Treatment options of pelvic and acetabular fractures in patients with osteoporotic bone

Quadrilateral plate fractures of the acetabulum: An update

“…4,5 Traction acts by ligamentotaxis of the capsular attachments of the femoral head to the acetabulum and is often not effective in reducing the medial wall fragments. 15,34 Most acetabular fractures have besides elements of translation also degrees of rotation, 15,17 which is extremely difficult to correct. This results in malunion of the medial wall in a displaced position, loss of reduction and late displacement when traction is removed even after several months.…”

“…73 Until recently elderly patients were frequently included in the list of contra-indications to surgery and managed in traction. 13,15,72 This is due to the difficulties associated with fixation in osteoporotic bone and risks of surgery. 15 Satisfactory results can be expected with minimally displaced (<2 mm) fractures, 2,13,17,21,22 those with apparent congruence of the hip with a both column fracture, an acetabulum which is intact superiorly as documented by roof arc measurements and congruence of the femoral head with the roof on the three standard radiographs (AP pelvis and obturator and iliac oblique Judet views) out of traction.…”

“…13,17,23 Traction commits the patient to six to eight weeks of bed rest and non-weight bearing and in the elderly can be fraught with medical complications. 13,15,17,25 The well documented disadvantages of prolonged immobilisation in cases with neck of femur fractures exist in the elderly population with an acetabular fracture. 23 Open reduction and internal fixation is considered the standard of care for most displaced acetabular fractures.…”

“…10,15,40,60,61 In 2001 Chen et al 40 reported the outcomes of cerclage wiring combined with reconstruction plates and screws. In thirty-five both column fractures a triradiate approach with trochanteric osteotomy was used and the displaced quadrilateral plate was reduced and fixed with 1.6 mm cerclage wires.…”

“…5,[9][10][11] They are reported to be more common in the, increasing in numbers, osteoporotic acetabular fractures. [11][12][13][14][15][16][17] These fractures of mainly the elderly population, also pose several specific treatment challenges compared to those of young high-energy trauma patients who are traditionally associated with acetabular fractures. 7,12,13,[18][19][20][21][22][23] Until the 1960s most acetabular fractures were treated nonoperatively.…”