Acetabulum fractures in elderly: A systematic review of fracture pattern and treatment

Abstract

Acetabulum fractures are being increasingly seen with low impact injuries in elderly patients. This article aimed to study systematically literature on geriatric acetabulum fractures. Objectives of this systematic review were to study (1) demography of patients, common mechanisms of injury and types of fracture patterns commonly seen in elderly patients, (2) treatment used for these fractures in literature and (3) mortality rates in elderly with these fractures. Methods: Systematic search was carried out in May 2020 using predefined search strategy for all studies published in the English language in last 20 years. Literature search and data abstraction was done by two independent reviewers. Results: After screening of all abstracts, a total of 48 studies were included in the systematic review. In total there were 7876 geriatric patients with acetabulum fractures. Mean age of the patients was 72.47 years. There were 4841 males (61.5%). Fall from low heights was the most common mechanism of injury, present in 47.12% patients followed by motor vehicular accidents in 28.73%. Most common fracture pattern was both column fracture, seen in 19.03% patients, followed by anterior column and posterior hemitransverse fracture in 17.23%, anterior column fractures in 17.13%, and posterior wall fractures in 13.46% patients. Out of total 5160 patients for whom details of treatment were available, 2199 (42.62%) were given non-operative treatment, 2285 (44.28%) were treated with ORIF of acetabulum fracture, 161 (3.12%) were treated with percutaneous fixation and 515 (9.98%) were treated with primary THA. Gull sign, femoral head injury and posterior wall comminution were associated with poorer prognosis after ORIF and may form an indication for a primary THA. Conclusion: Literature on treatment of geriatric acetabulum fractures is not enough to draw any definite conclusions. There is limited evidence from current literature that surgery could be considered a safe treatment option for displaced acetabulum fractures in elderly. Primary THA can provide early mobility and reduce chances of resurgery in fracture patterns where restoration of joint surface may not be possible.

Pubic root fractures are commonly misread as anterior column fractures by radiologists: Single-institution study from a level 1 trauma center

“…When displaced, they usually require operative intervention to maintain joint stability and prevent the development of post-traumatic arthritis. 8 The management of these anterior column fractures should ideally be undertaken by an appropriately qualified orthopaedic trauma surgeon and requires the advanced resources of a trauma center. Treatment of such patients with severe acetabular fractures at a level 1 trauma center has been shown to result in decreased mortality rate and improved physical function at one year compared to those treated at level II trauma or non-trauma centers.…”

“…7 Acetabular fractures involving the anterior column are one of the most common types of acetabular fractures sustained by the elderly and the high superior pubic ramus fracturedalso known as the pubic root fracturedcan be misread as anterior column fracture by the radiologists. 8 This can result in unnecessary health care costs because a patient with a stable pubic root fracture who may be safely managed at a community hospital may be transferred to a Level 1 trauma center due to a radiology report incorrectly identifying the fracture as an "anterior column fracture". 9,10 Thus, correctly distinguishing the stable pelvic ring injury, from an anterior column fracture may not only reduce health care costs but also provide a more accurate prognosis for the patient.…”

Team Approach: Management of Geriatric Acetabular Fractures

“…This type of fixation is most suited for patients who have nondisplaced or minimally displaced fractures that are at risk for displacement, or those who cannot walk because of pain. Studies have shown that the benefits of CRPF include decreased blood loss, shorter operative time, shorter length of stay, and fewer medical complications compared with patients who undergo ORIF 51 . Despite these benefits, there are limitations to a percutaneous approach.…”

Biomechanical comparison of acetabular fracture fixation with stand-alone THA or in combination with plating

“…In addition, preexisting osteoarthritis of the hip is often observed in older patients. Recent literature specified the most common fracture patterns with both column fractures (19%), followed by anterior column and posterior hemi-transverse fractures (17%) and anterior column fractures (17%) according to the Letournel classification [ 3 , 4 ].…”