Epidemiology and treatment of acetabular fractures in a level-1 trauma centre: Retrospective study of 414 patients over 10 years

Boudissa, Mehdi; Francony, Florent; Kerschbaumer, Gaël; Ruatti, Sébastien; Milaire, Michel; Merloz, P.; Tonetti, Jérôme

doi:10.1016/j.otsr.2017.01.004

Cited by 74 publications

(42 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…3 These findings necessitate the need to learn about acetabular fractures among elderly patients to adequately meet their medical demands in the coming decades. 4-8…”

Section: Introductionmentioning

confidence: 99%

A Survey of High- and Low-Energy Acetabular Fractures in Elderly Patients

Dyskin

Hill

Torchia

et al. 2019

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

Introduction: Geriatric patients represent 14% of acetabular fractures and are the fastest growing subset of patients affected by this injury in the US. Treatment outcomes have been reported as inferior to those achieved in younger patients after high-energy (HE) acetabular trauma. This study aimed to compare detailed demographic characteristics and clinical outcomes in elderly patients (≥65 years of age) treated in a tertiary North American trauma center for acetabular fractures after both high- and low-energy mechanisms of injury. Methods: Patients (≥65 years of age) diagnosed with an acetabular fracture were identified over a 7-year period. Patient and injury characteristics were extracted from our institutional trauma database. Length of stay, intervention, operative details, disposition, complications, readmissions, and mortality were analyzed. Results: One hundred nine patients were identified for inclusion. Low-energy mechanisms (simple falls) were found in 64 (58.7%) and HE mechanisms in 45 (41.3%) patients. The HE cohort was younger (74.6 vs 80.7 years; P < .001), had a higher male predominance (76% vs 56%; P = .10), a lower Charlson comorbidity index (1.29 ± 1.49 vs 2.16 ± 1.76; P = .01), and a higher injury severity score (19.90 ± 15.33 vs 6.46 ± 3.57; P < .001). Fracture patterns, described according to the Letournel-Judet classification, were similar between the 2 groups. Thirty-day mortality was significantly higher in the HE group (26.7% vs 3.1%; P < .001); however, the 1-year mortality rates were not statistically different (31.1% vs 25.0%; P = .20). Discussion: Patients with acetabular fractures sustained due to HE accidents demonstrate significantly higher 30-day mortality rate than patients with low-energy fractures, but similar mortality 1 year after the injury, despite having a much lower mean age and fewer comorbidities. Conclusion: Medical efforts made during initial hospital admission may have the biggest impact on survivorship following acetabular fracture.

show abstract

“…3 These findings necessitate the need to learn about acetabular fractures among elderly patients to adequately meet their medical demands in the coming decades. 4-8…”

Section: Introductionmentioning

confidence: 99%

A Survey of High- and Low-Energy Acetabular Fractures in Elderly Patients

Dyskin

Hill

Torchia

et al. 2019

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

show abstract

“…Older adults who present with concentric fractures of the acetabulum that are stable with mobilization and those medically unfit are managed nonoperatively. 19 If the patient is not fully resuscitated for surgery and cannot be made stable surgery should be delayed or the patient should be managed nonoperatively. The decision to operate varies both hospital-to-hospital and by surgeons within the health system.…”

Section: Discussionmentioning

confidence: 99%

High- Versus Low-Energy Acetabular Fracture Outcomes in the Geriatric Population

Cecil

Rodríguez

et al. 2020

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

Introduction: High-energy mechanisms of acetabular fracture in the geriatric population are becoming increasingly common as older adults remain active later in life. This study compared outcomes for high- versus low-energy acetabular fractures in older adults. Materials and Methods: We studied outcomes of 22 older adults with acetabular fracture who were treated at a level-I trauma center over a 4-year period. Fourteen patients were categorized as low-energy mechanism of injury, and 8 were identified as a high-energy mechanism. We analyzed patient demographics with univariate logistic regressions performed to assess differences in high- and low-energy group as well as patient characteristics compared with surgical outcomes. Results: Most high-energy mechanisms were caused by motor vehicle collision (n = 4, 50.0%), with most having posterior wall fractures (50.0%). Among patient characteristics, the mechanism of injury, hip dislocation, fracture types, and fracture gap had the largest differences between energy groups effect size (ES: 2.45, 1.43, 1.36, and 0.83, respectively). The high-energy group was more likely to require surgery (odds ratio [OR] = 2.80, 95% CI: 0.26-30.70), develop heterotopic bone (OR = 4.33, 95% CI: 0.33-57.65), develop arthritis (OR = 3.60, 95% CI: 0.45-28.56), and had longer time to surgery (mean = 4.8 days, standard deviation [SD] = 5.8 days) compared to low-energy group (mean = 2.5 days, SD = 2.3 days). Discussion: The results of this case series confirm previous findings that patients with high-energy acetabular fractures are predominantly male, younger, and have fewer comorbidities than those who sustained low-energy fractures. Our results demonstrate that the majority of the high-energy fracture patients also suffered a concurrent hip dislocation with posterior wall fracture and experienced a longer time to surgery than the low-energy group. Conclusion: Geriatric patients who sustained high-energy acetabular fractures tend to have higher overall rates of complications, including infection, traumatic arthritis, and heterotopic bone formation when compared with patients with a low-energy fracture mechanism.

show abstract

“…Acetabular fractures often result from injuries of high-energy trauma, but 25% of fractures are also attributed to low-energy trauma like our current patient [11]. They are more common among elderly people; hence, bone vulnerability must be considered for treatment as per age [12, 13].…”

Section: Discussionmentioning

confidence: 99%

“…Total hip replacement surgery is indicated if reconstruction of the acetabular surface is difficult. Boudissa et al reported that the mortality rate and perioperative infection rate were significantly higher in the total hip replacement group than in the ORIF group [11].…”

Section: Discussionmentioning

confidence: 99%

Surgical Repair of Acetabular Fracture Using Unidirectional Porous β-Tricalcium Phosphate

Kumagai

Iwasashi

Funayama

et al. 2019

Case Reports in Orthopedics

View full text Add to dashboard Cite

We report a case of an acetabular fracture treated using a unidirectional porous β-tricalcium phosphate artificial bone (Affinos®) to surgically repair bone defects. An 82-year-old man sustained an acetabular fracture on the left side and presented with shock on arrival along with impaired vital signs and systolic blood pressure. Upon stabilization, we performed an open reduction and internal fixation. However, there were significant bone defects, which were then fixed using Affinos® (both blocks and granules), an artificial β-tricalcium phosphate bone with a porosity of 57% (pore size: 25–300 μm), characterized by a novel unidirectional porous structure. By 18 months postoperatively, the patient was able to perform stair climbing and absorption and bone fusion around the artificial bone were observed. Affinos® has a frost-like structure, which endows it with good tissue-invasive properties because of the capillary effect. Moreover, it has excellent osteoconduction capability. In this case, both Affinos® blocks and granules showed good affinity, absorption, and bone substitution. Further prospective studies are required to confirm our findings.

show abstract

Epidemiology and treatment of acetabular fractures in a level-1 trauma centre: Retrospective study of 414 patients over 10 years

Abstract: Level IV, retrospective study.

Cited by 74 publications

References 12 publications

A Survey of High- and Low-Energy Acetabular Fractures in Elderly Patients

A Survey of High- and Low-Energy Acetabular Fractures in Elderly Patients

High- Versus Low-Energy Acetabular Fracture Outcomes in the Geriatric Population

Surgical Repair of Acetabular Fracture Using Unidirectional Porous β-Tricalcium Phosphate

Contact Info

Product

Resources

About