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Qoreishy M, Sajedi A, Gholipour M, Gorji M, Maleki A. Clinical results of acetabular fracture treatment with hybrid fixation by anterior and posterior approach : A minimally invasive technique. Wien Klin Wochenschr 2024; 136:556-561. [PMID: 37815673 DOI: 10.1007/s00508-023-02277-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 08/27/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Open reduction and internal fixation have been described as the gold standard for the treatment of acetabular fractures, but the high complications of these surgeries have led surgeons to seek less invasive procedures. In recent years, minimally invasive treatment, such as fixation through the skin have been proposed. The aim was to assess acetabular fracture outcomes of combination of posterior approach (Kocher-Langenbeck [KL]) with anterior percutaneous screw fixation (APSF) with minimally invasive surgery (MIS). METHODS Between February 2017 and July 2019, 155 patients with acetabular fractures underwent fixation with the KL + APSF approach. For 1 year functional outcomes, radiographic findings, and postoperative complications were evaluated. RESULTS Of 155 patients with a mean age of 40.16 ± 10.32 years, 82 patients were male and 73 were female. The most common pattern of fracture was both columns (32.9%). The average blood loss was approximately 527 ml. The average operation time was 85 min. The mean length of surgical incision was 113.3 mm. Harris' hip score was excellent in 75.5% of cases. The mean VAS score was approximately 4 and 91.6% of patients returned to pre-trauma activity. In 74.8% of cases, the reduction was anatomical. Complications after surgery were very insignificant and included the following: 2 patients had foot drop within 5 months both patients recovered, 2 patients had femoral nerve palsy and 3 cases of deep vein thrombosis and 1 case of pulmonary thromboembolism were treated. There were four patients with surgical site infections, all of whom recovered and two of the seven patients with osteoarthritis underwent total hip arthroplasty. CONCLUSION Combining posterior approach with minimally invasive anterior method in fixation and treatment of acetabular fractures is a safe and reliable method and showed significant functional results with minimal complications.
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Affiliation(s)
- Mohammad Qoreishy
- orthopedic surgery of medical science, Shahid Beheshti University of Medical Sciences, Akhtar hospital, Tehran, Iran
| | - Abdoreza Sajedi
- orthopedic surgery of medical science, Shahid Beheshti University of Medical Sciences, Akhtar hospital, Tehran, Iran
| | | | - Mona Gorji
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Maleki
- orthopedic surgery of medical science, Shahid Beheshti University of Medical Sciences, Akhtar hospital, Tehran, Iran.
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2
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Çevik HB, Ruggieri P, Giannoudis PV. Management of metastatic bone disease of the pelvis: current concepts. Eur J Trauma Emerg Surg 2024; 50:1277-1294. [PMID: 37934294 DOI: 10.1007/s00068-023-02382-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/17/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Metastatic disease of the pelvis is frequently associated with severe pain and impaired ambulatory function. Depending on the patient's characteristics, primary tumor, and metastatic pelvic disease, the treatment choice may be varied. This study aims to report on the current management options of metastatic pelvic disease. METHODS We comprehensively researched multiple databases and evaluated essential studies about current concepts of managing a metastatic bone disease of the pelvis, focusing on specific indications as well as on the result of treatment. RESULTS Pelvic metastases not in the periacetabular region can be managed with modification of weight-bearing, analgesics, bisphosphonates, chemotherapy and/or radiotherapy. Minimally invasive approaches include radiofrequency ablation, cryoablation, embolization, percutaneous osteoplasty, and percutaneous screw placement. Pathological or impending periacetabular fracture, excessive periacetabular bone defect, radioresistant tumor, and persistent debilitating pain despite non-surgical treatment and/or minimally invasive procedures can be managed with different surgical techniques. Overall, treatment can be divided into nonoperative, minimally invasive, and operative based on specific indications, the expectations of the patient and the lesion. CONCLUSION Different treatment modalities exist to manage metastatic pelvic bone disease. Decision-making for the most appropriate treatment should be made with a multidisciplinary approach based on a case-by-case basis.
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Affiliation(s)
- Hüseyin Bilgehan Çevik
- Orthopaedics and Traumatology, Ankara Etlik City Hospital, University of Health Sciences, Ankara, Turkey.
| | - Pietro Ruggieri
- Orthopaedics and Orthopaedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Padua, Italy
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
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Khalifa AA, Mahran DG, Fergany A, Farouk O. Epidemiology of acetabular fractures in elderly patients and the effect of various management options on the outcomes. A comprehensive narrative review. Int J Orthop Trauma Nurs 2024; 53:101049. [PMID: 37852917 DOI: 10.1016/j.ijotn.2023.101049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/02/2023] [Accepted: 09/04/2023] [Indexed: 10/20/2023]
Abstract
Owing to the expected increase in the world's elderly population (>65 years old), and the concomitant osteoporosis in this particular population, fragility fractures of the pelvis and the acetabulum is becoming a real concern, which could be life-threatening. In the current review, we aimed to discuss the various epidemiological characteristics of geriatric acetabular fractures, management options, and the outcomes. For the review synthesis, we searched PubMed to select the most relevant and updated articles published from various areas and institutions. Geriatric acetabular fractures are mainly caused by trivial trauma, constitute about 1.5%-3% of all skeletal injuries, and showed a 2.4-fold increase over the past three decades. Furthermore, these fractures' associated one-year mortality rate ranges from 14% to 25%. Management options differ largely according to the type and severity of the injury if there is an associated skeletal or non-skeletal injury, and preexisting patient comorbidities. These options could be nonoperative or operative (including surgical fixation and acute total hip arthroplasty), and both carry a specific risk in this vulnerable age group. There is controversy among various reports regarding the best management option leading to better function and health-related quality of life (HRQoL) outcomes. In conclusion, the incidence of acetabular fractures in elderly patients is rising. The decision-making on the best management option should consider the patient's fragility, injury severity, poor bone quality, and multiple medical comorbidities. The outcomes related to function, quality of life, and mortality are comparable between operative and nonoperative management options.
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Affiliation(s)
- Ahmed A Khalifa
- Orthopaedic Department, South Valley University, Qena, Egypt.
| | - Dalia Galal Mahran
- Department of Public Health and Community Medicine, Assiut University, Assiut, Egypt.
| | - Ali Fergany
- Orthopaedic Department, Assiut University Hospital, Assiut, Egypt.
| | - Osama Farouk
- Orthopaedic Department, Assiut University Hospital, Assiut, Egypt.
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Pagano S, Müller K, Alt V, Maderbacher G, Holzapfel DE, Baumann F, Freigang V. [Navigated or conventional acetabular surgery : Comparison of positional accuracy exemplified by the infra-acetabular screw]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:44-53. [PMID: 36929038 PMCID: PMC10786994 DOI: 10.1007/s00113-023-01304-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND The principle of joint-preserving treatment of acetabular fractures is the anatomic reduction of joint-bearing elements and internal osteosynthesis. For stabilization of the anterior and posterior columns against each other, the infra-acetabular screw (IAS) is regularly used in the clinical routine. OBJECTIVE The aim of this study was to compare the position of the IAS in the infra-acetabular corridor after navigated placement and after freehand placement. MATERIAL AND METHOD The position of the screw was evaluated in 42 patients using multiplanar reconstructions. The screw was placed freehand in 30 patients and using image-guided navigation in 12 patients. In addition to measurement of the position of the screw, demographic data, operating time, radiation exposure and blood loss were recorded. RESULTS The vast majority of the patients were male (86%), the median age was 67 years and the median body mass index (BMI) was 25 kg/m2. The median operating time was 166 min and the median blood loss was 900 ml. The adjusted values in the whole sample considering the position of the screw were: distance of screw to cartilage mean value (m) = 3.8 mm, distance of screw to corridor center m = 3.5 mm and angle of screw to corridor m = 1.4°. There were no differences between the groups in the demographic parameters and the accuracy of positioning of the screw (p-value > 0.05). There was a longer irradiation time and a higher radiation dose in the navigated group compared to the group without navigation (p-value < 0.001). CONCLUSION With appropriate experience both procedures are comparable taking into account the accuracy. Taking into consideration other perioperative parameters, such as radiation exposure and planned operating time, patient-related factors should be taken into consideration.
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Affiliation(s)
- Stefano Pagano
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - Karolina Müller
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Volker Alt
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Günther Maderbacher
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Dominik E Holzapfel
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Florian Baumann
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Viola Freigang
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
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Şibar K, Alemdaroğlu KB, Elibol FKE, Çalişkan Öİ, Demir T. Talon cannulated compression device as an alternative in the fixation of acetabulum posterior column fractures: A biomechanical study. Injury 2023; 54:110964. [PMID: 37573841 DOI: 10.1016/j.injury.2023.110964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/12/2023] [Accepted: 07/26/2023] [Indexed: 08/15/2023]
Abstract
To compare the amount of displacement and rigidity at the fracture line under static & dynamic axial loading and torsional stress of conventional cannulated screw (CS), plate screw fixation including inter-fragmentary screw (PL), and talon cannulated compression device or talon screw in other words (TS) in posterior column fracture models. Synthetic hemipelvis bone models presenting a posterior column fracture were used in this study. Group PL, CS, and TS were created with ten bone models prepared for each group for dynamic and static loading tests and another ten for torsional tests. Rigidity and displacement amounts before and after loading were measured at the reference points AL, BL, and CL, located at the acetabulum's top, middle, and bottom, respectively. Torsional tests for each group were used to calculate torsional rigidity and maximum torque values. In dynamic axial loading tests, Group CS showed more displacement than PL at the BL point (p = 0,032) and Group TS at AL (p = 0,032) and CL (p = 0,004) points. In static axial loading tests, Group CS significantly displaced more than TS at AL and CL points (p = 0,05 and p = 0,014, respectively). Group PL and Group TS exhibited similar behavior in dynamic, static axial loading tests and torsional rigidity. The maximum torque that Group PL could withstand was statistically significantly higher than the other two groups (p <0,001). Talon cannulated screws had promising results in posterior column fractures of the acetabulum, which may decline the need for open surgery for stable fixation.
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Affiliation(s)
- Kemal Şibar
- SBÜ Ankara Training and Research Hospital, Ankara, Turkey.
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Höller S, Wübbeke LF, Apel J, Hawellek T, Sehmisch S, Wiedenhöft J, Lehmann W, Hoffmann DB. Retrospective In-Hospital Mortality Analysis of GeriatricPatients Treated in a Level 1 Trauma Center. J Clin Med 2023; 12:jcm12103466. [PMID: 37240572 DOI: 10.3390/jcm12103466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/01/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
The aim of this study is to determine the critical time intervals and influencing covariates for in-hospital mortality in geriatric trauma and orthopedic patients. During a period of five years, we retrospectively review patients aged > 60 years who were hospitalized at the Department of Trauma, Orthopedic, and Plastic Surgery. The primary outcome is the mean time to death. Survival analysis is performed using an accelerated failure time model. A total of 5388 patients are included in the analysis. Two-thirds underwent surgery (n = 3497, 65%) and one-third were conservatively treated (n = 1891, 35%). The in-hospital mortality rate is 3.1% (n = 168; surgery, n = 112; conservative, n = 56). The mean time to death is 23.3 days (±18.8) after admission in the surgery group and 11.3 days (±12.5) in the conservative treatment group. The greatest accelerating effect on mortality is found in the intensive care unit (16.52, p < 0.001). We are able to identify a critical time interval for in-hospital mortality between days 11 and 23. The day of death on weekend days/holidays, hospitalization for conservative treatment, and treatment at the intensive care unit significantly increase the risk of in-hospital mortality. Early mobilization and a short hospitalization duration seem to be of major importance in fragile patients.
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Affiliation(s)
- Sebastian Höller
- Department of Trauma, Orthopedic and Plastic Surgery, University Medical Center Göttingen (UMG), 37075 Göttingen, Germany
| | - Lina F Wübbeke
- Department of Trauma, Orthopedic and Plastic Surgery, University Medical Center Göttingen (UMG), 37075 Göttingen, Germany
| | - Jamina Apel
- Department of Trauma, Orthopedic and Plastic Surgery, University Medical Center Göttingen (UMG), 37075 Göttingen, Germany
| | - Thelonius Hawellek
- Department of Trauma, Orthopedic and Plastic Surgery, University Medical Center Göttingen (UMG), 37075 Göttingen, Germany
| | - Stephan Sehmisch
- Department of Trauma Surgery, Medical School Hannover, 30625 Hannover, Germany
| | - John Wiedenhöft
- Scientific Core Facility for Medical Biometry and Statistical Bioinformatics (MBSB), University Medical Center Göttingen (UMG), 37075 Göttingen, Germany
| | - Wolfgang Lehmann
- Department of Trauma, Orthopedic and Plastic Surgery, University Medical Center Göttingen (UMG), 37075 Göttingen, Germany
| | - Daniel B Hoffmann
- Department of Trauma, Orthopedic and Plastic Surgery, University Medical Center Göttingen (UMG), 37075 Göttingen, Germany
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Comparison of Percutaneous Screw Fixation to Open Reduction and Internal Fixation in Acetabular Fractures: A Matched Pair Study Regarding the Short-Term Rate of Conversion to Total Hip Arthroplasty and Functional Outcomes. J Clin Med 2023; 12:jcm12031163. [PMID: 36769810 PMCID: PMC9917484 DOI: 10.3390/jcm12031163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Closed reduction and percutaneous internal fixation (CRPIF) for acetabular fractures was introduced as a less invasive alternative to open reduction and internal fixation (ORIF) for moderately displaced fractures. Currently, comparisons of ORIF and CRPIF outcomes are rare. Twenty-three patients treated with CRPIF were matched with patients treated with ORIF based on sex, age, and fracture classification. Surgery-dependent and -independent factors of the in-hospital stay, the conversion rate to total hip arthroplasty (THA), and quality of life were assessed. The ORIF group had a higher preoperative fracture step (p = 0.04) and gull wing sign (p = 0.003) compared with the CRPIF group. Postoperatively, the gap and step size were not significantly different between the groups (p > 0.05). CRPIF required less time (p < 0.0001) and transfusions (p = 0.009) and showed fewer complications (p = 0.0287). Four patients were converted to THA (CRPIF, n = 1; ORIF, n = 3; p = 0.155) because of posttraumatic osteoarthritis. Functional outcomes and pain were similar in both groups (p > 0.05). The present study revealed less blood loss and a lesser extent of reduction in patients treated with CRPIF than in those treated with ORIF. The rates of conversion to THA and functional outcomes did not differ between CRPIF and ORIF. CRPIF appeared to be a valuable treatment option for selected patients.
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Soni A, Gupta R, Sen R. Acetabulum fractures in elderly patients: A review. Chin J Traumatol 2022; 25:331-335. [PMID: 35033421 PMCID: PMC9751531 DOI: 10.1016/j.cjtee.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 09/30/2021] [Accepted: 11/21/2021] [Indexed: 02/04/2023] Open
Abstract
Fractures of the acetabulum in elderly patients were often caused by low energy trauma. Fractures involving anterior column are more common and often associated with impaction and comminution. Osteoporosis further complicates the management. Percutaneous fracture fixation has low morbidity but it is a technically demanding procedure. Open reduction and fracture fixation is done with or without simultaneous total hip replacement. Delayed total hip replacement is considered in posttraumatic arthritis patients. Patients with minimal displaced fractures, associated both-column fractures with secondary congruence of joint and patients who are medically unfit for surgery can be managed non-operatively. Whatever be the method of management, these elderly patients should be mobilised as early as possible.
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Affiliation(s)
- Ashwani Soni
- Department of Orthopaedics, Government Medical College and Hospital, Sector-32, Chandigarh, 160030, India,Corresponding author.
| | - Ravi Gupta
- Department of Orthopaedics, Government Medical College and Hospital, Sector-32, Chandigarh, 160030, India
| | - Ramesh Sen
- Department of Orthopaedics, Max Super Speciality Hospital, Sahibzada Ajit Singh Nagar, Mohali, 160062, India
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Koehl P, Pelk K, Necula R, Goyal T, Abbas K, Schuh A. [Hip fractures in the elderly - what should be done to achieve early recovery?]. MMW Fortschr Med 2022; 164:40-48. [PMID: 35941450 DOI: 10.1007/s15006-022-1217-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Philipp Koehl
- Klinik für Orthopädie und Unfallchirurgie/Hand-/Wirbelsäulenchirurgie, Klinikum Fichtelgebirge, Schillerhain 1-8, 95615, Marktredwitz, Deutschland.
| | - Kerstin Pelk
- Klinik für Akutgeriatrie, Klinikum Fichtelgebirge, 95100, Selb, Deutschland
| | - Radu Necula
- Klinik für Orthopädie und Traumatologie, Universität Transilvania Brașov, 500036, Brașov, Rumänien
| | - Tarun Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab, Indien
| | - Kashif Abbas
- Trauma and Orthopaedics, University Hospital Southampton, Southampton, UK
| | - Alexander Schuh
- Abteilung für Muskuloskelettale Forschung, Klinikum Fichtelgebirge gGmbH - Haus Marktredwitz, Marktredwitz, Deutschland
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Le Quang H, Schmoelz W, Lindtner RA, Dammerer D, Schwendinger P, Krappinger D. Single column plate plus other column lag screw fixation vs. both column plate fixation for anterior column with posterior hemitransverse acetabular fractures - a biomechanical analysis using different loading protocols. Injury 2021; 52:699-704. [PMID: 33454060 DOI: 10.1016/j.injury.2020.12.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Open reduction and internal fixation of both columns is considered the treatment of choice for displaced anterior column with posterior hemitransverse (ACPHT) fractures in non-geriatric patients. Plate fixation of one column combined with lag screw fixation of the other column allows to decrease operative time and approach-related morbidity compared to conventional both column plating. The aim of this biomechanical study was to evaluate whether single column plate plus other column lag screw fixation confers similar stability to both column plate fixation. Physiological loads were simulated using both the single-leg stance (SLS) as well as the sit-to-stand (STS) loading protocols. METHODS A clinically relevant ACPHT fracture model was created using fourth-generation composite hemipelves. Fractures were stabilized with three different fixation constructs: (1) anterior column plate plus posterior column screw fixation (AP+PCS), posterior column plate plus anterior column screw fixation (PP+ACS) and anterior column plate plus posterior column plate fixation (AP+PP). Specimens were loaded from 50 to 750 N with a ramp of 100 N/s. Fracture gap motion (FGM) and relative interfragmentary rotation (RIFR) between the three main fracture fragments were assessed under loads of 750 N using an optical 3D measurement system. RESULTS STS loading generally resulted in higher mean FGM and RIFR than STS loading in the AP+PCS and AP+PP groups, while no significant differences were found in the PP+ACS group. Compared to conventional both column plate fixation (AP+PP), PP+ACS displayed significantly higher FGM and RIFR between the iliac wing and the posterior column during SLS loading. No significant differences in FGM and RIFR were identified between the AP+PCS and the AP+PP group. CONCLUSION Overall, single column plate plus other column lag screw fixation conferred similar stability to conventional both column plate fixation. From a clinical point of view, AP+PCS appears to be the most attractive alternative to conventional AP+PP for internal fixation of ACPHT fractures.
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Affiliation(s)
- Huy Le Quang
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Werner Schmoelz
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Richard A Lindtner
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Dietmar Dammerer
- Department of Orthopaedic Surgery, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Peter Schwendinger
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Dietmar Krappinger
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
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Bastian JD, Tarrant SM, Buckley R. Geriatric acetabular fracture-ORIF or ORIF and acute total hip arthroplasty(aTHA). Injury 2021; 52:384-386. [PMID: 33483107 DOI: 10.1016/j.injury.2021.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Johannes D Bastian
- Head Orthogeriatric Service Department of Orthopedic Surgery and Traumatology Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Seth M Tarrant
- Dept of Traumatology, John Hunter Hospital, Locked Bag 1, Hunter Region Mail Center, Newcastle, NSW 2310, Australia
| | - Richard Buckley
- Orthopedic Trauma, University of Calgary, Foothills Medical Center, 3134 Hospital Drive NW, Calgary, Alberta T2N 5A1, Canada.
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Goyal T, Singh G, Kumar Tripathy S, Schuh A, Veerappa LA, Kumar Sen R. Acetabulum fractures in elderly: A systematic review of fracture pattern and treatment. J Clin Orthop Trauma 2020; 11:989-1001. [PMID: 33192001 PMCID: PMC7656468 DOI: 10.1016/j.jcot.2020.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/05/2020] [Accepted: 09/07/2020] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Acetabulum fractures are being increasingly seen with low impact injuries in elderly patients. This article aimed to study systematically literature on geriatric acetabulum fractures. Objectives of this systematic review were to study (1) demography of patients, common mechanisms of injury and types of fracture patterns commonly seen in elderly patients, (2) treatment used for these fractures in literature and (3) mortality rates in elderly with these fractures. METHODS Systematic search was carried out in May 2020 using predefined search strategy for all studies published in the English language in last 20 years. Literature search and data abstraction was done by two independent reviewers. RESULTS After screening of all abstracts, a total of 48 studies were included in the systematic review. In total there were 7876 geriatric patients with acetabulum fractures. Mean age of the patients was 72.47 years. There were 4841 males (61.5%). Fall from low heights was the most common mechanism of injury, present in 47.12% patients followed by motor vehicular accidents in 28.73%. Most common fracture pattern was both column fracture, seen in 19.03% patients, followed by anterior column and posterior hemitransverse fracture in 17.23%, anterior column fractures in 17.13%, and posterior wall fractures in 13.46% patients. Out of total 5160 patients for whom details of treatment were available, 2199 (42.62%) were given non-operative treatment, 2285 (44.28%) were treated with ORIF of acetabulum fracture, 161 (3.12%) were treated with percutaneous fixation and 515 (9.98%) were treated with primary THA. Gull sign, femoral head injury and posterior wall comminution were associated with poorer prognosis after ORIF and may form an indication for a primary THA. CONCLUSION Literature on treatment of geriatric acetabulum fractures is not enough to draw any definite conclusions. There is limited evidence from current literature that surgery could be considered a safe treatment option for displaced acetabulum fractures in elderly. Primary THA can provide early mobility and reduce chances of resurgery in fracture patterns where restoration of joint surface may not be possible.
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Affiliation(s)
- Tarun Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India
- Corresponding author.
| | - Gaganpreet Singh
- Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India
| | - Sujit Kumar Tripathy
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India
| | - Alexander Schuh
- Muskuloskelettales Zentrum Klinikum Neumarkt, Akademisches Lehrkrankenhaus der Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberger Str. 12, D-92318, Neumarkt i. d. OPf., Germany
| | | | - Ramesh Kumar Sen
- Institute of Orthopedic Surgery, Max Super Speciality Hospital, Mohali, India
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