Acetabular Fractures Research Articles

Hounsfield unit values are useful for predicting early outcomes after acetabular fractures: a retrospective study.

Acetabular fractures are among the most challenging orthopaedic fractures, and a high total hip arthroplasty (THA) conversion rate has been reported in older patients with acetabular fractures. Bone quality is a poor prognostic factor after acetabular fracture fixation and has been assessed using computed tomography (CT). However, the relationship between Hounsfield unit (HU) values measured using CT and early acetabular fracture outcomes remains unknown. This study aimed to elucidate the effect of HUs on early acetabular fracture outcomes. 50 consecutive patients who underwent open reduction and internal fixation for acetabular fractures were included. The mean follow-up duration was 24 months. 27 hips had elementary fractures and 23 had associated fractures. The reduction quality assessed using CT was as follows: anatomical, 13 hips; imperfect, 10 hips; and poor, 27 hips. Secondary hip osteoarthritis was observed in 5 patients (10%), and the surgery was converted to THA in 1 patient (2%). The HU values of the fifth vertebral body and the unaffected side of the femoral head were measured. The fracture type, radiological secondary hip osteoarthritis, conversion to THA, and postoperative displacement gap were recorded. The unaffected femoral head HU values in elementary fractures (250.5 ± 50.5) were significantly higher than those in associated fractures (221.5 ± 48) (p < 0.047). The HU values of the fifth vertebral body and the unaffected femoral head were significantly correlated with the postoperative residual displacement gap and were significantly lower in those with secondary osteoarthritis than in those without it. The cut-off value for predicting early osteoarthritic change after an acetabular fracture was approximately 180. The HU values were correlated with the fracture type, postoperative displacement gap, and early osteoarthritic change after acetabular fractures and are clinically useful prognostic factors for early acetabular fracture outcomes.

Minimally invasive stabilization of acetabular fractures with virtual navigation combined with robot-assisted 3D imaging

Minimally invasive stabilization of non- and minimally displaced acetabular fractures using intraoperative, robot-assisted three-dimensional (3D) imaging and anavigation system. Nondisplaced or only minimally displaced fractures of the acetabulum. Comminuted and highly displaced fractures of the acetabulum, protrusion of the femoral head into the pelvis with the need for open reduction, lack of possibility of intraoperative navigation. After supine positioning the patient, the patient-side navigation reference is attached to the anterior superior iliac spine using aSchanz screw. The 3D scan and registration of the dataset in the navigation system can then be performed. This allows the 7.3 mm screws to be planned using 3D imaging and then implanted through minimally invasive incisions. After successfully implanting the screws using the minimally invasive surgical technique, the patient can be mobilized the following day with pain-adapted physiotherapy exercises. Full weight bearing is usually possible. Between 2015 and 2023, 101 patients were treated using minimally invasive and navigation-assisted screw osteosynthesis for acetabular fractures. In 2patients, asecondary screw dislocation occurred in the hip joint after mobilization, which required revision surgery with repositioning of the screw osteosynthesis and ahip arthroplasty, respectively. Minimally invasive navigated screw osteosynthesis, thus, offers adequate treatment of nondisplaced and minimally displaced acetabular fractures. Attention must be paid to the correct indication and surgical technique.

The Use Of External Beam Radiation Therapy For Heterotopic Ossification Prophylaxis After Surgical Fixation Of Acetabular Fractures: A Randomized Controlled Trial.

To determine the effect of external beam radiation (XRT) on preventing severe heterotopic ossification (HO) after acetabular surgery. Design: Randomized controlled trial. Two level I academic trauma centers. Patients with an acetabular fracture (OTA/AO type 62) surgically treated through a posterior or combined anterior and posterior approach.Outcome Measures and Comparisons: Radiographic HO was determined using Brooker Classification at the last follow-up. The primary outcome was severe HO (Brooker class III-IV). The secondary outcome was any HO (Brooker class I-IV). The incidence of radiographic HO was compared between patients that did and did not undergo postoperative XRT. The results were analyzed in both an intention-to-treat (randomized to XRT) and as-treated (received XRT) basis. Severe HO occurred in 3 of 54 (6%) patients randomized to XRT and 9 of 50 (18%) patients randomized to no XRT (odds ratio (OR) 0.24, 95% confidence interval (CI) 0.05 to 0.94; p=0.05). Any HO occurred in 10 (19%) patients assigned to XRT and 17 (34%) patients in the no XRT control group (OR 0.39; 95% CI 0.13 to 1.05; p =0.07). The findings of this dual-center randomized controlled trial suggest that XRT after acetabular surgery significantly reduced the odds of severe HO compared to patients that did not receive XRT. These results can help guide shared decision-making between surgeons and patients regarding the use of XRT for HO prophylaxis. Level I, therapeutic.

Progress of fracture mapping technology based on CT three-dimensional reconstruction

Fracture Mapping is a new technology developed in recent years. This technology visually representing the morphology of fractures by overlaying fracture lines from multiple fracture models onto a standard model through three-dimensional reconstruction. Fracture mapping has been widely used in acetabular fracture, proximal humerus fractures, Pilon fracture, tibial plateau fractures, and so on. This technology provides a new research method for the diagnosis, classification, treatment selection, internal fixation design, and statistical analysis of common fracture sites. In addition, the fracture map can also provide a theoretical basis for the establishment of a biomechanical standardized fracture model. Herein, we reviewed various methods and the most advanced techniques for fracture mapping, and to discuss the issues existing in fracture mapping techniques, which will help in designing future studies that are closer to the ideal. Moreover, we outlined the fracture morphology features of fractures in various parts of the body, and discuss the implications of these fracture mapping studies for fracture treatment, thereby providing reference for research and clinical decision-making on bone and joint injuries to improve patient prognosis.

Anterior Approach for Fixation of Acetabular Fractures Using Anatomically Designed Plates: Maintenance of Reduction and Functional Outcomes at a Minimum Five-Year Follow-Up

Anterior Approach for Fixation of Acetabular Fractures Using Anatomically Designed Plates: Maintenance of Reduction and Functional Outcomes at a Minimum Five-Year Follow-Up

Percutaneous Titanium Elastic Nail Stabilization for Pelvic and Acetabular Fractures: Surgical Technique and Case Series.

The stabilization of fractures of the anterior pelvic ring and anterior column of the acetabulum with antegrade or retrograde intramedullary screws has been frequently described. However, these narrow and nonlinear bony corridors can be challenging and dangerous to accommodate with rigid linear implants. Titanium elastic nails (TEN) are ideal implants to navigate in the narrow, irregular medullary canal in this anatomical location. This study aims to describe this surgical technique and its preliminary results. From April 2018 to October 2023, patients who underwent acute TEN stabilization of their pelvic or acetabular fractures were identified from a review of medical records at a Level 1 trauma center. A focused review of their clinical documentation was performed to describe their demographics, injury patterns, the surgical techniques used in their treatment, and their clinical and radiographic outcomes. During the almost 6-year period, 19 patients were identified (age: 39 ± 22 years; 74% male). There were 3 acetabulum and 16 pelvic ring fractures stabilized. One of the 19 patients underwent bilateral TEN fixation of the superior pubic rami. Patients were followed-up through hospital outpatient clinics postoperatively (median follow-up 14 months, IQR: 8-24 months). No fractures were complicated by nonunion or secondary displacement of the reduction. A 14-year-old patient required hardware removal due to irritation, and a 19-month-old patient underwent planned hardware removal due to her age. No patients have undergone hip arthroplasty to date, and there were no instances of infection or neurovascular injury. These preliminary results are promising and suggest that larger scale assessment of the indications and feasibility of TEN stabilization in pelvic and acetabular surgery is warranted.

Short Term Outcome of Percutaneous Fixation of Transverse Acetabular Fractures

Short Term Outcome of Percutaneous Fixation of Transverse Acetabular Fractures

Diagnostic performance of digital tomosynthesis for postoperative assessment of acetabular fractures and pelvic ring injuries.

Digital tomosynthesis (DTS) has broad non-orthopaedic applications and has seen limited use within orthopaedics for imaging of the wrist. The utility of DTS for assessing reduction and hardware placement following operative treatment of pelvic ring injuries and acetabular fractures has not previously been investigated. All operatively treated acetabular fractures and pelvic ring injuries that underwent surgical fixation within a one-year time span received both a computed tomography (CT) scan and a DTS scan as part of their routine postoperative imaging workup. Three orthopaedic traumatologists independently reviewed the images for face-value clinical utility. Radimetrics and PCXMC software were utilized on a subset of the study population's DTS and CT studies to calculate the effective and organ radiation doses delivered. 52 patients (22 acetabular fractures, 22 pelvic ring injuries, 7 pelvic ring and acetabular fractures, 2 femoral head & acetabular fractures) were included. DTS was considered adequate to assess reduction 83% of the time, hardware position 83% of the time, and sufficient to replace the CT scan 67% of the time. DTS was associated with an 8.3 times lower effective radiation dose than CT. All organ doses were lower for DTS than CT. DTS appears to have face-value clinical utility for assessing reduction and hardware position following surgical treatment of acetabular fractures and pelvic ring injuries. Given that DTS is associated with significantly lower radiation doses to patients, further study utilizing more objective criteria is warranted.

The Role of Screening for Venous Thromboembolism in Pelvic Trauma Patients: A Single-Centre Retrospective Study.

Background: Venous thromboembolism (VTE) is a severe complication following pelvic trauma. Thromboprophylaxis has reduced the risk of VTE in the pelvic trauma population; nevertheless, the risk remains high. A substantial pulmonary embolism has emerged as the unexpected cause of death among patients presenting with 'minor pelvic fractures'. The purpose of this study was to analyse the single-centre experience with a surveillance protocol. We hypothesised that DVT surveillance with VUS and CTPA may reduce the perioperative mortality-morbidity rate in the subpopulation of patients with pelvic or acetabular fractures. Methods: This is a retrospective analysis of patients admitted with pelvic or acetabular fractures between January 2001 and December 2021. In April 2013, a screening protocol for VTE was introduced. This protocol included venous ultrasound and CTPA for patients with chest injuries. Patients from two groups-one screened for VTE and one without screening-were compared. Results: Of the 3186 patients with pelvic and/or acetabular fractures who were admitted, 1975 were not screened for VTE and 1211 underwent screening. There were more VTE cases in the screening group (5.62% vs. 0.86%, p < 0.001). Nine (0.46%) cases of sudden death occurred in the non-screening group, and all of them died with symptoms of acute PE. Since the screening was introduced, we have not encountered any deaths in the perioperative period (0.46 vs. 0, p = 0.02). Conclusions: The combined use of VUS and CTPA in chest-injured patients is a trustworthy means of screening for VTE, resulting in decreased mortality rates for those with pelvic and acetabular fractures by accurately diagnosing VTE during the perioperative phase.

Algorithms in acetabular fracture classifications.

Acetabular fractures are still challenging fractures. Fracture classification is the basis for understanding these injuries and to gain treatment and to choose a fracture type-based treatment concept. Using a systematic step-wise concept of fracture analysis, based on specific radiographic lines on standard X-rays allow even less experienced surgeons to get a correct classification of the elementary and associated fracture types of Letournel's classification. Algorithmic analysis of the iliopectineal line, (anterior column involvement), ilioischial line (posterior column involvement), presence of a posterior wall fragment, fracture lines involving the iliac wing and inferior ramus, and the spur sign (representing associated both column fractures) allow for approximately 80-90% correct classifications using standard X-rays when integrating these lines into an algorithm. Especially, T-shaped fractures, ABC and ACPHT fractures may be difficult to classify. Thus, advanced imaging, such as CT scans with multiplanar reconstruction and 3D reconstructions is additionally recommended.

Clinical Management, Prognosis, and Outcomes of Bilateral Acetabular Fractures: A Case Report

Background: Bilateral acetabular fractures are a rare type of acetabular fracture, and due to the scarcity of information regarding these types of fractures, managing bilateral acetabular fractures presents significant challenges. We presented a 25-year-old man with bilateral acetabular fractures (left transverse fracture of the acetabulum and right posterior column fracture of the acetabulum) secondary to severe trauma following a road accident with no other pelvic damage. Case Report: Because the displacement was more on the patient's left side (although the patient's pain was more on the right side), the open reduction and internal fixation (ORIF) surgery was first performed on the left side, and secondary ORIF surgery was performed on the right side, under general anesthesia with Kocher-Langenbeck approach for both sides. Conclusion: Due to the increase in road traffic accidents (RTAs) and improper safety of cars, especially in developing countries, this type of fracture may be repeated in the future, and regarding the complexity and comorbidities associated with this type of fracture, the high experience of the surgeon and detailed investigations are required to achieve successful results.

Simultaneous management of acetabular and ipsilateral subtrochanteric femur fractures in a polytrauma patient: A case report

Simultaneous management of acetabular and ipsilateral subtrochanteric femur fractures in a polytrauma patient: A case report

Practice Patterns Vary Widely in the Care of Pediatric and Adolescent Pelvic and Acetabular Fractures: A CORTICES Survey.

Pediatric pelvic and acetabular fractures are rare but potentially devastating injuries and significant management variation exists across the United States. This study sought to elucidate treatment decision-making trends, involvement of adult trauma fellowship-trained surgeons in pediatric care, and pre- and postoperative transfer patterns. Pediatric orthopaedic surgeons who serve as trauma liaisons at 20 PTCs were surveyed regarding training, practice volume, and factors contributing to institutional management of pelvic and acetabular injuries. Five clinical scenarios of pelvic ring and acetabular fractures that varied by injury pattern, age, and sex were presented. Descriptive statistics were used to summarize the results. Eighteen institutions responded to the survey (90% response rate, 16 Level, 1 PTC). All surgeons were pediatric fellowship-trained (77.7% in practice >5y). The four most common factors affecting whether surgeons independently managed both pelvic ring and acetabular fractures were patient age, fracture characteristics, displacement and need for surgery. The majority reported managing <10 acetabular (72.2%) but >10 pelvic ring (77.8%) injuries per year. In the clinical scenarios, patients <10 were more likely to have treatment decisions made by a pediatric orthopaedic surgeon. Older patients were more likely to be transferred to another institution for surgery but were often transferred back to the PTC postoperatively. In all clinical scenarios other than posterior hip dislocation, a trauma fellowship-trained surgeon was more likely to be the operative surgeon, even when the patient was not transferred. There is substantial variation in the management of pediatric and adolescent pelvic and acetabular fractures. Even at tertiary care PTCs, volumes are low, and trauma fellowship-trained surgeons are often involved in decision-making and operative management. Age and injury pattern seem to play a large role in variation, and patient transfers between facilities are common. V.

Hip joint rice body bursitis combined with hip dysplasia and pelvic fracture: a case report

BackgroundRice body formation is an uncommon, nonspecific inflammatory process. Certain clinical features, such as chronic synovitis associated with rheumatoid arthritis, tuberculous arthritis, and osteoarthritis, can induce a non-specific response that may lead to the development of rice bodies. Currently, the etiological and prognostic significance of rice bodies remains unknown. Magnetic resonance imaging (MRI) is the preferred diagnostic imaging modality for evaluating rice body formation.Case presentationThe patient, a 44-year-old female, presented with bursitis of the hip joint and the presence of numerous rice bodies. This case is exceptionally rare and unusual as it involves a combination of hip dysplasia and pelvic fracture. The patient underwent a one-stage resection of the rice body, internal fixation of the acetabular fracture, and two-stage total hip arthroplasty, resulting in an immediate improvement in her symptoms. We reviewed the relevant literature and observed that the majority of rice bodies were predominantly found within the capsules of the shoulder and knee joints, while instances of hip joint rice body bursitis were relatively infrequent. To our knowledge, there have been no previous reports documenting a case of hip joint rice body bursitis in conjunction with hip dysplasia and pelvic fracture.ConclusionThis paper presents the rare case of hip joint rice body bursitis combined with hip dysplasia and pelvic fracture, and is one of the highlights.

Occult Acetabular Fracture Associated With Periprosthetic Femoral Fracture (Vancouver Type B3) Following Hemiarthroplasty in an Elderly Patient: A Case Report

Occult Acetabular Fracture Associated With Periprosthetic Femoral Fracture (Vancouver Type B3) Following Hemiarthroplasty in an Elderly Patient: A Case Report

Computed tomography of the equine caudal spine and pelvis. Pathological findings in 56 clinical cases (2018-2023).

Computed tomography (CT) of the axial skeleton is increasing across many equine hospitals. CT of the pelvis and caudal spine in a large group of clinical cases has not been reported previously. To describe the pathological lesions identified in the caudal spine/pelvis in horses and ponies undergoing CT spine of this region. A retrospective case series. Horses with CT imaging of the caudal spine/pelvis were included. Horses aged under 6 months and those with CT examinations performed post-mortem were excluded. Fifty-six horses met the inclusion criteria. Ages ranged from 8 months to 20 years and bodyweights from 85 to 680 kg (mean 488 kg). Horses presented predominantly for lameness (30/56) and poor performance (18/56). Osseous pathology was identified in 41/56 horses; including osteoarthritis of the sacroiliac joint(s) (n: 28), pathology of the intervertebral disc joint(s) (n: 12), pelvic fractures (n: 9), osteoarthritis of the coxofemoral joint(s) (n: 8), ventral spondylosis (n: 6), acetabular rim fracture (n: 2), dislocation of coxofemoral joint(s) (n: 2), and dorsal dermal sinus of the sacrum (n: 1). The relationship between CT imaging findings and clinical signs in horses remains unclear. Further work is required to describe the relationship between congenital, developmental, and acquired changes in the caudal spine and pelvis, and clinical signs. CT of the caudal spine and pelvis can be utilised in horses and ponies for diagnosing a range of clinical disorders that may be causing 'lumbosacroiliac pain', poor performance, hindlimb lameness, and stiffness. The pathologies we observed were diverse and many patients had multiple lesions.

Recovery after neurologic injury in operative acetabular and pelvic fractures: Defining the natural history of foot drop

IntroductionDorsiflexion weakness, or footdrop, is a well-described sequela of high-energy acetabular and pelvic trauma, but little data exists describing the factors related to neurologic recovery and the timeline therein. An improved understanding of these factors would facilitate prognostication, patient education, and treatment decision-making. The aim of this study was to compare neurologic recovery between acetabular and pelvic fractures, delineate factors associated with recovery, and determine the expected timeline of recovery. MethodsA retrospective chart review was conducted at a level 1 tertiary referral center from 2000 to 2021 using CPT codes and keyword search functions to identify adult patients with neurologic injury in the setting of operative acetabular and/or pelvic ring trauma. Patients were included if they had documented, graded weakness not clearly explained by a concomitant injury (extremity or spine) following a pelvic/acetabular injury. Patients were followed to a minimum of 6 months follow-up or to neurologic recovery. Primary outcomes were the presence of motor recovery and time to initial and maximum recovery. The contributions of injury type and initial neurologic status were analyzed using logistic regression for impact on neurologic recovery. ResultsWe identified 121 patients with neurologic injury and resultant footdrop in the setting of an operative pelvic ring or acetabular fracture. From this cohort, 58 patients (47.9 %) demonstrated some degree of neurologic recovery in follow-up. There was no difference in recovery when comparing injury type (pelvis vs. acetabulum). Any motor function (including flicker) at time of initial evaluation was predictive of recovery (OR 6.18, [2.00 – 19.14]; p = 0.002). Initial neurologic function also correlated with more rapid recovery in comparison to patients with initial absent neurologic function both in time to initial recovery (56 days vs 107 days; p = 0.016) and time to maximum recovery (153 days vs 241 days; p = 0.027). ConclusionsThese results highlight the relatively poor prognosis for neurologic recovery in operative pelvic and acetabular injuries. Any initial neurologic function is predictive of likelihood of neurologic recovery and correlates with a more expedient neurologic recovery. Ultimately, this enables providers to better educate patients and facilitates decisions regarding further intervention.

Supra-pectineal quadrilateral buttress plating versus infra-pectineal plating in the management of quadrilateral plate fractures: A randomized controlled trial.

Management of quadrilateral plate fractures is technically demanding and requires specific fixation techniques. Infra-pectineal plating is the gold standard method of fixation. However, we recorded a high incidence of medial wall displacement and reoperations. Therefore, the aim of our study was to identify whether supra-pectineal quadrilateral buttress plating provides much more rigid fixation with a better functional and radiological outcome or not. The authors conducted this prospective, randomized control, single-blinded study at a level 1 single trauma centre. Between March 2022 and June 2023, 34 patients with quadrilateral plate fractures had anterior fixation, either via the anatomical QLP (17 cases) or infra-pectineal plating (17 cases) (Groups A and B, respectively). The radiological and clinical outcomes, as well as residual medial wall displacement, were the primary outcomes. The mean follow-up was 14.47months in group A and 15.24months in group B. In group A, the mean operative time (p = 0.02) was shorter, and the mean blood loss (p < 0.001) was significantly lower. However last follow-up showed no statistically significant differences as regards residual medial wall displacement (p = 1.0), final radiological (p = 0.86), and clinical outcomes (p = 1.0). Authors concluded that the anatomical QLP made it easier to reduce and fix acetabular fractures with a displaced medial wall. This was done by using multidirectional screws in the posterior column through its infra-pectineal extension and a strong screw purchase aimed at the posterior column through its supra-pectineal part. The two groups were similar in terms of final radiological and clinical outcomes, as well as residual medial wall displacement rates. However, the QLP had less morbidity than the classic infra-pectineal plating (shorter operation time and less blood loss).

Application of a posterior anatomical integrated locking compression plate in the treatment of posterior wall acetabular fractures

BackgroundTraditional fixation methods for posterior wall acetabular fractures (PWAFs) typically require the utilization of multiple plates and intraoperative plate contouring, which are technically demanding and carry the risk of intra-articular screw penetration. A novel posterior anatomical integrated locking compression plate (PAILCP) has been designed to optimize these shortcomings. This study aims to evaluate the feasibility and effectiveness of the PAILCP fixation method for the surgical management of PWAFs.MethodsA total of 48 patients with PWAFs who were treated surgically in our department between January 2018 and December 2022 were selected for retrospective analysis. The 48 patients were classified into groups A (PAILCP fixation, n = 25) and B (traditional fixation, n = 23) according to different fixation methods. Fracture reduction quality, number of utilized plates, blood loss, surgical time, instrumentation time, hip function, and complications were compared between the two groups.ResultsA total of 25 PAILCPs were used in group A, while 34 mini-T plates and 29 reconstruction plates were employed in group B. Compared to the patients in group B, those in group A had significantly shorter instrumentation time (− 16 min) and surgical time (− 23 min) as well as lower blood loss (− 123 ml). However, no significant differences were observed in fracture reduction quality and hip function between the two groups. Additionally, the complication rate was slightly lower in group A (3/25 patients) than in group B (6/23); however, this difference was not statistically significant. Finally, follow-up examination revealed no main plate breakage, miniplate displacement, screw loosening, or intra-articular screw penetration in all patients.ConclusionThe surgical treatment of PWAFs using the PAILCP fixation method results in shorter instrumentation and surgical time and lower blood loss than the traditional fixation method. Thus, the PAILCP fixation method is a promising alternative for PWAFs management, offering enhanced surgical ease and safety.

SIMULTANEOUS VERSUS STAGED TOTAL HIP ARTHROPLASTY FOLLOWING ACETABULAR FRACTURE FIXATION: A COMPARISON OF OUTCOMES

Acetabular fractures present a challenge. Anatomical reduction can be achieved by open reduction and internal fixation (ORIF). However, in elderly patients with complex fracture patterns and osteoporotic bone stock, “fix and replace” has become an option in the management of these injuries. This involves ORIF of the acetabulum to enable insertion of a press fit cup and subsequent cemented femoral stem at the index surgery.A Retrospective analysis of all operatively managed acetabular fractures by a regional Pelvic and Acetabular Trauma service (01/01/2018-30/05/2023) STATA used for analysis. 34 patients undergoing “fix and replace” surgery. Of the 133 patients managed with ORIF, 21 subsequently required Total Hip Arthroplasty (THA). Mean follow up was 2.7 years versus 5.1. There was no statistical significance between the two groups with regards to BMI or sex. Mean age in the “fix and replace” group was 68 compared to 48 in the ORIF and subsequent THA group. This reached statistical significance between the two groups (p=0.001).ASA and Charlson Comorbidity Index (3 and 3 in “fix and replace” and 2 and 1.2 in ORIF to THA group) and Charlson Comorbidity Index both were statistically significantly different (p=0.006 and p=0.027, respectively). High energy mechanism of injury accounted for 56% of the “fix and replace” group compared to 48% in the ORIF to THA. 74% of “fix and replace” were associated fractures compared to 53% of ORIF to THA. Wait to surgery was 3 days for “fix and replace” while 186 days was the mean wait time from listing to THA for the ORIF to THA group. Complication rate was 41% versus 43% in the two groups. 14% in the ORIF to THA group developed PJI versus 6% in “fix and replace”.Fix and replace allows early mobilisation in frailer, elderly patients. Our results show fewer returns to theatre and less PJI in patients having arthroplasty as part of “fix and replace” than subsequent to Open reduction internal fixation.