Abstract
ObjectivesWhile open reduction and internal fixation is considered the gold standard for the treatment of acetabular fractures, it is associated with significant complications due to prolonged immobilization for elderly patients. The aim of this study was to investigate the clinical and radiological outcomes in elderly patients treated with an acute total hip arthroplasty (THA).Patients and methodsThis retrospective study included 16 patients (10 women and 6 men) with a mean age of 80.1 years suffering from a displaced acetabular fracture after a low-energy trauma. Primary THA was performed in all cases, by the same surgeon, within a three-week period after the fracture. The Burch-Schneider reinforcement ring with a cemented cup was used in 10 patients and a jumbo acetabular cup was used in 6 patients, whereas autologous bone graft was used in all cases.ResultsWith a mean follow-up of 72 months, one dislocation occurred that was treated with close reduction, and one patient developed superficial site infection that was managed conservatively with antibiotics. No periprosthetic fractures, deep infections, or other adverse events were observed. One case of asymptomatic radiographic loosening was reported and treated conservatively. And autologous bone graft was well incorporated. Clinical scores were significantly improved, and all patients were able to walk independently.ConclusionsAcute THA for the treatment of displaced acetabular fractures in elderly patients seems to be a safe option with good functional and radiological outcomes and low complication rates, offering early mobilization and weight-bearing ability to elderly patients.
Highlights
Acetabular fractures have a reported annual incidence of around three cases per 100,000 worldwide [1,2]
The Burch-Schneider reinforcement ring with a cemented cup was used in 10 patients and a jumbo acetabular cup was used in 6 patients, whereas autologous bone graft was used in all cases
With a mean follow-up of 72 months, one dislocation occurred that was treated with close reduction, and one patient developed superficial site infection that was managed conservatively with antibiotics
Summary
Acetabular fractures have a reported annual incidence of around three cases per 100,000 worldwide [1,2]. Acetabular fractures are complex intra-articular injuries that occur in a bimodal distribution, typically in younger patients involved in high-energy blunt trauma, usually secondary to road traffic collisions. In the elderly population, low-energy trauma is responsible for a high percentage of acetabular fractures due to the frequency of falls and increased prevalence of osteopenia and osteoporosis. The acetabular fractures in the elderly population are often characterized by displacement of the anterior column with the separation of a quadrilateral plate fragment and comminution, and femoral head and dome impaction [4]. Open reduction and internal fixation (ORIF) is considered the gold standard of treatment for displaced fractures. Several authors have reported that ORIF in elderly patients is
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