Operative versus non-operative treatment of displaced acetabular fractures in elderly patients

Boudissa, Mehdi; Francony, Florent; Drevet, Sabine; Kerschbaumer, Gaël; Ruatti, Sébastien; Milaire, Michel; Merloz, P.; Tonetti, Jérôme

doi:10.1007/s40520-019-01231-5

Cited by 21 publications

(17 citation statements)

References 23 publications

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“…Open reduction and internal fixation (ORIF) of acetabular fractures in patients of old age is an accepted method of treatment [9,10]. The goal is achieving an anatomical reduction and stable fixation of the acetabulum to prevent secondary osteoarthritis of the hip joint [11].…”

Section: Introductionmentioning

confidence: 99%

Medial buttressing of the quadrilateral surface in acetabular and periprosthetic acetabular fractures

et al. 2020

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Background In geriatric acetabular fractures, the quadrilateral plate is often involved in the fracture pattern and medially displaced. Open reduction and internal fixation (ORIF) includes reduction of the quadrilateral plate and securing its position. In this study, the concept of medial buttressing in acute and periprosthetic acetabular fractures is evaluated. Materials and methods Patients, who sustained an acetabular fracture between 2012 and 2018, in whom ORIF with a specific implant for medial buttressing was performed, were included in the study. Patients were divided in two groups; acute acetabular fractures (group 1) and periprosthetic acetabular fractures (group 2). Demographics, type of fracture, surgical approach, type of implant for medial buttressing, comorbidities, general and surgical in-hospital complications and length of hospital stay were recorded retrospectively. The following data were collected from the surviving patients by telephone interview: EQ-5D-5L, SF-8 physical and SF-8 mental before trauma and at follow-up, UCLA activity scale, Parker Mobility Score and Numeric Rating Scale. Results Forty-six patients were included in this study, 30 males (65.2%) and 16 females (34.8%). Forty patients were included group 1 and six patients in group 2. The median age of patients of group 1 was 78 years. Among them, 82.5% presented with comorbidities. Their median length of in-hospital stay was 20.5 days. 57.5% of patients suffered from in-hospital complications. The concept of medial buttressing was successful in all but one patient. ORIF together with primary total hip arthroplasty (THA) was carried out as a single stage procedure in 3 patients. Secondary THA was performed in 5 additional patients (5/37 = 13.5%) within the observation period. Among surviving patients, 79.2% were evaluated after 3 years of follow-up. Quality of life, activity level and mobility dropped importantly and were lower than the values of a German reference population. SF-8 mental did not change. The median age of patients of group 2 was 79.5 years, all of them presented with one or several comorbidities. The median length of in-hospital stay was 18.5 days. 50% of patients suffered from in-hospital complications. The concept of medial buttressing was successful in all patients. 5 of 6 patients (83.3%) could be evaluated after a median of 136 weeks. In none of these patients, secondary surgery was necessary. Quality of life, activity level and mobility importantly dropped as well in this group. SF-8 mental remained unchanged. Conclusion In geriatric acetabular fractures with involvement and medial displacement of the quadrilateral plate, medial buttressing as part of ORIF proved to be reliable. Only 13.5% of patients of group 1 needed a secondary THA within 3 years of follow-up, which is lower than in comparable studies. Despite successful surgery, quality of life, activity level and mobility dropped importantly in all patients. The loss of independence did however not influence SF-8 mental values.

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Section: Introductionmentioning

confidence: 99%

Medial buttressing of the quadrilateral surface in acetabular and periprosthetic acetabular fractures

et al. 2020

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“…Количество и характер интраоперационных осложнений напрямую зависит от используемых доступов и от их количества [28,29,30]. Специалисты, применяющие два доступа, априори получают больше интра-и послеоперационных осложнений [4,22,25,27,31,32]. Так, you-Shui Gao с соавторами применили одновременно два доступа в 48 случаях, доступ Кохера -Лангенбека -в 12 и подвздошно-паховый -в одном случае, при этом получили в 20 (39,2%) случаях различные осложнения [27].…”

Section: Discussionunclassified

“…Два и более доступа применяют при сложных сочетанных двухколонных переломах [4,6,28,32,33,34]. Применяя одновременно два доступа, подвздошно-паховый и Кохера -Лангенбека, авторы по-разному их используют.…”

Section: Discussionunclassified

“…T. Borg с соавторами доступ Кохера -Лангенбека использовали для выполнения ORIF и первичного эндопротезирования (ПЭ) ТБС, а при использовании подвздошно-пахового доступа в случае эндопротезирования ТБС вынуждены дополнительно применять боковой доступ [35]. М. Boudissа с соавторами подвздошнопаховый доступ применяли только для ORIF [32].…”

Section: Discussionunclassified

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Complications of Acute Acetabular Fractures Surgical Treatment: Systematic Review

Kolesnik

Zagorodniy

Загородний³

et al. 2021

Traumatology and Orthopedics of Russia

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Background.The combination of classical anterior and posterior approaches, as well as their modifications, is recognized as the most effective in acetabular fractures surgical treatment. The use of classical and modified approaches is accompanied by serious intra- and postoperative complications associated primarily with the duration of surgery, significant blood loss, tissue trauma, surgical site infection. The aim of review — to determine the main and most frequent complications associated with surgical approaches to the acetabulum. material and methods. Access to literature sources is carried out in the information systems and databases PubMed/Medline, Embase, Scopus, Сochran Library, eLibrary, Wiley Online Library. Keywords: acetabular fractures, surgical treatment, approach to the acetabulum, total hip replacement.Results. The most common intraoperative complications are incorrect fragments reduction, sciatic nerve injury, less often — intraarticular implant position, damage to the superior gluteal artery and other vessels, among the early postoperative complications - wound infection, both superficial and deep, less often — venous thrombosis. Late postoperative complications are mainly represented by the development of heterotopic ossification, post-traumatic coxarthrosis, less often revealed aseptic necrosis of the femoral head, residual protrusion and secondary femoral head lesion. Conclusion. The main approach to the acetabulum are the ileo-inguinal and the Kocher-Langenbeck approach, as well as their combination.Complications were more common using two approaches, especially in cases of simultaneous use. The main intraoperative complications are the sciatic nerve and the superior gluteal artery injury with posterior approaches, the femoral lateral cutaneous nerve with expanded ilio-femoral approach, and the obturator nerve with anterior approaches.

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“…1: AP and Judet views have been reported following displaced acetabular fractures in the elderly managed conservatively due to medical comorbidities [37], other studies have reported diminished outcome results with only 29% of patients returning to baseline ambulatory status following non-operative management [43]. When directly comparing functional outcomes following acetabular fractures in elderly patients, Boudissa et al reported functional outcomes and post-injury autonomy status were significantly better in those managed surgically [44]. A possible contribution to this is that those deemed fit for surgical management may be a self-selecting group that were likely to do better notwithstanding their treatment due to their potentially favourable baseline.…”

Section: Outcomes Following Conservative Treatmentmentioning

confidence: 99%

Acetabular fractures in the elderly: modern challenges and the role of conservative management

et al. 2021

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Introduction The incidence of acetabular fractures in the elderly population is ever increasing. While management of acetabular fractures in young patients following high-energy trauma is well described, treatment of the elderly patient subgroup is complex and requires a unique, individualized approach. A variety of treatment strategies including operative and non-operative approaches exists to manage this vulnerable patient group. Conservative management of acetabular fractures in the elderly continues to play an important role in treatment of both stable fracture patterns and those medically unfit for surgery. Aim This review assessing the current literature was undertaken with the purpose of summarising the challenges of management in this at-risk cohort as well as quantifying the role and outcomes following conservative management in the elderly. Conclusion Our recommendation is that conservative management of acetabular fractures in the elderly can be considered as a treatment option on a case-by-case basis accounting for patient, injury, and surgical factors. If it is to be pursued, we advise a multidisciplinary approach focused on early mobility, minimisation of risk and regular follow-up to optimise patient outcomes.

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Operative versus non-operative treatment of displaced acetabular fractures in elderly patients

Cited by 21 publications

References 23 publications

Medial buttressing of the quadrilateral surface in acetabular and periprosthetic acetabular fractures

Medial buttressing of the quadrilateral surface in acetabular and periprosthetic acetabular fractures

Complications of Acute Acetabular Fractures Surgical Treatment: Systematic Review

Acetabular fractures in the elderly: modern challenges and the role of conservative management

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