No Difference in Acute Outcomes for Patients Undergoing Fix and Replace versus Fixation Alone in the Treatment of Geriatric Acetabular Fractures

Abstract

OBJECTIVE (s): To compare acute outcomes between patients undergoing fix and replace (FaR) versus open reduction and internal fixation (ORIF) alone in the treatment of geriatric acetabular fractures. METHODS: Design: Retrospective Cohort Study Setting: Single Level 2 Trauma Center Patient Selection Criteria: Consecutive acetabular fracture patients aged ≥ 55 years old treated by two orthopedic trauma surgeons at one tertiary care center from January 2017 to April 2022 with FaR vs ORIF were identified. Included were those with complete datasets within the 180-day global period. Excluded were patients with previous ORIF of the acetabulum or femur, or revision total hip arthroplasty. Outcome Measures and Comparisons : The primary outcomes were length of hospital stay (LOS), postoperative weight-bearing status, postoperative disposition, time to postoperative mobilization, and 90-day readmission rates. Secondary outcomes compared included demographic information, injury mechanism, surgical time, complications, revisions, and pre- and postoperative Hip Disability and Osteoarthritis Outcomes Score for Joint Replacement (HOOS Jr.) scores. These were compared between FaR and ORIF groups. RESULTS: Seventeen FaR patients (average age 74.5 ± 9.0 years) and 11 ORIF patients (average age 69.4 ± 9.6 years) met inclusion criteria. Mean follow-up was 26.4 months (range: 6 – 75.6 months). More FaR group patients were ordered immediate weightbearing as tolerated or partial weightbearing compared to ORIF alone (70% vs 9.0%, p=0.03). More patients in the FaR group had pre-existing hip osteoarthritis compared to ORIF alone (71% vs 27%, p=0.05). Fracture classification (p=0.03) and Charlson Comorbidity Index (p=0.02) differed between the two groups. There were no other differences in demographics, LOS (p=0.99), postoperative disposition (p=0.54), time to postoperative mobilization (p=0.38), 90-day readmission rates (p=0.51), operative time (p=0.06), radiographic union (p=0.35), time to union (p=0.63), pre- (p=0.32) or postoperative HOOS Jr. scores (p=0.80), delta HOOS Jr. scores (p=0.28), or reoperation rates between groups (p=0.15). CONCLUSION: Both FaR and ORIF appear to be sound treatment options in the management of geriatric acetabular fractures. Patients in the FaR group achieved immediate or partial weightbearing earlier than the ORIF group, however time to postoperative mobilization did not differ between the two groups. The remainder of acute postoperative outcomes (LOS, postoperative disposition, and 90-day readmission rates) did not differ between the two groups.