Management of Acetabular Fractures in the Elderly

Antell, Nicholas B.; Switzer, Julie A.; Schmidt, Andrew H.

doi:10.5435/jaaos-d-15-00510

Cited by 60 publications

(59 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The 47 patients that had survived until final follow up in the present study showed a fair functional outcome and no difference between operatively and non-operatively treated patients. While there seems to be consensus that good functional outcomes can be achieved by operative treatment of acetabular fractures in the elderly [12,[16][17][18], there is little data available on functional outcome after non-operative treatment. A recent retrospective case series of elderly patients with acetabular fractures that met criteria for surgery found that these patients can have good functional outcome also with non-operative treatment [14].…”

Section: Discussionmentioning

confidence: 99%

“…Secondary conversion rate to THA was 12.4% in the whole cohort and there was no significant difference between the operative and the non-operative group. Secondary conversion rates to THA have been reported to range from 10 to 37% [16] for patients in this age group when treated by open reduction and internal fixation and 15% when treated non-operatively [14]. A recent registry analysis of 678 acetabular fractures among all age groups reported that 19.8% of the patients required secondary THA [19].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2020

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

View full text Add to dashboard Cite

show abstract

“…A combined, multidisciplinary collaboration has been shown to reduce time to surgery, perioperative complications and mortality and overall improved outcomes in these patients. 18 The treatment aim is to shorten the period of immobilization, thereby minimizing adverse events associated with immobility, to restore pre-injury level of function and independence, to achieve pain relief and prevention of long-term pain, and to initiate osteoporotic treatment to prevent future fractures. In managing fragility fractures in our hospital, we adopted a multidisciplinary approach under a standardized protocol involving early co-management with physicians, anaesthetists and fracture liaison nurse.…”

Section: Discussionmentioning

confidence: 99%

“…16,17 There is increasing interest in minimally invasive techniques due to reduced soft tissue disruption and reduced blood loss. 18 Computer-assisted fluoroscopy-navigated percutaneous screw fixation (minimally invasive) techniques, in particular, have been advocated for its accuracy and versatility in traumatic pelvic fractures. 16,17,[19][20][21] In a meta-analysis, computed tomography (CT)-guided navigation was associated with the lowest rate of screw malposition.…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional-guided navigation percutaneous screw fixation of fragility fractures of the pelvis

Wong

Lau

Chui

et al. 2019

J Orthop Surg (Hong Kong)

View full text Add to dashboard Cite

Background: Three-dimensional (3D)-guided navigation percutaneous screw fixation of pelvi-acetabular fractures has been reported in patients with high-energy trauma. Its use in fragility fractures of the pelvis is expanding and its results are promising. Methods: We report a series of 17 consecutive patients with fragility fractures of the pelvis treated with 3D-guided navigation percutaneous screw fixation from 2016 to 2017. Percutaneous screw trajectories were planned preoperatively for the majority of patients. Closed reduction was performed prior to fixation in grossly displaced fractures. Results: The mean time to surgery was 8.6 + 2.4 days, and the mean intraoperative blood loss was 94.1 + 26.6 mL. One early surgical complication occurred involving an infected pelvic external fixator iliac pin track site, and there were no cases of neurological deficits after fixation. In total, 7 of the 14 patients had screw backout, and the mean backout distance was 8.3 + 4.4 mm. Cortical perforation was seen in one patient involving an anterior column screw by 5.7 mm; 14 patients were followed up for a mean of 18.7 + 2.8 months; 13 patients achieved complete fracture union, and 1 patient had a fracture non-union. Premorbid ambulatory function was restored in 8 of the 14 patients. The mean visual analogue scale for pain severity at follow-up was 0.36 + 0.50. There were no cases of 30-day and 1-year mortality. Conclusion: 3D-guided navigation percutaneous screw fixation is a safe, precise, and effective surgical technique for managing fragility fractures of the pelvis.

show abstract

“…As the worldwide population ages and the elderly remain active later in life, the incidence of acetabular fractures among patients >60 years of age has increased by 2 to 3 times over the past 3 decades 1 - 3 . The anterior column-posterior hemitransverse fracture pattern, the classic acetabular fracture in the geriatric population, is often associated with protrusion of the femoral head and medial migration of the quadrilateral surface (QLS) 4 - 6 .…”

mentioning

confidence: 99%

Biomechanical Comparison of Different Fixation Techniques for Typical Acetabular Fractures in the Elderly

Chen

Yang

Yao

et al. 2020

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

Background: Anterior column-posterior hemitransverse fractures are prevalent in the elderly and are often associated with quadrilateral surface (QLS) comminution. Several special QLS buttress plates have been introduced, but evidence of their comparability with traditional fixation devices is lacking. This biomechanical study aimed to compare special QLS buttress plates with traditional fixation devices. Methods: Anterior column-posterior hemitransverse fractures with an isolated QLS fragment were created on 24 composite hemipelves and were allocated to 4 fixation groups: (1) infrapectineal QLS buttress plate, (2) suprapectineal QLS buttress plate, (3) suprapectineal reconstruction plate with 3 periarticular long screws, and (4) infrapectineal reconstruction plate with 3 periarticular long screws. Specimens were loaded to simulate partial weight-bearing (35 to 350 N) or full weight-bearing (75 to 750 N). A testing machine was synchronized with a 3-dimensional video tracking system to optically track displacement at the points of interest and to calculate construct stiffness. The fixation systems were compared using the Kruskal-Wallis and Mann-Whitney U tests. Results: The experimental results of the partial and full weight-bearing simulations were surprisingly similar. During 40 loading cycles, the maximum displacement on the 6 predetermined points did not exceed 1.1 mm. Multiple-group comparisons of relative displacements of each predetermined measurement point did not differ significantly (p > 0.05). The suprapectineal reconstruction plate with 3 periarticular long screws demonstrated the greatest construct stiffness and significantly greater stiffness than the infrapectineal plate with long screws (p < 0.017). However, no significant difference (p > 0.017) in stiffness was identified between the infrapectineal QLS buttress plate and the suprapectineal reconstruction plate with long screws. Conclusions: The suprapectineal pelvic brim plate with 3 periarticular long screws remains the gold standard to treat anterior column-posterior hemitransverse fractures. The special infrapectineal QLS buttress plate provides stiffness and stability comparable with those of standard fixation. However, moving the pelvic brim plate from the suprapectineal border to the infrapectineal border is not recommended for anterior column-posterior hemitransverse fractures because it significantly decreases fixation stiffness. Clinical Relevance: Special QLS buttress plates may be an alternative fixation method for anterior column-posterior hemitransverse acetabular fractures in the elderly, especially when a less invasive anterior intrapelvic approach is selected.

show abstract

Management of Acetabular Fractures in the Elderly

Cited by 60 publications

References 42 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

Three-dimensional-guided navigation percutaneous screw fixation of fragility fractures of the pelvis

Biomechanical Comparison of Different Fixation Techniques for Typical Acetabular Fractures in the Elderly

Contact Info

Product

Resources

About