Abstract
IntroductionPurpose of the study is to present and discuss the femoral neck osteotomy as a salvage procedure for unstable, locked geriatric acetabular fractures in selected frail patients. When disadvantages and possible risks of other treatments exceed the benefits, this method may relieve pain and allow for early wheelchair mobilization in frail patients with limited mobility.Materials and MethodsWe report nine patients from 2008 to 2020, which were treated with an osteotomy of the femoral neck for an unstable acetabular fracture. Indications, ASA-Score, Frailty Index, operative procedure, length of hospital stay, complications and outcomes will be discussed.ResultsPatient’s age averaged 86 years (range 81–92). Acetabular fractures were classified as six both column fractures, two anterior column posterior hemitransversal fractures and one destruction of the acetabulum by multiple metastases. Fracture dislocation with medialization plus locking of the femoral head and a superomedial dome impaction were present in all patients. All patients were classified as ASA III/ IV and the average value on the CSHA Frailty index was 7 (range 6–7). The operation time averaged 52 min (range 34–62). Immediate wheelchair mobilization in seven out of nine patients was started postoperatively.ConclusionThe osteotomy of the femoral neck may be discussed as a salvage procedure in low functional demanding, multimorbid, frail geriatric patients with unstable acetabular fractures and impairment of mobilisation due to a locked femoral head. The procedure has the advantages of a short operation time and immediate mobilization of the patients. However, this procedure only applies as a salvage solution in selected individual cases.
Highlights
Purpose of the study is to present and discuss the femoral neck osteotomy as a salvage procedure for unstable, locked geriatric acetabular fractures in selected frail patients
Since Anglen et al have already described that osteopenic geriatric patients with superomedial dome impaction (Gull sign) did not benefit from attempted open reduction and internal fixation [13]
All the patients in this study showed these factors with a clear medialization of the femoral head so that one has to assume a insufficient result after osteosynthesis
Summary
Purpose of the study is to present and discuss the femoral neck osteotomy as a salvage procedure for unstable, locked geriatric acetabular fractures in selected frail patients. The majority of geriatric acetabular fractures may be treated with one of the mentioned procedures, but for a small group of patients, who are not candidates for extensive surgery due to an extensively limited functional status, considerable dementia or a malignoma in palliative situation, with limited expected lifetime in combination with multiple significant comorbidities, other treatment options might be considered This is the case if femoral rotation might be painfully blocked by locking of the femoral head within the fracture or by extensive medialization of the femoral head, which results in further immobilization of the patient and difficulties in patient care. Since Anglen et al have already described that osteopenic geriatric patients with superomedial dome impaction (Gull sign) did not benefit from attempted open reduction and internal fixation [13] For those patients an osteotomy of the femoral head as a salvage procedure with a functional girdlestone situation should be discussed to reduce pain, to avoid a femoral traction and allow for early and free mobilisation of the hip and avoid further immobilisation
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