Top

International Orthopaedics

Published in:

01-06-2015 | Original Paper

Acetabular fractures in elderly patients: a comparative study of low-energy versus high-energy injuries

Authors: Ji Wan Kim, Benoit Herbert, Jiandong Hao, William Min, Bruce H. Ziran, Cyril Mauffrey

Published in: International Orthopaedics | Issue 6/2015

Abstract

Purpose

The goal of this study is to compare the characteristics, clinical course, and mortality rates of acetabular fractures in the elderly population with respect to two types of injury.

Methods

We reviewed 183 consecutive patients with acetabular fractures aged 60 years old and older. One hundred eighty-three patients (129 men and 54 women) were included in the study with an average age of 70.2 years. There were 186 fractures, which included three cases of bilateral fractures. Patients were divided into two groups: low-energy injuries (group I), 56, and high-energy injuries (group II), 130. Patient characteristics and fracture pattern, as well as in-hospital mortality rates were compared between the low-energy and high-energy groups.

Results

Patient demographics and comorbidities were significantly different between the groups. In group I, the average age was 74.9 years, versus 68.2 years in group II (p < 0.001). The percent of females in each group was 39.3 % and 24.6 %, respectively (p = 0.043), and the average body mass index (BMI) was 25.6 and 28.4, respectively (p = 0.001). The Charlson comorbidity index was higher in group I (1.98 vs 0.95 in group II, p < 0.001). However, the American Society of Anesthesiologists physical status (ASA) was similar between groups (2.56 vs 2.53, respectively, p = 0.808). The proportion of surgical treatment was 44.6 % in group I and 61.6 % in group II (p = 0.019). Group II had a longer hospital stay (10.4 days vs 14.5 days, p = 0.025), but in-hospital death was not significantly different (5.3 % vs 7.9 %, respectively, p = 0.567).

Conclusion

Patients with acetabular fractures resulting from low-energy injuries were older and had lower BMI with more comorbidities. This study may highlight characteristics of fragility fractures of the acetabulum.

Mears DC (1999) Surgical treatment of acetabular fractures in elderly patients with osteoporotic bone. J Am Acad Orthop Surg 7(2):128–141PubMed

WHO (1998) Guidelines for preclinical evaluation and clinical trials in osteoporosis. World Health Organization, Geneva

Dell R, Greene D, Schelkun SR, Williams K (2008) Osteoporosis disease management: the role of the orthopaedic surgeon. J Bone Joint Surg Am 90(Suppl 4):188–194. doi:10.2106/JBJS.H.00628 PubMedCrossRef

Lin JT, Lane JM (2004) Osteoporosis: a review. Clin Orthop Relat Res 425:126–134PubMedCrossRef

Rowe SM, Yoon TR, Ryang DH (1993) An epidemiological study of hip fracture in Honam, Korea. Int Orthop 17(3):139–143PubMed

Carretta E, Bochicchio V, Rucci P, Fabbri G, Laus M, Fantini MP (2011) Hip fracture: effectiveness of early surgery to prevent 30-day mortality. Int Orthop 35(3):419–424. doi:10.1007/s00264-010-1004-x PubMedCentralPubMedCrossRef

Khan MA, Hossain FS, Ahmed I, Muthukumar N, Mohsen A (2013) Predictors of early mortality after hip fracture surgery. Int Orthop 37(11):2119–2124. doi:10.1007/s00264-013-2068-1 PubMedCentralPubMedCrossRef

Saracen A, Kotwica Z (2014) Treatment of multiple osteoporotic vertebral compression fractures by percutaneous cement augmentation. Int Orthop 38(11):2309–2312. doi:10.1007/s00264-014-2470-3 PubMedCrossRef

Rosa MA, Maccauro G, D’Arienzo M (1999) Bilateral acetabular fracture without trauma. Int Orthop 23(2):120–121PubMedCentralPubMedCrossRef

10.

Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47(11):1245–1251PubMedCrossRef

11.

American Society of Anesthesiologists. ASA Physical Status Classification System. Available at: http://asahq.org/resources/clinical-information/asa-physical-status-classification-system

12.

Letournel E (1980) Acetabulum fractures: classification and management. Clin Orthop Relat Res 151:81–106PubMed

13.

Bergstrom U, Bjornstig U, Stenlund H, Jonsson H, Svensson O (2008) Fracture mechanisms and fracture pattern in men and women aged 50 years and older: a study of a 12-year population-based injury register, Umea, Sweden. Osteoporos Int 19(9):1267–1273. doi:10.1007/s00198-007-0549-z PubMedCrossRef

14.

Chuang-Stein C, Tong DM (1995) Multiple comparisons procedures for comparing several treatments with a control based on binary data. Stat Med 14(23):2509–2522PubMedCrossRef

15.

Ferguson TA, Patel R, Bhandari M, Matta JM (2010) Fractures of the acetabulum in patients aged 60 years and older: an epidemiological and radiological study. J Bone Joint Surg Br 92(2):250–257. doi:10.1302/0301-620X.92B2.22488 PubMedCrossRef

16.

Vanderschot P (2007) Treatment options of pelvic and acetabular fractures in patients with osteoporotic bone. Injury 38(4):497–508. doi:10.1016/j.injury.2007.01.021 PubMedCrossRef

17.

Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E (2008) FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19(4):385–397. doi:10.1007/s00198-007-0543-5 PubMedCentralPubMedCrossRef

18.

Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB (2009) Incidence and mortality of hip fractures in the United States. JAMA 302(14):1573–1579. doi:10.1001/jama.2009.1462 PubMedCentralPubMedCrossRef

19.

Katz JN, Chang LC, Sangha O, Fossel AH, Bates DW (1996) Can comorbidity be measured by questionnaire rather than medical record review? Med Care 34(1):73–84PubMedCrossRef

20.

Poses RM, McClish DK, Smith WR, Bekes C, Scott WE (1996) Prediction of survival of critically ill patients by admission comorbidity. J Clin Epidemiol 49(7):743–747PubMedCrossRef

21.

Belmont PJ Jr, Garcia EJ, Romano D, Bader JO, Nelson KJ, Schoenfeld AJ (2014) Risk factors for complications and in-hospital mortality following hip fractures: a study using the National Trauma Data Bank. Arch Orthop Trauma Surg 134(5):597–604. doi:10.1007/s00402-014-1959-y PubMedCrossRef

22.

Frost SA, Nguyen ND, Black DA, Eisman JA, Nguyen TV (2011) Risk factors for in-hospital post-hip fracture mortality. Bone 49(3):553–558. doi:10.1016/j.bone.2011.06.002 PubMedCrossRef

23.

Bible JE, Wegner A, McClure JM, Kadakia RJ, Richards JE, Bauer JM, Mir HR (2013) One-year mortality after acetabular fractures in elderly patients presenting to a level-one trauma center. J Orthop Trauma 28(3):154-159. doi:10.1097/BOT.0b013e31829e801b CrossRef

24.

Ferguson TA, Patel R, Bhandari M, Matta JM (2010) Fractures of the acetabulum in patients aged 60 years and older: an epidemiological and radiological study. J Bone Joint Surg (Br) 92(2):250–257. doi:10.1302/0301-620X.92B2.22488 CrossRef

25.

Culemann U, Holstein JH, Kohler D, Tzioupis CC, Pizanis A, Tosounidis G, Burkhardt M, Pohlemann T (2010) Different stabilisation techniques for typical acetabular fractures in the elderly—a biomechanical assessment. Injury 41(4):405–410. doi:10.1016/j.injury.2009.12.001 PubMedCrossRef

Title: Acetabular fractures in elderly patients: a comparative study of low-energy versus high-energy injuries
Authors: Ji Wan Kim
Benoit Herbert
Jiandong Hao
William Min
Bruce H. Ziran
Cyril Mauffrey
Publication date: 01-06-2015
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 6/2015
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-015-2711-0

At a glance: The STEP trials

Springer Medicine

Acetabular fractures in elderly patients: a comparative study of low-energy versus high-energy injuries

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2015

History of femoral head fracture and coronal fracture of the femoral condyles

Unstable hip arthroplasties. A prospective cohort study on seventy dislocating hips followed up for four years

Does balloon kyphoplasty improve the global spinal alignment in osteoporotic vertebral fracture?

Minimum five-year wear rate of metal-on-highly cross-linked polyethylene in primary total hip arthroplasty

A review of forty five open tibial fractures covered with free flaps. Analysis of complications, microbiology and prognostic factors

A prospective randomized comparison of PEEK cage containing calcium sulphate or demineralized bone matrix with autograft in anterior cervical interbody fusion