14 days) after trauma. Anaesthesia was chosen according to the patient’s condition. Operations were performed under spinal anaesthesia in 5 patients, general anaesthesia in 4 and local anaesthesia in 11.All of the patients were allowed to sit in bed on the 1st post-operative day. Weight bearing was started at 8-16 weeks after operation with a mean of 12 weeks. All patients were discharged from the hospital after improvement of the general condition (2-4 days) after operation .The frame used in this study was an unilateral uniplanar ilizarov fixator. It consists of two schanz screws crossing the fracture line and passing through the neck of femur, another two schanz screws are inserted into the shaft of femur . All schanz screws are connected by Ilizarov accessories like plates, rancho cubes, male supports, rodes and nuts . The final position of the screws and reduction are checked by C-arm in both antero-posterior and lateral view and the construct is tightened .The mean hospitalization time post-operatively was 3 days (range 2-4 days). Patients were followed up every 4 weeks until the Ilizarov fixator was removed. When union was proved the Ilizarov 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 the Merle d’Aubigne scoring system .The mean operative time was 37.5 min. (range 30-45 min). Also, blood transfusion and open surgical procedure were not required in any patient. Union occurred in all patients, the mean time of union was 12.4±1.9 weeks (range 10-16 weeks) .Overall results were excellent in 4 patients, good in 12, fair in 2 and poor in 2. All patients developed pin-tract infection to different extent. The average shortening ranged between 0 - 3 cm., shortening more than 1 cm was found in 8 patients(40%). Varus malalignment more than 10 degrees was present in 4 cases . There was 2 cases of penetration of the femoral head .The results were not affected by the sex, side affected, time lag before surgery, medical diseases, pin tract infection and penetration of the femoral head but they were affected by age, type of the fracture and shortening.