Acetabular fractures in the elderly (≥ 60 years old): a propos of 33 cases

Abstract

Acetabular fractures in the elderly are serious fractures because they affect a deep, load-bearing and at first difficult surgical joint, all complicated by an osteoporotic tissue condition. We conducted a retrospective descriptive study over 10 years (January 2010 to January 2020, including 33 patients aged ≥ 60 years with acetabular fractures treated at the Orthopedics and Traumatology Department B4 of CHU Hassan II Fes. The aim was to study the types of fractures and to evaluate their treatment as well as the functional result obtained in order to compare them with those of the literature. We collected the data using an exploitation sheet and their analysis was facilitated by the EPI info7 statistical analysis software. The average age of our patients was 65.5 years, with a clear male predominance. Road Traffic Accidents represented the main etiology (72.7%), and the left side was the most affected 54.5%. The para-clinical assessment, based on the Anteroposterior iliac and obturator radiological views and confronted with the CT scan made it possible to pose the diagnosis of the fracture, to establish the type according to the Judet and Letournel classification of acetabular fractures, and to evaluate the displacement and articular congruence according to the Duquennoy and Coll criteria as well as those of Matta. Elementary fractures were the most frequent at 54.5%. We opted for orthopedic treatment in 72.7% of the cases with none weight bearing in 62.5%; whereas the surgical treatment was carried out in 27.3% with the use of the special acetabular plate in 66.7% of the operated cases. The Kocher-Langenbeck posterior approach was the most used (66.7%). The vertical congruence between the femoral head and the roof of the acetabulum after reduction was satisfactory in 27.3% of the cases and the horizontal congruence between the femoral head and the entire acetabulum in 18.2% of the cases. In our series, we noted as a complication 12 cases of post-traumatic osteoarthritis, ie 36.3%. The results according to the Postel Merle d´Aubigne score at an average follow-up of 62 months were satisfactory (excellent, very good and good) in 27.3% of the cases and unsatisfactory (fair, poor and bad) in 72.7% cases. The surgical management of fractures of the acetabulum in elderly and osteoporotic patients remains subject to controversy and is not entirely satisfactory. Would not primary arthroplasty combined with open reduction internal fixation constitute a better management approach in old people?