Fix and replace: An emerging paradigm for treating acetabular fractures in older patients

Tissingh, Elizabeth K; Johnson, Andrew; Queally, Joseph M.; Carrothers, Andrew

doi:10.5312/wjo.v8.i3.218

Cited by 10 publications

(14 citation statements)

References 12 publications

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“…The annual incidence of acetabular fractures is estimated at 2000 per year in the United Kingdom with 72.5% of these occurring in older patients (patients greater than 65 years of age) 38 These fractures also lead to a major impact on walking ability and are associated with increased morbidity and mortality due to complications associated with bedrest and concomitant medical conditions. 1e5 These fractures are commonly low energy injuries and usually occur after falls from standing height although high energy injuries are also seen from traffic collisions or accidents involving pedestrians.…”

Section: Introductionmentioning

confidence: 99%

Management of acetabular fractures in elderly patients

Shah

Gill

Kempanna

et al. 2020

Journal of Clinical Orthopaedics and Trauma

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Section: Introductionmentioning

confidence: 99%

Management of acetabular fractures in elderly patients

Shah

Gill

Kempanna

et al. 2020

Journal of Clinical Orthopaedics and Trauma

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“…Abnormal contact stress caused by unsatisfactory joint fixation is one of the crucial factors underlying development of post-traumatic arthritis. Because of the risk of arthritis and the high complication rates of surgical fixation, the option of total hip arthroplasty is preferred for acetabular fractures in older patients as an alternative to surgery[10]. CCRPs and PABPs, with or without inter-fragmentary screws, are the most common fixation methods practiced as treatment for posterior acetabular wall fractures.…”

Section: Discussionmentioning

confidence: 99%

Precontoured buttress plate vs reconstruction plate for acetabulum posterior wall fractures: A biomechanical study

Altun

Saka²,

Demir

et al. 2019

WJO

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BACKGROUND The purpose of open reduction and internal fixation of acetabulum posterior wall fractures is to restore anatomical structure and stability of the hip joint, in order to start weight bearing as soon as possible and prevent hip arthrosis; restoration of the anatomy should preserve function of the joint as well. Although “special shaped precontoured plates” have been developed in recent years for surgical treatment of this region, studies comparing the traditional plates with the newly designed precontoured plates are lacking. AIM To evaluate the biomechanical properties of precontoured anatomic buttress and conventional curved reconstruction plates (CCRPs) for posterior wall acetabulum fracture treatment. METHODS Twelve pelvis models were created for testing plate treatment of fracture in the posterior wall of the acetabulum. These 12 pelvis models were used to create 24 hemipelvis models (experimental) by cutting from the sagittal plane and passing over the center of gravity, after which the posterior wall acetabular fractures (of similar type and size) were created. In these experimental models, the right acetabulum was fixed with a 5-hole CCRP, while the left was fixed with a precontoured anatomic buttress plate (PABP). Samples were placed through the test device and were subjected to static load testing, with a constant testing velocity of 2 mm/min until the load reached 2.3 kN or the acetabular fixation failed. Dynamic tests were also performed with sinusoidal wave load, with a maximal load of 2.3 kN and a load ratio of 0.1. RESULTS The average stiffness values were 460.83 ± 95.47 N/mm for the PABP and 291.99 ± 118.58 N/mm for the 5-hole CCRP. The precontoured anatomic acetabulum buttress plates had significantly higher rigidity than the CCRPs ( P = 0.022). There was a statistically significant difference between the unloaded and 2.3 kN-loaded values of AL (posterosuperior fracture line vertical to the ground surface) and CL (posteroinferior fracture line vertical to the ground surface) parameters for both the PABPs and the 5-hole CCRPs ( P = 0.036 and P = 0.045, respectively). According to the static tests, the amount of total displacement was significantly less in the PABPs than in the CCRPs. Comparative analysis of the displacement in the BL (posterior wall fracture line horizontal to the ground) parameter yielded no statistically significant differences between the PABP and the 5-hole CCRPs ( P = 0.261). CONCLUSION PABP provides more stable fixation in acetabulum posterior wall fractures than 5-hole CCRP, allowing for proximal or distal fracture line screw application without reshaping.

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“…9 Nevertheless, nonoperative treatment often leads to inadequate reduction, and operative outcomes, even when improved techniques are used, are still worse than those of younger patients. 3,9,13 -22…”

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

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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.

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Fix and replace: An emerging paradigm for treating acetabular fractures in older patients

Cited by 10 publications

References 12 publications

Management of acetabular fractures in elderly patients

Management of acetabular fractures in elderly patients

Precontoured buttress plate vs reconstruction plate for acetabulum posterior wall fractures: A biomechanical study

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

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