Effect of Surgical Treatment on Mortality After Acetabular Fracture in the Elderly

Gary, Joshua L.; Paryavi, Ebrahim; Gibbons, Steven D.; Weaver, Michael J.; Morgan, Jordan H.; Ryan, Scott P.; Starr, Adam J.; O’Toole, Robert V.

doi:10.1097/bot.0000000000000223

Cited by 78 publications

(50 citation statements)

References 24 publications

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“…We found no differences between the operative and the non-operative group in regards to all-cause 1year-mortality. This finding is consistent with a previous studies that conclude that there is no difference in 1- year mortality between operative and non-operative management, once comorbidities are taken into account [4,10]. Existing literature states 1-year mortality rates of 16 to 35% for non-operative treatment [10,[12][13][14] and of 4 to 21% for operative treatment [10,12,13].…”

Section: Discussionsupporting

confidence: 91%

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Mortality, complications and long-term functional outcome in elderly patients with fragility fractures of the acetabulum

et al. 2020

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Background: Early operative treatment of acetabulum fractures in geriatric patients has been suggested to reduce pain and allow for earlier mobilization. The aim of this study was to determine mortality, complications and functional outcome after operative and non-operative treatment. Methods: Patients aged ≥60 years with operative treatment of low-energy fragility fracture of the acetabulum from 2009 to 2016 and a follow-up of at least 24 months were identified. The patients were contacted by phone and a modified Merle d'Aubigné score was obtained. If patients or their relatives were not available for follow-up, mortality data was assessed using a national social insurance database. Results: One hundred seventy-six patients (mean age 78, SD 10 years; 73 female) were available for analysis of mortality data. At final follow-up (68 months, SD 26, range, 24 to 129), 99/176 patients (56.3%) had deceased. Oneyear-mortality was 25.0% and 2-year mortality 35.8%. Type of treatment (non-operative vs. operative) did not affect mortality at 1 and 2 years (p = .65 and p = .10). Hospital-acquired infections were observed in 31/176 cases (17.6%), thromboembolic events and delirium in 6 patients (3.4%). In-hospital mortality was 5.7%. Patients who underwent operative treatment were more likely to have an in-hospital infection (p = .02) but less likely to sustain thromboembolic events (p = .03). The mean hospital stay was 14 days (SD 10 days, range, 1 to 66). Patients with operative treatment were longer hospitalized than patients with non-operative treatment (p < .001). The rate of secondary conversions to THA was 12.4%, this was not affected by initial treatment. The mean modified Merle d'Aubigné Score of those patients available for a final follow-up (n = 47; follow-up 56 months, SD 28, range, 24 to 115) was 14/18 points, SD 3 (range 7 to 18). Functional results at final follow-up between operatively and non-operatively treated patients were without difference. Conclusions: All-cause mortality and in-hospital complications are high among geriatric patients with low-energy fractures of the acetabulum even when treated operatively. Secondary conversion rates to THA are similar to those seen in younger patients. Mid-term functional outcome in those surviving is fair.

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Section: Discussionsupporting

confidence: 91%

“…Whereas the main mechanism of injury for younger patients is high-energy-trauma, the majority of acetabular fractures in the elderly are a result of a fall from standing height [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Mortality, complications and long-term functional outcome in elderly patients with fragility fractures of the acetabulum

et al. 2020

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“…This results in a selection bias, with published series of surgically managed elderly acetabular fractures being inherently healthier than those of neck of femur fractures. Gary et al attempted to look at mortality with a retrospective review of cases from 3 level 1 trauma centres, cases being stratified into nonoperative, percutaneous fixation, open reduction and internal fixation, or acute total hip replacement [ 14 ]. Although they found no significant improvement of surgical over nonoperative management (and thus concluded that decisions regarding surgical management of these cases should not be based on concern over the mortality of nonoperative management) their final adjusted mortality by treatment graph shows a clinically important if not statistically significant advantage to immediate hip arthroplasty over all other forms of management.…”

Section: Discussionmentioning

confidence: 99%

Acetabular Fractures in the Elderly: Midterm Outcomes of Column Stabilisation and Primary Arthroplasty

Ortega-Briones

Smith

Rickman

2017

BioMed Research International

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Background. Interest in arthroplasty techniques for periarticular or intra-articular fractures in the elderly/osteoporotic patient continues to rise, including for geriatric acetabular fractures. In line with this, many acetabular fracture surgeons are now undertaking acute total hip arthroplasty in elderly/osteoporotic patients. Little is known however of the outcomes of this procedure, beyond the first year after surgery. Questions/Purposes. We determined the clinical outcomes of a series of elderly osteoporotic patients (mean age at surgery 77.4 years) treated for acetabular fractures with column fixation and simultaneous total hip arthroplasty, at a mean of 49 months after surgery. Methods. 24 patients (25 hips) were reviewed at a mean of 49 months after surgery. The surgical technique employed has previously been described. Radiographs were obtained, and clinical outcomes were assessed using Harris Hip Scores and the Merle d'Aubigné score. Results. 14 hips were available for assessment (9 deceased, 2 lost to follow-up). No patient suffered any complications beyond the perioperative period, no acetabular components were loose clinically or on latest radiographs, and the mean Harris Hip Score was 92. All but one patient scored good or excellent on the Merle d'Aubigné score. Conclusions. Column fixation and simultaneous total hip arthroplasty are a viable option for complex geriatric acetabular fractures, with encouraging midterm results. We conclude that THR is a viable long-term solution in this situation provided that the acetabular columns are stabilised prior to implantation, but more research is needed to aid in overall management decision making.

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“…In young patients, better reduction is associated with a better clinical outcome and a lower rate of secondary osteoarthritis [3,[8][9][10][11][12]. Many studies identified higher age as a negative predictor regarding reduction, mortality and complications, though [1,[13][14][15]. Percutaneous screw fixation of acetabulum fractures has the advantage of less invasive approaches and lower blood loss and, hence, seems to be a potential alternative for geriatric patients [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Minimally displaced acetabulum fractures in geriatric patients: a comparison of open, percutaneous and non-operative treatment from the German Pelvic Injury Register data

Ernstberger

Pieroh

Höch

et al. 2020

Eur J Trauma Emerg Surg

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Purpose In elderly patients with minimally displaced acetabulum fractures, the patients' inability to partially weight-bear and the need for early mobilisation may trigger the decision towards a treatment with higher primary stability. The purpose of this study was to compare open reduction and internal fixation (ORIF), closed reduction and percutaneous fixation (CRPIF) and non-operative treatment in geriatric minimally displaced acetabulum fractures with regard to complications and quality of reduction. Methods Data from the prospective German Pelvic Injury Register collected between 2008 and 2018 were used to evaluate 608 geriatric patients with isolated minimally displaced (≤ 5 mm) acetabulum fractures. In total, 429 received non-operative treatment, 117 ORIF and 62 CRPIF. Demographics, injury severity, fracture pattern, complications and fracture displacement before and after treatment were analysed. Results Both operative methods reduced fracture gap displacement. CRPIF was associated with lower blood loss and shorter operative time compared to ORIF (p < 0.001). Hospital stay was 12.9 days in the non-operative group, 16.8 with CRPIF and 23.6 with ORIF (p < 0.001). Non-surgical general complications were more likely to occur following ORIF (22.2%) compared to CRPIF (8.1%) and non-operative treatment (8.4%, p < 0.001). The rate of surgical complications was not different for ORIF and CRPIF (p = 0.122) Conclusion Both operative treatments improve fracture displacement and joint congruency in elderly patients with minimally displaced acetabulum fractures. Compared to ORIF, CRPIF achieves similar quality of reduction but is associated with fewer complications, smaller intraoperative blood loss, shorter operative time and shorter length of hospital stay.

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Effect of Surgical Treatment on Mortality After Acetabular Fracture in the Elderly

Abstract: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Cited by 78 publications

References 24 publications

Mortality, complications and long-term functional outcome in elderly patients with fragility fractures of the acetabulum

Mortality, complications and long-term functional outcome in elderly patients with fragility fractures of the acetabulum

Acetabular Fractures in the Elderly: Midterm Outcomes of Column Stabilisation and Primary Arthroplasty

Minimally displaced acetabulum fractures in geriatric patients: a comparison of open, percutaneous and non-operative treatment from the German Pelvic Injury Register data

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