Abstract
Introduction: Open reduction and internal fixation (ORIF) is standard care for most acetabular fractures. With increasing numbers of acetabular fractures in the elderly, the risk of revision surgery and conversion to total hip replacement (THR) is increasing. Alarmingly, about 20–25% of acetabular fractures in the elderly following ORIF needed revision and conversion to delayed THR. Methods: Recently, prognostic factors have been identified, which correlate with an increased risk of worse outcomes following ORIF of acetabular fractures in the elderly patient. Patient risk factors include, for example, age, comorbidities, and degree of osteoporosis. Injury risk factors mainly include the fracture pattern. Results: The concept of primary THR following acetabular fractures is an alternative to ORIF, especially in the elderly patient. Satisfactory outcomes have been reported in different studies for primary THR following acetabular fractures in the elderly. The surgeon should be aware of strict selection criteria in order to achieve these satisfactory outcomes. Therefore, an individualized treatment plan has to be defined for elderly patients following acetabular fractures. Discussion: Here, the advantages and disadvantages of ORIF versus THR following acetabular fractures in the elderly are discussed.
Highlights
Management of acetabular fractures in the geriatric patientWith increasing numbers of acetabular fractures in the elderly, the risk of revision surgery and conversion to total hip replacement (THR) is increasing
The overall incidence of fractures of the acetabulum has, despite introduction of higher safety standards in cars, not undergone significant changes
Young patients suffer from acetabular fractures due to high energy trauma, this has to be distinguished from elderly patients suffering from low energy trauma
Summary
With increasing numbers of acetabular fractures in the elderly, the risk of revision surgery and conversion to total hip replacement (THR) is increasing. About 20–25% of acetabular fractures in the elderly following ORIF needed revision and conversion to delayed THR. Methods: Recently, prognostic factors have been identified, which correlate with an increased risk of worse outcomes following ORIF of acetabular fractures in the elderly patient. Results: The concept of primary THR following acetabular fractures is an alternative to ORIF, especially in the elderly patient. Satisfactory outcomes have been reported in different studies for primary THR following acetabular fractures in the elderly. An individualized treatment plan has to be defined for elderly patients following acetabular fractures. Discussion: Here, the advantages and disadvantages of ORIF versus THR following acetabular fractures in the elderly are discussed
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