Geriatric Acetabular Surgery: Letournel's Contraindications Then and Now—Data From the German Pelvic Registry

Abstract

Objective: In his original series of 129 surgically treated acetabular fractures, Letournel did not operate on patients older than 60 years. Almost 30 years later, he still emphasized that no patients with reduced bone quality should be operated on. The aim of the study was to analyze epidemiologic characteristics and treatment modes for today's cohort of elderly patients with acetabular fractures. Design: Retrospective analysis. Setting: Multicenter registry/Level I trauma center. Patients: Three thousand seven hundred ninety-three patients who had sustained a fracture of the acetabulum. Intervention: Operative and nonoperative treatment of acetabular fractures. Main Outcome Measurements: Epidemiologic characteristics, treatment mode, in-hospital mortality, rate of secondary hip arthroplasty, and quality of life indicated by EQ-5D score. Results: For the multicenter registry, more than 50% of all patients with acetabular fractures had an age of 60 years or over. The age peak was found at 75–80 years. Fifty percent of the elderly patients were treated surgically. The in-hospital mortality was significantly higher in elderly patients than patients younger than 60 years. In our Level I trauma center, surgical treatment by open reduction and internal fixation did not influence in-hospital mortality or quality of life of elderly patients with acetabular fractures. Conclusions: Today, elderly persons represent the dominant cohort among patients with fractures of the acetabulum. Fifty-five years after the publication of Letournel's original case series, data indicate that currently, surgical treatment is a common and necessary option in the therapy of acetabular fractures in elderly patients. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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

“…Data from German pelvic registry has shown that elderly patients with acetabulum fractures were significantly more likely to get conservative treatment as compared to their younger counterparts. 2 They did not see a significant difference in distribution of fracture types in patients treated nonoperatively compared to those treated operatively. Ernstberger et al 30 found that patients receiving nonoperative treatment were significantly older than patients treated with surgery.…”

“…Similar outcomes have been reported by several authors for operative as well nonoperative treatment of these fractures, particularly in anterior fracture patterns. Herath et al 2 did not find any significant difference in quality of life score (EQ-5D) between the operatively and nonoperatively treated subgroups. Majority of them (41%) had poor reduction according to Matta et al 37 at one year.…”

“…Elderly patients had a higher incidence of involvement of anterior column and quadrilateral plate, and impaction of the articular surface. 2,20 In younger patients, posterior wall fracture was the most common fracture pattern seen, followed by transverse with posterior wall, and T-type fractures. 21,22 Ferguson et al 1 found that anterior column fracture, and anterior column with posterior hemitransverse fracture were more common among the geriatric patients as compared to the younger patients, and transverse with posterior wall fracture pattern was more common among the younger patients.…”

“…Acetabulum fractures were initially discussed in context to high energy trauma in adults, but are now becoming increasingly common with low impact injuries in elderly. 1,2 They behave differently in elderly as compared to younger patients. 1,3 The number of elderly patients is rising across the globe.…”

Deep Learning in the Detection of Rare Fractures – Development of a “Deep Learning Convolutional Network” Model for Detecting Acetabular Fractures

“…Beckenfrakturen sind mit einem Anteil von etwa 3-8% aller Frakturen selten. Die Daten aus dem deutschen Beckenregister zeigen allerdings in den letzten Jahren eine Zunahme der Beckenringund Azetabulumfrakturen, insbesondere bei älteren Patienten [1,2]. Dieser Trend zeichnet sich auch international ab [3].…”