Managing Acetabular Fractures in the Elderly With Fixation and Primary Arthroplasty: Aiming for Early Weightbearing

Rickman, Mark; Young, J.; Trompeter, Alex; Pearce, R.; Hamilton, Mark

doi:10.1007/s11999-014-3467-3

Cited by 101 publications

(88 citation statements)

References 34 publications

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“…Usually after operative stabilization of acetabular fractures, the patient is instructed to remain nonweight-bearing for period of 6 to 12 weeks; however, these restrictions have been questioned recently with several authors moving toward earlier weight-bearing for elderly patients following operative fixation. 359 …”

Section: Surgical Treatmentmentioning

confidence: 99%

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Mears¹,

Kates²

2015

Geriatr Orthop Surg Rehabil

134

121

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Over the past 4 decades, much has been learned about the pathophysiology and treatment of osteoporosis, the prevention of fragility fractures, and the perioperative management of patients who have these debilitating injuries. However, the volume of published literature on this topic is staggering and far too voluminous for any clinician to review and synthesize by him or herself. This manuscript thoroughly summarizes the latest research on fragility fractures and provides the reader with valuable strategies to optimize the prevention and management of these devastating injuries. The information contained in this article will prove invaluable to any health care provider or health system administrator who is involved in the prevention and management of fragility hip fractures. As providers begin to gain a better understanding of the principles espoused in this article, it is our hope that they will be able to use this information to optimize the care they provide for elderly patients who are at risk of or who have osteoporotic fractures.

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Section: Surgical Treatmentmentioning

confidence: 99%

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Mears¹,

Kates²

2015

Geriatr Orthop Surg Rehabil

134

121

View full text Add to dashboard Cite

show abstract

“…Moreover, all the complications seen in the ORIF group are found in the literature [16] as well as those in the THA group [17]. The poor bone quality of the osteoporotic bone and the subchondral hematoma make the anatomical reduction very difficult [18]. Many surgeons are very restrictive in granting early mobilization of the hip and the load, convinced that older patients would not follow the prescribed therapy [18].…”

Section: Discussionmentioning

confidence: 99%

“…The poor bone quality of the osteoporotic bone and the subchondral hematoma make the anatomical reduction very difficult [18]. Many surgeons are very restrictive in granting early mobilization of the hip and the load, convinced that older patients would not follow the prescribed therapy [18]. There is little in the literature suggesting good results with the fixation of the acetabular fracture in the elderly [18].…”

Section: Discussionmentioning

confidence: 99%

“…Many surgeons are very restrictive in granting early mobilization of the hip and the load, convinced that older patients would not follow the prescribed therapy [18]. There is little in the literature suggesting good results with the fixation of the acetabular fracture in the elderly [18]. So, it is very important to evaluate the algorithm proposed by Pagenkopf et al [2] for the treatment of associated acetabular fractures in the elderly (Letournel classification).…”

Section: Discussionmentioning

confidence: 99%

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Total hip arthroplasty vs. osteosynthesis in acute complex acetabular fractures in the elderly: Evaluation of surgical management and outcomes

Carta

Falzarano

Rollo

et al. 2016

JAD

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Objective: To retrospectively evaluate the open reduction internal fixation and total hip arthroplasty directions, results and complications associated with internal fixation in managing these fractures. Methods: In 8 years at 4 centers, 61 patients with associated acetabular fractures (Letournel classification) were treated. The patients were divided into two groups. The total hip arthoplasty (THA) group consisted of 30 patients, while the open reduction internal fixation group had 31 patients. The average age of the patients was 74.7 years. The following parameters were compared: the duration of surgery and hospitalization, the international unit of red blood cell concentrate transfusion, the time for the verticalization of the patient, perioperative complications, Harris hip score, and the short form (12) health survey. The clinical and radiographic follow-up was performed at 1 month, 3 months, 6 months and 12 months and annually thereafter. Patients with post-traumatic osteoarthritis formed the third comparison group. P ≤ 0.05 was considered statistically significant according to the analytical Student's t-test. Results: The P < 0.05 in favor of the THA group was: surgical time, length of stay, number of the international unit of red blood cell concentrate transfusions, verticalization, quality of life and hip function, a reduction of perioperative complications and reinterventions. Conclusions: Our experience shows that the THA treatment for acetabular fractures in the elderly is to be preferred.

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“…This has led to early radiographic loosening being reported in up to 21% of cases [25]. As a result, several ancillary techniques have been reported, including Burch-Schneider antiprotrusion cages [32], cable fixation [18], plate fixation [24], and cup-cage construct [1]. Although not all papers reporting on the results of THA for acute acetabular fractures have reported early cup loosening, no study has used a sensitive radiographic method to assess acetabular component migration.…”

Section: Introductionmentioning

confidence: 99%

Does Cup-cage Reconstruction With Oversized Cups Provide Initial Stability in THA for Osteoporotic Acetabular Fractures?

Solomon

Studer

Abrahams

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background The incidence of acetabular fractures in osteoporotic patients is increasing. Immediate total hip arthroplasty (THA) has potential advantages, but achieving acetabular component stability is challenging and, at early followup, reported revision rates for loosening are high. Questions/purposes This study measured acetabular component stability and the initial surface contact achieved between the acetabular component and unfractured region of the pelvis after THA using an oversized acetabular component and cup-cage reconstruction. Methods Between November 2011 and November 2013, we treated 40 acute acetabular fractures in patients older than 70 years of age. Of these, 12 (30%) underwent immediate THA using an oversized acetabular component with screws inserted only into the ilium and a cup-cage construct. Postoperatively all patients were mobilized without weightbearing restrictions. Indications for immediate THA after acetabular fractures were displaced articular comminution deemed unreducible. Eleven of the 12 were prospectively studied to evaluate the initial stability of the reconstructions using radiostereometric analysis. One of the patients died of a pulmonary embolism after surgery, and the remaining 10 (median age, 81 years; range, 72-86 years) were studied. Of these, five were analyzed at 1 year and five were analyzed at 2 years. Acetabular component migration was defined as acceptable if less than the limits for primary THA that predict later loosening (1.76 mm of proximal migration and 2.53°of sagittal rotation). The contact surface between the acetabular component and ilium in direct continuity with the sacroiliac joint, and the ischium and pubis in direct continuity with the symphysis pubis, was measured on postoperative CT scans.Results At 1 year the median proximal migration was 0.83 mm (range, 0.09-5.13 mm) and sagittal rotation was 1.3°(range, 0.1°-7.4°).

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Managing Acetabular Fractures in the Elderly With Fixation and Primary Arthroplasty: Aiming for Early Weightbearing

Cited by 101 publications

References 34 publications

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Total hip arthroplasty vs. osteosynthesis in acute complex acetabular fractures in the elderly: Evaluation of surgical management and outcomes

Does Cup-cage Reconstruction With Oversized Cups Provide Initial Stability in THA for Osteoporotic Acetabular Fractures?

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