Influence of age on results following surgery for displaced acetabular fractures in the elderly

Abstract

BackgroundElderly patients have more special medical needs when compared with young ones; thus, the results of open reduction and internal fixation (ORIF) for acetabular fractures should be stratified by age in these patients. This study seeks to determine whether the age of the patient influences the results of the ORIF for acetabular fractures.MethodsWe performed a retrospective analysis of prospectively collected data on 53 elderly patients with displaced acetabular fractures who underwent ORIF between May 2004 and May 2011. Patients were divided into two groups by age: young–old group (60–74 years) and old–old group (75–90 years). The number of patients in each group was 28 and 25. The reduction quality and clinical function was evaluated using the Matta criteria and modified Postel Merle D’Aubigne Score, respectively. Operative time, bleeding amount, and complications were recorded.ResultsPatients in old–old group had significantly lower anatomical reduction rate (p = 0.024), less operative time (p = 0.021), and less bleeding amount (p = 0.016) than those in the young–old group. The reduction quality in the young–old group was strongly associated with clinical function (p < 0.05). However, no difference in clinical function was detected among the different reduction qualities in the old–old group (p > 0.05). Moreover, no significant difference in clinical functions (p = 0.787) and complications (p = 0.728) was detected between the two groups.ConclusionsOld–old patients may expect comparable clinical functions and complications with young–old patients. The reduction quality in old–old patients may be not significantly associated with clinical function. Different treatment strategies may be applied for acetabular fractures with ORIF in different age groups.Electronic supplementary materialThe online version of this article (10.1186/s12891-017-1817-5) contains supplementary material, which is available to authorized users.

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

“…12 Irrespective of the age, rate of conversion to secondary THA after ORIF was 19.8%. 13 This was comparable to the rates found in different studies in this review. Fragility fractures of hip and spine have been found to be associated with increased one-year mortality.…”

“…About three-fourth of secondary hip replacements were necessary within the first 12 months after the fracture. 2 Zha et al 13 divided 62 patients above 60 years undergoing surgery for acetabulum fractures into two groups: youngeold group (60e74 years) and oldeold group (75e90 years). Accurate reduction was attempted for the former and a limited operative procedure was used for the latter.…”

“…Several radiological findings have been associated with poorer clinical outcomes. Zha et al 13 found that Gull sign, femoral head injury (wear, abrasions, or defects in the articular cartilage) and posterior wall comminution (more than three separate fragments of the posterior wall) were associated with poor quality of reduction and poorer outcomes. Posterior wall comminution was also associated with early loss of reduction and failure of fixation.…”

Single Ilioinguinal Approach to Treat Complex Acetabular Fractures with Quadrilateral Plate Involvement: Outcomes Using a Novel Dynamic Anterior Plate–Screw System

“…Other scholars have applied the technology of buttress plate, such as the T‐shaped plate, the L‐shaped plate, the butterfly plate, the omega plate, or the one‐third tubular plate to fix quadrilateral fracture. Subsequently, several scholars have reported a successful experience when using a buttress plate for osteopenic acetabular fractures involving the quadrilateral plate. However, taking the T‐shaped, L‐shaped, and one‐third tubular plates as examples, these plates can be difficult to accurately contour to provide adequate medial buttress for all individuals, because of the single fulcrum, limited fixation range, and the weak effect in correcting fracture separation.…”