Minimally displaced acetabulum fractures in geriatric patients: a comparison of open, percutaneous and non-operative treatment from the German Pelvic Injury Register data

Abstract

Purpose In elderly patients with minimally displaced acetabulum fractures, the patients' inability to partially weight-bear and the need for early mobilisation may trigger the decision towards a treatment with higher primary stability. The purpose of this study was to compare open reduction and internal fixation (ORIF), closed reduction and percutaneous fixation (CRPIF) and non-operative treatment in geriatric minimally displaced acetabulum fractures with regard to complications and quality of reduction. Methods Data from the prospective German Pelvic Injury Register collected between 2008 and 2018 were used to evaluate 608 geriatric patients with isolated minimally displaced (≤ 5 mm) acetabulum fractures. In total, 429 received non-operative treatment, 117 ORIF and 62 CRPIF. Demographics, injury severity, fracture pattern, complications and fracture displacement before and after treatment were analysed. Results Both operative methods reduced fracture gap displacement. CRPIF was associated with lower blood loss and shorter operative time compared to ORIF (p < 0.001). Hospital stay was 12.9 days in the non-operative group, 16.8 with CRPIF and 23.6 with ORIF (p < 0.001). Non-surgical general complications were more likely to occur following ORIF (22.2%) compared to CRPIF (8.1%) and non-operative treatment (8.4%, p < 0.001). The rate of surgical complications was not different for ORIF and CRPIF (p = 0.122) Conclusion Both operative treatments improve fracture displacement and joint congruency in elderly patients with minimally displaced acetabulum fractures. Compared to ORIF, CRPIF achieves similar quality of reduction but is associated with fewer complications, smaller intraoperative blood loss, shorter operative time and shorter length of hospital stay.

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

“…They did not find a statistically significant difference in mortality at one year. In a study by Ernstberger et al, 30 there was no effect of the type of treatment (nonoperative vs. operative) on mortality at one and two years (P ¼ 0.65 and P ¼ 0.10).…”

“…Since they are low energy injuries, proportion of undisplaced fractures may be high. 1,30 Undisplaced fractures can be managed conservatively. Certain fracture types like associated both column fractures with secondary congruence may also be managed conservatively.…”

“…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.…”

“…No evidence of fracture displacement was seen. Ernstberger et al 30 compared outcomes of ORIF, percutaneous fixation and nonoperative treatment. Percutaneous fixation was associated with lesser blood loss, shorter operative time, shorter duration of hospital stay and lesser nonsurgical complications compared to ORIF.…”

Primary stability of multi-hole cups compared to plate osteosynthesis in osteoporotic anterior column and posterior hemi-transverse acetabular fractures—A biomechanical comparison

“…We decided to test the ACPHT fracture as this is one of the most common acetabular fracture in old patients following low energy trauma [ 22 ]. However, we are aware that the sole arthroplasty of e.g.…”