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European Journal of Trauma and Emergency Surgery

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Open Access 19-10-2022 | Hip Dislocation | Original Article

Operative management of acetabular fractures in the elderly: a case series

Authors: Michalis Panteli, Panayiotis Souroullas, Sushmith R. Gowda, James S. H. Vun, Anthony J. Howard, Nikolaos K. Kanakaris, Peter V. Giannoudis

Published in: European Journal of Trauma and Emergency Surgery | Issue 2/2023

Abstract

Background

Our objective was to identify acetabular fractures in the elderly population (over 60 years of age), treated with open reduction and internal fixation (ORIF), and to examine their outcomes, primarily the risk for need for further surgery in the form of a total hip arthroplasty (THA), and factors associated with it. Additional outcomes such as infection, avascular necrosis (AVN) of the femoral head, and heterotopic ossification (HO) were also investigated.

Methods

Following institutional review board (IRB) approval, a retrospective analysis of all consecutive patients presenting to a Level I Trauma Centre over a 13-years period (January 2003–February 2016) was conducted. Patients were excluded if their initial treatment was conservative or simultaneous ORIF with THA.

Results

A total of 62 patients with an age of 71.5 ± 8.04 years were included (14 female; follow-up 54.2 months, range 1–195 months). Sixteen patients required a THA as a secondary procedure due to symptomatic post-traumatic arthritis (25.8%), five (8.1%) of whom having a THA within a year from the original trauma (three patients presenting with loss of reduction and two patients with early AVN). No associations with progression to THA were identified. Surgical approach (ilioinguinal) was the only factor associated with increased risk of development of HO (p = 0.010). The median post-operative survival following an acetabular fracture treated with ORIF was calculated at 90.1 months (95% CI 72.9–107.2).

Conclusion

Acetabular fractures ORIF in the elderly, is a safe and reliable option. The relatively incidence of development of severe post-operative arthritis was 45.2%. Conversion to THA was 25.8%, with 8.1% having the arthroplasty procedure within a year of the original trauma surgery.

Level of evidence

III.

Mears DC. Surgical treatment of acetabular fractures in elderly patients with osteoporotic bone. J Am Acad Orthop Surg. 1999;7(2):128–41.CrossRefPubMed

Tissingh EK, Johnson A, Queally JM, Carrothers AD. Fix and replace: an emerging paradigm for treating acetabular fractures in older patients. World J Orthopedics. 2017;8(3):218.CrossRef

Ferguson T, Patel R, Bhandari M, Matta J. Fractures of the acetabulum in patients aged 60 years and older: an epidemiological and radiological study. J Bone Joint Surg Br Volume. 2010;92(2):250–7.CrossRef

Judet R, Judet J, Letournel E. Fractures of the acetabulum: classification and surgical approaches for open reduction. Preliminary report. J Bone Joint Surg Am. 1964;46:1615–46.CrossRefPubMed

Letournel E. Acetabulum fractures: classification and management. Orthopedic Trauma Directions. 2007;5(05):27–33.CrossRef

Urist R. Fractures of the acetabulum: the nature of the traumatic lesions, treatment and two-year end-results. Ann Surg. 1948;127(6):1150–64.CrossRefPubMedPubMedCentral

Okelberry A, editor. Fractures of the floor of the acetabulum. Journal of Bone and Joint Surgery-American Volume; 1956: Journal Bone Joint Surgery Inc 20 Pickering ST, Needham, MA 02192

Tannast M, Najibi S, Matta JM. Two to twenty-year survivorship of the hip in 810 patients with operatively treated acetabular fractures. JBJS. 2012;94(17):1559–67.CrossRef

Rowe CR, Lowell JD. Prognosis of fractures of the acetabulum. JBJS. 1961;43(1):30–92.CrossRef

10.

Bombelli R. Osteoarthritis of the hip: pathogenesis and consequent therapy. Springer Science & Business Media; 2012.

11.

Day W, Swanson S, Freeman M. Contact pressures in the loaded human cadaver hip. J Bone Jt Surg Br Volume. 1975;57(3):302–13.CrossRef

12.

Matta J. Fractures of the acetabulum: accuracy of reduction and clinical results of fractures operated within three weeks after the injury. J J Boe Joint Surg. 1996;78:1632–45.CrossRef

13.

Matta JM, Merritt PO. Displaced acetabular fractures. Clin Orthop Relat Res. 1988;230:83–97.CrossRef

14.

Briffa N, Pearce R, Hill A, Bircher M. Outcomes of acetabular fracture fixation with ten years’ follow-up. J Bone Jt Surg Br volume. 2011;93(2):229–36.CrossRef

15.

Hanschen M, Pesch S, Huber-Wagner S, Biberthaler P. Management of acetabular fractures in the geriatric patient. SICOT J. 2017;3:37. https://doi.org/10.1051/sicotj/2017026.CrossRefPubMedPubMedCentral

16.

Keller JM, Sciadini MF, Sinclair E, O’Toole RV. Geriatric trauma: demographics, injuries, and mortality. J Orthop Trauma. 2012;26(9):e161–5.CrossRefPubMed

17.

Fölsch C, Alwani M, Jurow V, Stiletto R. Surgical treatment of acetabulum fractures in the elderly. Osteosynthesis or endoprosthesis Der Unfallchirurg. 2015;118(2):146–54.PubMed

18.

Khoshbin A, Hoit G, Henry PDG, Paterson JM, Huang A, Atrey A, et al. Risk of total hip arthroplasty after acetabular fracture fixation: the importance of age. J Arthroplasty. 2021;36(9):3194–9. https://doi.org/10.1016/j.arth.2021.04.025 (e1).CrossRefPubMed

19.

Navarre P, Gabbe BJ, Griffin XL, Russ MK, Bucknill AT, Edwards E, et al. Outcomes following operatively managed acetabular fractures in patients aged 60 years and older. Bone Joint J. 2020;102-B(12):1735–42. https://doi.org/10.1302/0301-620X.102B12.BJJ-2020-0728.R1.CrossRefPubMed

20.

Weaver MJ, Smith RM, Lhowe DW, Vrahas MS. Does total hip arthroplasty reduce the risk of secondary surgery following the treatment of displaced acetabular fractures in the elderly compared to open reduction internal fixation? A pilot study. J Orthop Trauma. 2018;32:S40–5.CrossRefPubMed

21.

Rollmann MF, Holstein JH, Pohlemann T, Herath SC, Histing T, Braun BJ, et al. Predictors for secondary hip osteoarthritis after acetabular fractures-a pelvic registry study. Int Orthop. 2019;43(9):2167–73. https://doi.org/10.1007/s00264-018-4169-3.CrossRefPubMed

22.

Chen MJ, Wadhwa H, Bellino MJ. Sequential ilioinguinal or anterior intrapelvic approach with anterior approach to the hip during combined internal fixation and total hip arthroplasty for acetabular fractures. Eur J Orthop Surg Traumatol. 2021;31(4):635–41. https://doi.org/10.1007/s00590-020-02810-3.CrossRefPubMed

23.

Manson TT, Slobogean GP, Nascone JW, Sciadini MF, LeBrun CT, Boulton CL, et al. Open reduction and internal fixation alone versus open reduction and internal fixation plus total hip arthroplasty for displaced acetabular fractures in patients older than 60 years: a prospective clinical trial. Injury. 2022;53(2):523–8. https://doi.org/10.1016/j.injury.2021.09.048.CrossRefPubMed

24.

Borg T, Hernefalk B, Hailer NP. Acute total hip arthroplasty combined with internal fixation for displaced acetabular fractures in the elderly: a short-term comparison with internal fixation alone after a minimum of two years. Bone Jt J. 2019;101(4):478–83.CrossRef

25.

Nicol GM, Sanders EB, Kim PR, Beaulé PE, Gofton WT, Grammatopoulos G. Outcomes of total hip arthroplasty after acetabular open reduction and internal fixation in the elderly-acute vs delayed total hip arthroplasty. J Arthroplasty. 2021;36(2):605–11. https://doi.org/10.1016/j.arth.2020.08.022.CrossRefPubMed

Title: Operative management of acetabular fractures in the elderly: a case series
Authors: Michalis Panteli
Panayiotis Souroullas
Sushmith R. Gowda
James S. H. Vun
Anthony J. Howard
Nikolaos K. Kanakaris
Peter V. Giannoudis
Publication date: 19-10-2022
Publisher: Springer Berlin Heidelberg
Keywords: Hip Dislocation
Acetabular Fracture
Hip-TEP
Hip-TEP
Published in: European Journal of Trauma and Emergency Surgery / Issue 2/2023
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-022-02129-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Operative management of acetabular fractures in the elderly: a case series

Abstract

Background

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Level of evidence

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