Occult Acetabular Fracture in Elderly Patients

Abstract

Acetabular fractures in the elderly are increasingly common; however, an antecedent of trauma may not be known, and the diagnosis easily missed. Early identification and prompt management are needed in order to minimise morbidity rates, but little has been published on occult acetabular fracture.In this paper we present three cases of occult acetabular fracture in patients older than 75 years. All three are females and had previously been operated on the ipsilateral hip with an implant (two proximal femur fractures treated with a proximal intramedullary femoral nail, and one case of total joint replacement); these acetabular fractures could be related to the existence of a stress shielding mechanism.We believe that whenever an elderly patient feels groin pain, and anteroposterior pelvis X-rays are normal, oblique Judet projections (obturator and iliac) should be obtained. In any case, displacement will make any fracture evident within a few weeks.

The Current Incidence and Future Projection of Acetabular Fractures in Korea

“… 23 This might be due to the rise of age-adjusted incidence of osteoporosis, 26 or the application of more sensitive diagnostic imaging including computed tomography and magnetic resonance imaging in diagnosing the “occult” acetabular fractures. 27 28 29 Using the French registry, Melhem et al 17 estimated 19% increase of acetabular fractures in 2030 compared to 2016. This is especially in line with the projected increase of the acetabular fractures to 2030 found in this study.…”

Artrosis rápidamente progresiva de cadera secundaria a una fractura por insuficiencia subcondral del acetábulo. Reporte de un caso

“…describieron una serie de pacientes >75 años a quienes se les había diagnosticado una fractura oculta del acetábulo secundaria a la osteosíntesis endomedular para tratar una fractura de cadera. 16 No debe dejarse de lado la evaluación por imágenes de la columna, porque la cifosis lumbar degenerativa y otras alteraciones del balance espinopélvico podrían ser factores predisponentes. 17 Sin embargo, en el caso reportado, nuestra paciente no tenía alteraciones en el espinograma.…”

Multi-Site Insufficiency Pelvic Fracture Following Total Hip Arthroplasty

“…In our case, the symptoms of the medial wall acetabular fracture were masked by concomitant ramus/ischium fractures. In previous studies, CT and MRI were reportedly useful for identifying fracture lines that were not visible on radiography [ 18 , 25 , 26 ]. Mandell et al [ 27 ] reported that in the clinical setting of suspected occult fracture, the sensitivity of clinical CT results for detecting pelvic fractures was 88%, the specificity was 98%, and the negative predictive value was 94%.…”