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International Orthopaedics

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01-09-2017 | Original Paper

Comparison of open reduction and internal fixation and primary total hip replacement for osteoporotic acetabular fractures: a retrospective clinical study

Authors: Sebastian P. Boelch, Martin C. Jordan, Rainer H. Meffert, Hendrik Jansen

Published in: International Orthopaedics | Issue 9/2017

Abstract

Purpose

Treating acetabular fractures with open reduction and internal fixation (ORIF) may lead to poorer outcomes in older patients. As data for osteoporotic acetabular fractures are limited, we compared primary total hip replacement (THR) with ORIF for treating osteoporotic acetabular fractures, including those with posterior column instability.

Methods

All patients with osteoporotic acetabular fractures, treated with ORIF or primary THR from 2005 to 2015, were assessed retrospectively for clinical and radiologic outcomes. Indication criteria for selecting primary THR were evaluated.

Results

Twenty-three patients were treated with ORIF and nine with primary THR (performed with an anti-protrusion cage). If the posterior column was unstable, THR was combined with posterior column bridge plating. Indications for THR were the presence of a comminuted fracture pattern, approach-related risk factors for ORIF, and mobilization issues. Biomechanical reconstruction was acceptable with THR. Acetabular component loosening was observed only once. Secondary THR was indicated in 45 % of the ORIF cases.

Discussion

ORIF for acetabular fracture in older patients is unsatisfactory and may be even worse for osteoporotic fractures. Immobilization for long-term restricted weight bearing after ORIF is hazardous. Primary THR may enable early post-operative full weight-bearing. Various techniques, affording fixation of the unstable acetabular columns, are described. In THR with an anti-protrusion cage, only dorsal column instability needs to be addressed.

Conclusion

The described technique achieved sufficient acetabular component stability. Primary THR with an anti-protrusion cage is an advantageous option to ORIF and should be strongly considered for osteoporotic acetabular fractures.

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Title: Comparison of open reduction and internal fixation and primary total hip replacement for osteoporotic acetabular fractures: a retrospective clinical study
Authors: Sebastian P. Boelch
Martin C. Jordan
Rainer H. Meffert
Hendrik Jansen
Publication date: 01-09-2017
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 9/2017
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-016-3260-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison of open reduction and internal fixation and primary total hip replacement for osteoporotic acetabular fractures: a retrospective clinical study

Abstract

Purpose

Methods

Results

Discussion

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Discussion

Conclusion

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