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Park KT, Park EK, Lee DH, An JH, Won J, Kim SH, Lee YK, Park JW. The Current Incidence and Future Projection of Acetabular Fractures in Korea. J Korean Med Sci 2024; 39:e204. [PMID: 39015002 PMCID: PMC11249580 DOI: 10.3346/jkms.2024.39.e204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 06/02/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND As one of the most challenging fractures to orthopedic surgeons, acetabular fractures show a wide range of incidence among countries and regions with even more variance in the treatment modalities. In this study, we aimed to investigate the epidemiology of acetabular fractures, and to compare the rate of subsequent total hip arthroplasty (THA) between nonoperative and operative treatments in South Korea using a medical claims database. METHODS This was a retrospective study using the Korean Health Insurance Review and Assessment database. Patients admitted for acetabular fractures from January 2007 to December 2018 were identified using International Classification of Diseases-10 codes. Kaplan-Meier survival analysis was used to compare the cumulative incidence of THA between two groups. We also evaluated the survivorship of operative group according to the type of institutions. RESULTS The incidence rate of acetabular fractures increased by 28% between 2007 and 2018. Acetabular fractures were more common in men (62%) than women (38%), and most common in the patients older than 80 years. The number of acetabular fractures was estimated to increase 1.7-fold in 2030 compared to 2018. Operative treatment accounted for 16% of cases, and nonoperative treatment for 84%. The incidence of subsequent THA was higher in the operative treatment group than in the nonoperative group (P < 0.001). The higher rate in the operative treatment group is probably related with the severity of the fracture type. The rate of subsequent THA was higher in patients who initially treated in general hospitals compared with those who were initially treated in tertiary hospitals. CONCLUSION The incidence of acetabular fractures is increasing in South Korea, in line with global trends. Most acetabular fractures are treated conservatively, and those who receive surgery are more likely to require a subsequent THA. Patients who were operated in general hospitals had highest possibility of subsequent THA after acetabular fractures.
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Affiliation(s)
- Ki-Tae Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Kyung Park
- Department of Radiology, We Comfortable Clinic, Seoul, Korea
| | - Dong-Hoon Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joon Hwan An
- Department of Orthopaedic Surgery, Chamjoeun Hospital, Gwangju, Korea
| | - Jonghwa Won
- Department of Orthopaedic Surgery, Chamjoeun Hospital, Gwangju, Korea
| | - Sung Hwa Kim
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
| | - Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
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Nolte E, Blommer J, Som M, Parsa S, Kim P, Hasan S, Boissonneault A, O’Hara NN, Slobogean GP, O’Toole RV. Frequency and Characteristics of Posterior Labral Injuries in Operative Acetabular Fractures Treated Through a Posterior Approach: A Prospective Observational Study. J Orthop Trauma 2024; 38:83-87. [PMID: 38032226 PMCID: PMC10843808 DOI: 10.1097/bot.0000000000002736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/17/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES The association between labral injuries and acetabular fractures is unknown. This study aimed to identify the frequency and characteristics of labral injuries in operatively treated acetabular fractures that cannot be identified on preoperative imaging. METHODS . DESIGN Prospective observational cohort. SETTING Level I trauma center. PATIENT SELECTION CRITERIA Adult patients with an acetabular fracture operatively treated through a posterior approach. OUTCOME MEASURES AND COMPARISONS The frequency and characteristics of labral injuries. RESULTS Fifty-three of 71 acetabular fractures (75%; 95% confidence interval, 63%-83%) demonstrated a labral injury visible via the posterior approach. Posterior labral injuries occurred in 89% of operative acetabular fracture patterns involving the posterior wall and most commonly represent a detachment of the posteroinferior labrum (n = 39, 75%). Fractures with a labral injury were more likely to have gluteus minimus damage (93% vs. 61%, P = 0.02), femoral head lesions (38% vs. 17%, P = 0.03), joint capsule detachment (60% vs. 33%, P = 0.05), and fracture patterns involving the posterior wall (89% vs. 50%, P = 0.05). CONCLUSIONS This study describes the high rate (89%) of posterior labral injuries in posterior wall fractures, the most common injury pattern being a detachment of the posteroinferior labrum. Labral injuries in acetabular fractures may have important clinical implications and this study is the first to identify the frequency and characteristics of these injuries. Further studies should assess the relationship between labral injuries, treatment strategies, and the progression to post-traumatic osteoarthritis. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Elizabeth Nolte
- Department of Orthopaedic Surgery, The Medical College of Wisconsin, Milwaukee, WI
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Joseph Blommer
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Maria Som
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Shirin Parsa
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Peter Kim
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Sania Hasan
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Adam Boissonneault
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA
| | - Nathan N. O’Hara
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Gerard P. Slobogean
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Robert V. O’Toole
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
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Tucker A, Roffey DM, Guy P, Potter JM, Broekhuyse HM, Lefaivre KA. Evaluation of the trajectory of recovery following surgically treated acetabular fractures. Bone Joint J 2024; 106-B:69-76. [PMID: 38160696 DOI: 10.1302/0301-620x.106b1.bjj-2023-0499.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Aims Acetabular fractures are associated with long-term morbidity. Our prospective cohort study sought to understand the recovery trajectory of this injury over five years. Methods Eligible patients at a level I trauma centre were recruited into a longitudinal registry of surgical acetabular fractures between June 2004 and August 2019. Patient-reported outcome measures (PROMs), including the 36-Item Short Form Health Survey (SF-36) physical component summary (PCS), were recorded at baseline pre-injury recall and six months, one year, two years, and five years postoperatively. Comparative analyses were performed for elementary and associated fracture patterns. The proportion of patients achieving minimal clinically important difference (MCID) was determined. The rate of, and time to, conversion to total hip arthroplasty (THA) was also established. Results We recruited 251 patients (253 fractures), with a 4:1 male to female ratio and mean age of 46.1 years (SD 16.4). Associated fracture patterns accounted for 56.5% of fractures (n = 143). Trajectory analysis showed all timepoints had significant disability versus baseline, including final follow-up (p < 0.001). Elementary fractures had higher SF-36 PCS at six months (p = 0.023) and one year (p = 0.007) compared to associated fractures, but not at two years (p = 0.135) or five years (p = 0.631). The MCID in SF-36 PCS was observed in 37.3% of patients (69/185) between six months and one year, 26.9% of patients (39/145) between one and two years, and 23.3% of patients (20/86) between two and five years, highlighting the long recovery potential of these injuries. A significant proportion of patients failed to attain the MCID after five years (38.1%; 40/105). Conversion to THA occurred in 13.1% of patients (11/110 elementary and 22/143 associated fractures). Approximately two-thirds of THAs (21/33 patients; 63.6%) were performed within two years of index surgery. Conclusion Acetabular fractures significantly impact physical function. Recovery trajectory is often elongated beyond one year, with two-thirds of our patients displaying persistent clinically relevant long-term disability.
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Affiliation(s)
- Adam Tucker
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Darren M Roffey
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, Canada
| | - Pierre Guy
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, Canada
| | - Jeffrey M Potter
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, Canada
| | - Henry M Broekhuyse
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, Canada
| | - Kelly A Lefaivre
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, Canada
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Liang K, Gani MH, Griffin X, Culpan P, Mukabeta T, Bates P. Acute versus delayed total hip arthroplasty after acetabular fracture fixation: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2683-2693. [PMID: 36810707 PMCID: PMC10504200 DOI: 10.1007/s00590-023-03489-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/05/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Post-traumatic osteoarthritis (PTOA) is a disabling complication of open reduction and internal fixation (ORIF) for acetabular fractures. There is a trend towards acute total hip arthroplasty (THA), 'fix-and-replace', in patients considered to have a poor prognosis and likelihood of PTOA. Controversy remains between early fix-and-replace, versus delayed THA as required after initial ORIF. This systematic review included studies comparing functional and clinical outcomes between acute versus delayed THA after displaced acetabular fractures. METHODS Comprehensive searches following the PRISMA guideline were performed on six databases for articles in English published anytime up to 29 March 2021. Two authors screened articles and discrepancies were resolved by consensus. Patient demographics, fracture classification, functional and clinical outcomes were compiled and analysed. RESULTS The search yielded 2770 unique studies, of which five retrospective studies were identified with a total of 255 patients. Of them, 138 (54.1%) were treated with acute and 117 (45.9%) treated with delayed THA. Delayed THA group represented a younger cohort compared to the acute group (mean age, 64.3 vs 73.3). The mean follow-up time for the acute and delayed group was 23 and 50 months, respectively. There was no difference in functional outcomes between the two study groups. Complication and mortality rates were comparable. Delayed THA had a higher revision rate compared to the acute group (17.1 vs 4.3%; p = 0.002). CONCLUSION Fix-and-replace had functional outcomes and complication rates similar to ORIF and delayed THA, but lower revision rates. Although the quality of studies was mixed, sufficient equipoise now exists to justify randomised studies in this area. PROSPERO registration: CRD42021235730.
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Affiliation(s)
- Kaifeng Liang
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, The Royal London Hospital, Whitechapel Road, London, E1 1FR, UK.
| | | | - Xavier Griffin
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, The Royal London Hospital, Whitechapel Road, London, E1 1FR, UK
- Bone & Joint Health, Barts Health NHS Trust, London, UK
| | - Paul Culpan
- Bone & Joint Health, Barts Health NHS Trust, London, UK
| | | | - Peter Bates
- Bone & Joint Health, Barts Health NHS Trust, London, UK
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van den Broek M, Govaers K. Total Hip Arthroplasty with Cemented Dual Mobility Cup into a Fully Porous Multihole Cup with Variable Angle Locking Screws for Acetabular Fractures in the Frail Elderly. Hip Pelvis 2023; 35:54-61. [PMID: 36937212 PMCID: PMC10020729 DOI: 10.5371/hp.2023.35.1.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/19/2022] [Accepted: 11/25/2022] [Indexed: 03/21/2023] Open
Abstract
Purpose The purpose was to examine the clinical and radiological outcomes after surgical treatment of acetabular fractures with total hip arthroplasty with a dual mobility cup cemented into a porous multihole cup in the population of frail elderly patients. Materials and Methods A retrospective review of 16 patients who underwent surgery (mean age, 76.7 years) with a mean follow-up period of 36.9 months was conducted. Following surgery, patients underwent postoperative follow-up at six weeks, three, six, and 12 months and clinical and radiological examinations were performed. Results Classification of fractures was based on the Letournel classification. Following surgery, all patients were allowed weight-bearing as tolerated immediately postoperative. Fourteen patients showed maintenance of preoperative mobility status at one year. The mean Harris hip score was 64.8 (range, 34.7-82.8) and 80.0 (range, 60.8-93.8) at three months and one year, respectively. The mortality rate was 12.5% at one year (2/16). Complications included heterotopic ossification (2/16), deep venous thrombosis (1/16), heamatoma (1/16), and femoral revision due to a Vancouver B2 fracture (1/16). No case of deep infection, dislocation, or implant loosening was reported. Conclusion Total hip arthroplasty using a dual mobility cup cemented into a porous multihole cup with locking screws resulted in a stable construct with a capacity for immediate weight-bearing as tolerated with rapid relief of pain. The findings of this study suggest that this procedure can be regarded as a safe method that has shown promising clinical and radiological outcomes for treatment of patients with medical frailty.
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Affiliation(s)
| | - Kris Govaers
- Department of Orthopaedic Surgery, az Sint-Blasius, Dendermonde, Belgium
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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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Zhang BF, Zhuang Y, Liu L, Xu K, Wang H, Wang B, Wen HQ, Xu P. Current indications for acute total hip arthroplasty in older patients with acetabular fracture: Evidence in 601 patients from 2002 to 2021. Front Surg 2023; 9:1063469. [PMID: 36684223 PMCID: PMC9853543 DOI: 10.3389/fsurg.2022.1063469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/13/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose Older patient population with acetabular fractures is increasing rapidly, requiring enhanced recovery. Acute total hip arthroplasty (THA) is a good option for these patients, and it is becoming increasing popular. However, acute THA has different indications in different studies. Therefore, a systematic review is needed to assess and comprehend the indications for acute THA in older patients. Methods A systematic literature review was conducted to identify a retrospective series or prospective studies in older patients (>60 years) with acetabular fractures. The search timeline was from database construction till December 2021; PubMed, Embase, and Cochrane Library databases were searched. Two trained professional reviewers independently read the full text of documents that met the inclusion criteria and extracted information on the specific methods used and indication information based on the research design. Results In total, there were 601 patients with acetabular fractures aged >60 years from 33 studies were obtained. Twenty-eight studies reported that THA was a feasible treatment option for acetabular fractures in geriatric patients with good outcome. The primary indications were dome impaction, irreducible articular comminution, femoral head injury, and pre-existing osteoarthritis or avascular necrosis. The most common patterns were anterior column and posterior hemitransverse, posterior wall, both columns, and T-type. Conclusion Acute THA is an effective treatment strategy for older patients with acetabular fractures and should be considered when the abovementioned indications are observed on preoperative images. (PROSPERO: CRD42022329555).
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Affiliation(s)
- Bin-Fei Zhang
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Yan Zhuang
- Department of Orthopaedic Trauma, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Lin Liu
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Ke Xu
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Hu Wang
- Department of Orthopaedic Trauma, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Bo Wang
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Hong-Quan Wen
- Department of Orthopaedic Trauma, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Peng Xu
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China,Correspondence: Peng Xu
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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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Cantrell CK, Butler BA. A Review on Management of Insufficiency Fractures of the Pelvis and Acetabulum. Orthop Clin North Am 2022; 53:431-443. [PMID: 36208886 DOI: 10.1016/j.ocl.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
"Insufficiency fractures of the pelvis and acetabulum are occurring at increasing rates. Osteoporosis is the most prevalent risk fracture. Diagnosis begins with plain radiographs followed by advanced imaging with computed tomography and/or MRI. Pelvic ring fragility injuries are classified by the Fragility fractures of the pelvis system. Elderly acetabular fractures may be classified by the Letournel system. Management of these injuries is primarily nonoperative with early immobilization when allowed by fracture characteristics. When warranted, percutaneous fixation and open reduction internal fixation are options for both. Both acute and delayed total hip arthroplasty are options for acetabular fractures."
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Affiliation(s)
- Colin K Cantrell
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair, Suite 1350, Chicago, IL 60611, USA.
| | - Bennet A Butler
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair, Suite 1350, Chicago, IL 60611, USA
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[Translated article] Primary total hip arthroplasty for acetabular fractures in elderly patients. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022. [DOI: 10.1016/j.recot.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Cichos KH, Spitler CA, Quade JH, McGwin G, Ghanem ES. Fracture and Patient Characteristics Associated With Early Conversion Total Hip Arthroplasty After Acetabular Fracture Fixation. J Orthop Trauma 2021; 35:599-605. [PMID: 33993173 DOI: 10.1097/bot.0000000000002083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine risk factors for early conversion total hip arthroplasty (THA) after operative treatment of acetabular fractures. DESIGN Retrospective cohort. SETTING Level I trauma center. PATIENTS AND INTERVENTION We reviewed 685 operative acetabular fractures at our institution from 2011 to 2017, with a median follow-up of 12 months (range, 4-105 months). MAIN OUTCOME MEASURE Multivariable regression analysis was performed after univariate analysis to identify independent risk factors for conversion THA. Sensitivity analysis was performed with minimum follow-up set at 6 and 12 months. RESULTS One hundred eight patients (16%) underwent conversion THA, with 52% of conversions occurring within 1 year, an additional 27% within 2 years, and the remaining 21% within 6 years of the index acetabular open reduction internal fixation. The median time to conversion THA was 11.5 months (range, 0.5-72 months). The risk of conversion THA by fracture pattern was 53 of 196 (27%) for transverse posterior wall (TPW), 12 of 52 (23%) for T shaped, 10 of 68 (15%) for posterior column with posterior wall, and 25 of 207 (12%) for posterior wall. Independent risk factors for early conversion included the following: TPW fracture, protrusio, hip dislocation, increased body mass index, increased age, infection, and dislocation after open reduction internal fixation. Independent risk factors for early conversion THA specific to patients with TPW fractures include only increased age and body mass index. Sensitivity analysis showed no change in results using either 6 or 12-month minimum follow-up. CONCLUSION Transverse posterior wall fractures have a high risk of early conversion THA compared with other acetabular fracture patterns, especially when in combination with other significant risk factors. Consideration for different and novel management options warrants further study in this subset of acetabular fracture patients. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kyle H Cichos
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and
| | - Clay A Spitler
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and
| | - Jonathan H Quade
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and
| | - Gerald McGwin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Elie S Ghanem
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and
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Abstract
Optimal management of acetabular fractures (AF) in the elderly has not been defined clearly. The incidence of such fractures is rising in the aging population. Advancements in implant technology have improved the longevity of combined or staggered total hip arthroplasty procedures for this patient population, thus allowing earlier weight bearing and continued functional independence. Perioperative/postoperative complication rates remain significantly high in all treatment arms. Overall, the best outcomes with the lowest complication rates are achieved when AF are treated by a surgeon or a team of surgeons who specialize in both orthopedic traumatology and adult reconstruction.
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Survivorship of the Hip Joint After Acetabulum Fracture. J Am Acad Orthop Surg 2021; 29:781-788. [PMID: 34047724 DOI: 10.5435/jaaos-d-20-00517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 04/20/2021] [Indexed: 02/01/2023] Open
Abstract
PURPOSE The purposes of this study were to determine the rate of failure of the hip joint after acetabulum fracture and to identify risk factors. METHODS Acetabulum fractures treated over 17 years at a level-1 trauma center were reviewed. Patient, injury, and treatment factors were assessed regarding possible association with failure of the hip joint: end-stage arthrosis and/or total hip arthroplasty (THA). RESULTS Seventy percent were treated with primary open reduction and internal fixation (ORIF). Seventy-two (12.5%) of 575 fractures underwent THA; 64 were after initial ORIF. The mean follow-up was 80 months, and the median time to THA was 14 months (range 10-200 months). Age, body mass index, fracture type, marginal impaction, and hip dislocations were independent predictors of hip joint failure. The mean injured age of THA patients was 53 versus 43 (P < 0.001). T-type fractures were most likely to fail (21% within 2 years, 45% within 10 years, P = 0.001). Other injury features: marginal impaction and posterior hip dislocation were associated with failure with odds ratios 2.79 and 1.73, respectively (P < 0.001). CONCLUSION Eighty-five percent of native hips survived; the median time to THA was 14 months. Most who had THA had initial posterior fracture-dislocations. Older age, elevated body mass index, T-type pattern, marginal impaction, and hip dislocation increase the likelihood of hip joint failure.
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Sarasa-Roca M, Angulo-Castaño MC, Gómez-Vallejo J, Torres-Campos A, Lasierra-SanRomán JM, Albareda-Albareda J. Primary total hip arthroplasty for acetabular fractures in elderly patients. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 66:52-59. [PMID: 34130928 DOI: 10.1016/j.recot.2021.02.001] [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: 11/26/2020] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Life expectancy has risen, leading to an increase in acetabular fractures in fragile patients. Total hip arthroplasty with a reinforcement cage is a technically complex option, but allows fracture control and early mobilization. Our aim is to assess whether the use of Burch-Schneider cage in fragile patients with acetabular fractures allows immediate load stabilization without threatening the early survival of the arthroplasty. MATERIAL AND METHODS Descriptive study of a series of 14 patients with acetabular fractures treated by a reinforcement cage associated with autologous bonegraft plus a cemented acetabular cup, and mobilization and bearing. Judet Letournel fracture types, surgical delay, and complications during admission were analyzed. Following hospital discharge we recorded the incorporation of grafts according to Gie's classification, presence of calcifications according to Brooker, consolidation of the fracture, loosening of implants and functional aspects according to the HHS and Merlé D'Aubigné Postel score. RESULTS The most common fracture was both columns (6/14), with a surgical delay being of 11 days mean and 21,5 days of length of stay. One patient died after surgery. The mean follow-up was 34.4 months. All fractures healed and the bonegraft was incorporated in all cases. The mean HHS was 82 points and the Merle Score was 15/18. There were no complications related to arthroplasty. CONCLUSIONS Total hip arthroplasty with Burch-Schneider cage on bonegraft and no added osteosynthesis is a good option of treatment of all types of displaced acetabular fractures in a fragile patient.
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Affiliation(s)
- M Sarasa-Roca
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
| | - M C Angulo-Castaño
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - J Gómez-Vallejo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - A Torres-Campos
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - J M Lasierra-SanRomán
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - J Albareda-Albareda
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
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Treatment modalities and outcomes following acetabular fractures in the elderly: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:649-659. [PMID: 34076747 DOI: 10.1007/s00590-021-03002-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The treatment of geriatric acetabular fractures remains controversial. Treatment options include nonoperative management, open reduction and internal fixation (ORIF), total hip arthroplasty (THA) with or without internal fixation, and closed reduction with percutaneous pinning (CRPP). There is currently no consensus on the optimal treatment strategy for geriatric patients with acetabular fractures. The purpose of this study is to compare adverse event rates, functional and radiographic outcomes, and intraoperative results between the various treatment modalities in order to help guide surgical decision making. METHODS We performed a systematic review (registration number CRD42019124624) of observational and comparative studies including patients aged ≥ 55 with acetabular fractures. RESULTS Thirty-eight studies including 3,928 patients with a mean age of 72.6 years (range 55-99 years) and a mean follow-up duration of 29.4 months met our eligibility criteria. The pooled mortality rate of all patients was 21.6% (95% confidence interval [CI] 20.9-22.4%) with a mean time to mortality of 12.6 months, and the pooled non-fatal complication rate was 24.7% (95% CI 23.9-25.5%). Patients treated with ORIF had a significantly higher non-fatal complication rate than those treated with ORIF + THA, THA alone, CRPP, or nonoperative management (odds ratios [ORs] 1.87, 2.24, 2.15, and 4.48, respectively; p < 0.01). Patients that underwent ORIF were significantly less likely to undergo subsequent THA than these treated with CRPP (OR 0.49, 95% CI 0.32-0.77) but were more likely to require THA than patients treated nonoperatively (OR 6.81, 95% CI 4.63-10.02). CONCLUSION Elderly patients with acetabular fractures tend to have favorable functional outcomes but suffer from high rates of mortality and complications. In patients treated with internal or percutaneous fixation, there was a high rate of conversion to THA. When determining surgical treatment in this population, THA alone or concurrent with ORIF should be considered given the significantly lower rate of non-fatal complications and similar mortality rate. Nonoperative management remains a viable option and was associated with the lowest non-fatal complication rate. LEVEL OF EVIDENCE This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Walls A, McAdam A, McMahon SE, Diamond OJ. The management of osteoporotic acetabular fractures: Current methods and future developments. Surgeon 2021; 19:e289-e297. [PMID: 33597085 DOI: 10.1016/j.surge.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/11/2020] [Accepted: 01/03/2021] [Indexed: 11/30/2022]
Abstract
Acetabular fractures in the elderly are challenging. Management is complicated by patients' poor physiological status and osteoporotic bone. Analysis of the management of these patients must be separated from the treatment of younger patients. Conservative management continues to have a role in patients who sustain fractures that are non-displaced and are considered stable with weight bearing mobilisation, and in those patients considered too medically frail to undergo surgical intervention. The mainstay of current surgical intervention is open reduction and internal fixation (ORIF) and variations of ORIF and total hip arthroplasty (THA), or fix and replace. Fix and replace is being increasingly favoured in those patients who display poor prognostic factors for long term joint survival after ORIF. Percutaneous fixation has the theoretical benefits of minimally invasive surgery and the potential to make any subsequent THA less complicated. However, it requires specialised fluoroscopic skills and is not suitable for all fracture patterns. There are a number of developments being reported. The use of a reinforcement ring and THA in has been reported in a number of centres, as has the use of trabecular metal acetabular implants. A coned hemi pelvic prosthesis and THA has been described in our centre, with promising early results. The potential for 3D printing to improve preoperative planning and reduce intra-operative time is also being explored. The aim of this review is to provide a summary of the literature supporting current and future treatment methods, tips on reduction techniques and an overview of the treatment algorithm of these patients in our unit.
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Affiliation(s)
- Andrew Walls
- Specialist Registrar Trauma and Orthopaedics, Royal Victoria Hospital, Belfast, UK
| | - Andrew McAdam
- Core Surgical Trainee, Royal Victoria Hospital, Belfast, UK.
| | - Samuel E McMahon
- Specialist Registrar Trauma and Orthopaedics, Royal Victoria Hospital, Belfast, UK
| | - Owen J Diamond
- Consultant Trauma and Orthopaedic Surgeon, Royal Victoria Hospital Belfast, Belfast, UK
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17
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Provisional Minifragment Plate Fixation of Acetabular Fractures-A Technical Trick. J Orthop Trauma 2020; 34:e454-e459. [PMID: 32379226 DOI: 10.1097/bot.0000000000001798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 02/02/2023]
Abstract
Acetabular fractures may not always be amenable to classic clamp-assisted reductions and interfragmentary lag screw fixation. The routine clamp-assisted reductions with limited osseous territory availability can inhibit typical 3.5-mm reconstruction plate application. Provisional minifragment plate fixation of these fracture patterns with subsequent clamp removal allows for definitive plate application. The provisional minifragment plates may also be retained to theoretically augment fixation. The authors present a step-by-step technique and clinical series of 57 patients demonstrating provisional minifragment fixation of elementary (n = 8) and associated (n = 49) acetabular fractures.
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18
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Shah N, Gill IP, Hosahalli Kempanna VK, Iqbal MR. Management of acetabular fractures in elderly patients. J Clin Orthop Trauma 2020; 11:1061-1071. [PMID: 33192010 PMCID: PMC7656530 DOI: 10.1016/j.jcot.2020.10.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 01/10/2023] Open
Abstract
Management of acetabular fractures in elderly patients is challenging. The challenges arise due to associated medical comorbidities, poor bone quality and comminution. There are multiple modalities of treatment. the exact algorithms or treatment remain undefined. Treatment is still based on experience and some available evidence. The options include conservative treatment, percutaneous fixation, open reduction internal fixation and the acute fix and replace procedure. There is a well recognised risk of each treatment option. We present a narrative review of the relevant available evidence and our treatment principles based on experience from a regional tertiary pelvic-acetabular fracture service.
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Affiliation(s)
- Nikhil Shah
- The North West Pelvic and Acetabular Surgery Service, Wrightington Hospital, Salford Royal Hospital, Manchester Royal Infirmary, United Kingdom
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19
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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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Ernstberger H, Pieroh P, Höch A, Josten C, Herath SC, Osterhoff G. Minimally displaced acetabulum fractures in geriatric patients: a comparison of open, percutaneous and non-operative treatment from the German Pelvic Injury Register data. Eur J Trauma Emerg Surg 2020; 47:1763-1771. [PMID: 32270221 PMCID: PMC8629882 DOI: 10.1007/s00068-020-01346-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/10/2020] [Indexed: 11/28/2022]
Abstract
Purpose In elderly patients with minimally displaced acetabulum fractures, the patients’ inability to partially weight-bear and the need for early mobilisation may trigger the decision towards a treatment with higher primary stability. The purpose of this study was to compare open reduction and internal fixation (ORIF), closed reduction and percutaneous fixation (CRPIF) and non-operative treatment in geriatric minimally displaced acetabulum fractures with regard to complications and quality of reduction. Methods Data from the prospective German Pelvic Injury Register collected between 2008 and 2018 were used to evaluate 608 geriatric patients with isolated minimally displaced (≤ 5 mm) acetabulum fractures. In total, 429 received non-operative treatment, 117 ORIF and 62 CRPIF. Demographics, injury severity, fracture pattern, complications and fracture displacement before and after treatment were analysed. Results Both operative methods reduced fracture gap displacement. CRPIF was associated with lower blood loss and shorter operative time compared to ORIF (p < 0.001). Hospital stay was 12.9 days in the non-operative group, 16.8 with CRPIF and 23.6 with ORIF (p < 0.001). Non-surgical general complications were more likely to occur following ORIF (22.2%) compared to CRPIF (8.1%) and non-operative treatment (8.4%, p < 0.001). The rate of surgical complications was not different for ORIF and CRPIF (p = 0.122) Conclusion Both operative treatments improve fracture displacement and joint congruency in elderly patients with minimally displaced acetabulum fractures. Compared to ORIF, CRPIF achieves similar quality of reduction but is associated with fewer complications, smaller intraoperative blood loss, shorter operative time and shorter length of hospital stay.
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Affiliation(s)
- Helene Ernstberger
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany.
| | - Philipp Pieroh
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Andreas Höch
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Christoph Josten
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Steven C Herath
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Building 57, Kirrbergerstr. 1, 66421, Homburg, Germany
| | - Georg Osterhoff
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
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Long-term total hip arthroplasty rates in patients with acetabular and pelvic fractures after surgery: A population-based cohort study. PLoS One 2020; 15:e0231092. [PMID: 32243484 PMCID: PMC7122785 DOI: 10.1371/journal.pone.0231092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 03/16/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND/OBJECTIVE Osteoarthritis typically develops after surgery for traumatic fractures of the acetabulum and may result in total hip arthroplasty (THA). We conducted a population-based retrospective study to investigate the incidence of THA after treatment of acetabular, pelvic, and combined acetabular and pelvic fractures with open reduction-internal fixation surgery compared with that in the control group. DESIGN A retrospective population-based cohort study. SETTING Data were gathered from the Taiwan National Health Insurance Research Database. PARTICIPANTS We enrolled 3041 patients with acetabular fractures, 5618 with pelvic fractures, and 733 with combined pelvic and acetabular fractures between January 1, 1997, and December 31, 2013, totaling 9392 individuals. The control group comprised 664,349 individuals. Study participants were followed up for the occurrence of THA until death or the end of the study period. RESULTS The THA rates after surgical intervention were 17.82%, 7.28%, and 18.01% in patients with acetabular, pelvic, and combined acetabular and pelvic fractures, respectively. Moreover, they were significantly higher for the acetabular fracture, pelvic fracture, and combined-fracture groups (adjusted hazard ratios [aHRs] = 58.42, 21.68, and 62.04, respectively) than for the control group (p < 0.0001) and significantly higher for the acetabular fracture and combined-fracture groups than for the pelvic fracture group (aHRs = 2.59 and 2.68, respectively; p < 0.0001). CONCLUSION The incidence rates of THA after surgical intervention in the pelvic fracture, acetabular fracture, and combined-fracture groups were significantly higher than that of the control group.
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Jauregui JJ, Weir TB, Chen JF, Johnson AJ, Sardesai NR, Maheshwari AV, Manson TT. Acute total hip arthroplasty for older patients with acetabular fractures: A meta-analysis. J Clin Orthop Trauma 2020; 11:976-982. [PMID: 33191999 PMCID: PMC7656476 DOI: 10.1016/j.jcot.2020.01.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/05/2020] [Accepted: 01/06/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Multiple treatment options for acetabular fractures in geriatric patients exist. However, no large-scale studies have reported the outcomes of acute total hip arthroplasty (THA) in this patient population. We systematically evaluated all available evidence to characterize clinical outcomes, complications, and revisions of acute THA for acetabular fractures in geriatric patients. METHODS Meta-analysis of 21 studies of 430 acetabular fractures with mean follow-up of 44 months (range, 17-97 months). Two independent researchers searched and evaluated the databases of Ovid, Embase, and United States National Library of Medicine using a Boolean search string up to December 2019. Population demographics and complications, including presence of heterotopic ossification (HO), dislocation, infection, revision rate, neurological deficits, and venous thromboembolic event (VTE), were recorded and analyzed. RESULTS Weighted mean Harris Hip Score was 83.3 points, and 20% of the patients had reported complications. The most common complication was HO, with a rate of 19.5%. Brooker grade III and IV HO rates were lower at 6.8%. Hip dislocation occurred at a rate of 6.1%, 4.1% of patients developed VTE, deep infection occurred in 3.8%, and neurological complications occurred in 1.9%. Although the revision rate was described in most studies, we were unable to perform a survival analysis because the time to each revision was described in only a few studies. The revision rate was 4.3%. CONCLUSIONS Acute THA is a viable option for treatment of acetabular fracture and can result in acceptable clinical outcomes and survivorship rates in older patients but with an associated complication rate of approximately 20%. Considering the limited treatment options, THA might be a viable alternative for appropriately selected patients.
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Affiliation(s)
- Julio J. Jauregui
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Tristan B. Weir
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Jin F. Chen
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Aaron J. Johnson
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Neil R. Sardesai
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Aditya V. Maheshwari
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Theodore T. Manson
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA,Corresponding author. Towson Orthopaedics Associates, 8322 Bellona Avenue, Towson, MD, 21204, USA.
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Technical Considerations and Fluoroscopy in Percutaneous Fixation of the Pelvis and Acetabulum. J Am Acad Orthop Surg 2019; 27:899-908. [PMID: 31192885 DOI: 10.5435/jaaos-d-18-00102] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Surgical treatment of the pelvic ring and acetabulum continues to evolve. Improved imaging technology and means for closed reduction have meant that percutaneous techniques have gained popularity in the treatment of the pelvic ring and, more recently, in the acetabulum. Potential benefits include decreased soft-tissue dissection, blood loss, and surgical time. However, these are technically demanding procedures that require substantial expertise from both the surgeon and the radiographer. This article details the necessary fluoroscopic views and general methods used in percutaneous techniques around the pelvis and acetabulum. Despite most studies reporting good-to-excellent clinical and radiographic results, further work is needed to facilitate standardization and optimization of these outcomes.
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Stevens JM, Shiels S, Whitehouse MR, Ward AJ, Chesser TJ, Acharya M. Bilateral acetabular fractures: Mechanism, fracture patterns and associated injuries. J Orthop 2019; 18:28-31. [PMID: 32189879 DOI: 10.1016/j.jor.2019.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/30/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Acetabular fractures are uncommon and their management is often reserved for specialist pelvic and acetabular surgeons. Bilateral acetabular fractures are a particularly rare subgroup. We report the incidence, fracture pattern, mechanism of injury and outcome of patients presenting to a tertiary trauma centre with traumatic bilateral acetabular fractures. Method Bilateral acetabular fractures were identified from a prospective database of acetabular fractures presenting to one institution over a six-year period. Patient notes and imaging studies were reviewed to identify demographics, mechanism of injury, Injury Severity Score, fracture pattern and management. Timing of operative management was explored. Patient outcomes were collected in the form of radiographs and Oxford Hip Scores at a minimum of one-year post injury. Results Eight patients with bilateral acetabular fracture were identified from a database which contained records of 519 patients with acetabular fractures (incidence of 1.5% amongst patients with acetabular fractures). Motor vehicle accidents were the most common mechanism. Four acetabular fracture patterns were observed within the cohort. Radiographic union occurred in all cases and Oxford Hip Scores are suggestive of moderate to well functioning hip joints. Fractures were treated as single or staged procedures. Conclusion Bilateral acetabular fractures are very rare due to the unique degree and pattern of force required to fracture both acetabula. They are associated with 4 main fracture patterns and present with Injury Severity Scores that averaged 25 (severe). They are typically observed in young males with road traffic collision being the most common mechanism of injury.
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Affiliation(s)
- Jarrad M Stevens
- Department of Trauma and Orthopaedics, Southmead Hospital Bristol, BS10 5NB, United Kingdom.,St Vincent's Hospital Melbourne, Australia
| | - Sarah Shiels
- Department of Trauma and Orthopaedics, Southmead Hospital Bristol, BS10 5NB, United Kingdom
| | - Michael R Whitehouse
- Department of Trauma and Orthopaedics, Southmead Hospital Bristol, BS10 5NB, United Kingdom.,Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, United Kingdom.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, United Kingdom
| | - Anthony J Ward
- Department of Trauma and Orthopaedics, Southmead Hospital Bristol, BS10 5NB, United Kingdom
| | - Tim J Chesser
- Department of Trauma and Orthopaedics, Southmead Hospital Bristol, BS10 5NB, United Kingdom
| | - Mehool Acharya
- Department of Trauma and Orthopaedics, Southmead Hospital Bristol, BS10 5NB, United Kingdom
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Osterhoff G, Wulsten D, Babu S, Heyland M, Pari C. Antegrade versus retrograde screw fixation of anterior column acetabular fractures: a biomechanical in vitro study. Eur J Trauma Emerg Surg 2019; 47:1307-1312. [PMID: 31664465 DOI: 10.1007/s00068-019-01255-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/22/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND To compare the mechanical strength of antegrade versus retrograde lag screw fixation of anterior column acetabular fractures. METHODS Standardised anterior column fractures were created in synthetic pelvis models and stabilised by either antegrade (ANTE, n = 4) or retrograde (RETRO, n = 4) anterior column screw fixation. In a validated setup, a cyclic loading protocol was applied with increasing axial force (750 cycles, 250-750 N) followed by load to failure. Construct survival, energy absorbed, construct stiffness, and load to failure were assessed. Descriptive and opto-metric methods were used to describe the mode of failure. RESULTS All constructs failed with loads below 1500 N. With regard to energy absorbed until failure, the ANTE group resisted to 3.763 × 105 N*cycles (range 3.760 × 105-3.763 × 105) and the RETRO group to 3.762 × 105 N*cycles (range 3.761 × 105-3.765 × 105; p = 1.0). The load to failure was 1254 N (range 977-1299) in the ANTE group and 1234 N (range 1087-1456) in the RETRO group (p = 1.0). Construct stiffness with 250 N was not different between the two groups (ANTE 192 N/mm vs. RETRO 215 N/mm, p = 0.486). In all samples, the mode of failure was a transiliac fracture with screw breakout due to rotation of the pubic fragment around the axis of the screw with a range of rotational motion [ROM] during cyclic testing of 0.96° in one ANTE sample and 0.82° in one RETRO sample for 750 N, and ROM at failure of 2.53° in one ANTE sample and 2.23° in one RETRO sample. There was some plastic deformation of the screws in all cases but no breakage. CONCLUSIONS In this in vitro mechanical study, antegrade screw fixation of an anterior column acetabular fracture was not different in construct survival, load to failure, stiffness, and mode of failure when compared to retrograde screw fixation.
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Affiliation(s)
- Georg Osterhoff
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - Dag Wulsten
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Satish Babu
- Trauma and Orthopaedic Department, Frimley Park Hospital, Camberley, UK
| | - Mark Heyland
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Carlotta Pari
- Orthopaedic, and Trauma Department, Santa Maria Delle Croci Hospital, Ravenna, Italy
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Lont T, Nieminen J, Reito A, Pakarinen TK, Pajamäki I, Eskelinen A, Laitinen MK. Total hip arthroplasty, combined with a reinforcement ring and posterior column plating for acetabular fractures in elderly patients: good outcome in 34 patients. Acta Orthop 2019; 90:275-280. [PMID: 30931684 PMCID: PMC6534240 DOI: 10.1080/17453674.2019.1597325] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Low-energy acetabulum fractures are uncommon, and mostly occur in elderly patients. Determining the optimal operative treatment for such fractures is challenging. Here we investigated whether acutely performed total hip arthroplasty plus posterior column plating (THA) reduced complications and reoperations compared with open reduction and internal fixation (ORIF) in elderly patients with acetabular fractures. Patients and methods - We retrospectively reviewed the records of 59 patients, > 55 years of age, with complex acetabular fractures, caused by low-energy trauma, treated between January 2008 and September 2017. Of these patients, 34 underwent acute THA, and 25 ORIF alone. Patient and implant survival were compared between groups using Kaplan-Meier survival analysis and Cox multiple regression. Functional outcomes assessed by Oxford Hip Score (OHS) were compared between the THA patients and those 9 ORIF patients who underwent secondary THA due to posttraumatic hip osteoarthritis (OA) during follow-up. Results - Overall patient survival was 90% (95% CI 82-98) at 12 months, and 64% (CI 47-81) at 5 years. Of 25 ORIF patients, 9 required secondary THA due to posttraumatic OA. Large fragments on the weight-bearing acetabular dome upon imaging predicted ORIF failure and secondary THA. The acute THA group and secondary THA group had similar 12-month OHS. Interpretation - Acute THA including a reinforcement ring resulted in fewer reoperations than ORIF alone in elderly patients with acetabular fractures. These findings support acute THA as first-line treatment for complex acetabular fractures in elderly patients.
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Affiliation(s)
- Tõnis Lont
- Coxa Hospital for Joint Replacement, Tampere, Finland;; ,Correspondence:
| | | | - Aleksi Reito
- Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland;;
| | - Toni-Karri Pakarinen
- Coxa Hospital for Joint Replacement, Tampere, Finland;; ,Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland;;
| | - Ilari Pajamäki
- Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland;;
| | | | - Minna K Laitinen
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
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Abstract
OBJECTIVES To evaluate the incidence of unplanned reoperations after pelvic ring injuries and to develop a risk prediction model. DESIGN Retrospective review. SETTING Level I Trauma Center. PATIENTS The medical records of 913 patients (644 male and 269 female patients; mean age, 39 years; age range, 16-89 years) with unstable pelvic ring fractures operatively treated at our center from 2003 to 2015 were reviewed. INTERVENTION Multiple logistic regression analysis was conducted to evaluate the relative contribution of associated clinical parameters to unplanned reoperations. A risk prediction model was developed to assess the effects of multiple covariates. MAIN OUTCOME MEASUREMENTS Unplanned reoperation for infection, fixation failure, heterotopic ossification, or bleeding complication. RESULTS Unplanned reoperations totaled 137 fractures, with an overall rate of 15% (8% infection, 6% fixation failure, <1% heterotopic ossification, and <1% bleeding complication). Reoperations for infection and fixation failure typically occurred within the first month after the index procedure. Four independent predictors of reoperation were open fractures, combined pelvic ring and acetabular injuries, abdominal visceral injuries, and increasing pelvic fracture grade. No independent association was shown between reoperation and patient, treatment, or other injury factors. CONCLUSIONS Unplanned reoperations were relatively common. Infection and fixation failure were the most common indications for unplanned reoperations. Factors associated with reoperation are related to severity of pelvic and abdominal visceral injuries. Our findings suggest that these complications might be inherent and in many cases unavoidable despite appropriate current treatment strategies. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Functional Outcomes of Elderly Patients With Nonoperatively Treated Acetabular Fractures That Meet Operative Criteria. J Orthop Trauma 2017; 31:644-649. [PMID: 28742787 DOI: 10.1097/bot.0000000000000990] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To report functional outcomes of displaced acetabular fractures treated nonoperatively in the geriatric patient population. DESIGN Retrospective case series. SETTING Two Level I trauma centers. PATIENTS Twenty-seven patients 60 years of age or older who sustained displaced acetabular fractures during an 11-year period. INTERVENTION Nonoperative treatment. MAIN OUTCOME MEASUREMENTS Primary outcome measurements were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and Short Form 8 (SF-8) scores. Secondary outcome measurements were conversion to open reduction and internal fixation or total hip arthroplasty and 1-year mortality. RESULTS Twenty-six patients completed the WOMAC and SF-8 surveys. The overall WOMAC score was 12.9 ± 15.6 (range, 0-59.4). The average physical SF-8 was 51.1 ± 8.7 (range, 30.4-58.6), and the average mental SF-8 was 55 ± 6.2 (range, 30.4-58.6). The 1-year mortality rate was 24%. Conversion of treatment occurred in 15% of patients. CONCLUSIONS Elderly patients with fracture patterns that would qualify for operative treatment in younger healthy patients had surprisingly good outcome scores when treated nonoperatively. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Spitler CA, Kiner D, Swafford R, Doty D, Goulet R, Jones LC, Hydrick J, Nowotarski P. Generating stability in elderly acetabular fractures-A biomechanical assessment. Injury 2017; 48:2054-2059. [PMID: 28778730 DOI: 10.1016/j.injury.2017.07.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/20/2017] [Accepted: 07/05/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND & OBJECTIVES As the overall health and life expectancy increases in the United States, the incidence of fragility fractures in elderly patients also continues to increase. Given their medical comorbidities and decreased bone mineral density, acetabular fractures in the elderly population present a significant challenge to the orthopaedic trauma surgeon. The anterior column posterior hemitransverse (ACPHT) fracture pattern is a common fracture pattern in this population, and is often associated with central subluxation/dislocation of the femoral head with articular impaction. This study sought to delineate the most stable fixation construct in ACPHT fracture patterns in the elderly population. MATERIALS AND METHODS The sample consisted of 3 groups of synthetic hemipelves (N=15), which were tested in order to compare stiffness by measuring motion at fracture lines under applied loads. The three groups of unique quadrilateral plate fixation were as follows: a specialty quadrilateral surface plate; 4 long peri-articular screws parallel to the quadrilateral surface into the ischium,; and an 8 hole infrapectineal buttress plate. Digital imaging system measured construct motion under load. Construct stiffness was estimated by linear regression of load between 50 and 850N versus average relative motion (average of relative motion at 200 points along the line of the osteotomy). Permanent deformation was estimated as the magnitude of relative motion upon unloading. RESULTS Using ANOVA with Tukey's test to determine construct stiffness in loading, the group long peri-articular screws was found to have significantly higher stiffness than either of the other groups. Maximal fracture displacement was located at the intersection of the low transverse fracture line in the posterior column and the free quadrilateral surface fragment. CONCLUSIONS Results indicate that the best fixation construct for this ACPHT acetabular fracture pattern includes independent lag screws across the anterior column and a pelvic brim plate with long periarticular screws maximizing posterior column fixation and preventing medialization of the free quadrilateral fragment. Although there are potential patient considerations that may complicate the placement of all 4 long screws, in most patients one or more of these screws can be safely placed in order to help prevent secondary displacement.
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Affiliation(s)
- Clay A Spitler
- Department of Orthopedic Surgery, University of Mississippi Medical Center, Jackson, MS, United States.
| | - Dirk Kiner
- Department of Orthopaedic Surgery, University of Tennessee Health and Science Center, College of Medicine, Chattanooga, TN, United States.
| | - Rachel Swafford
- Department of Orthopaedic Surgery, University of Tennessee Health and Science Center, College of Medicine, Chattanooga, TN, United States.
| | - Daniel Doty
- Department of Orthopaedic Surgery, University of Tennessee Health and Science Center, College of Medicine, Chattanooga, TN, United States.
| | - Ron Goulet
- Division of Orthopaedic Trauma Surgery, University of Tennessee Health and Science Center, College of Medicine, Chattanooga, TN, United States
| | - LaRita C Jones
- Department of Orthopedic Surgery, University of Mississippi Medical Center, Jackson, MS, United States.
| | - Josie Hydrick
- Department of Orthopedic Surgery, University of Mississippi Medical Center, Jackson, MS, United States.
| | - Peter Nowotarski
- Department of Mechanical Engineering, University of Tennessee Chattanooga, College of Engineering & Computer Science, Chattanooga, TN, United States.
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Abstract
In the time since Letournel popularised the surgical treatment of acetabular fractures, more than 25 years ago, there have been many changes within the field, related to patients, surgical technique, implants and post-operative care. However, the long-term outcomes appear largely unchanged. Does this represent stasis or have the advances been mitigated by other negative factors? In this article we have attempted to document the recent changes within the surgery of patients with a fracture involving the acetabulum, outline contemporary management, and identify the major problem areas where further research is most needed. Cite this article: Bone Joint J 2017;99-B:1125–31
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Affiliation(s)
- M. Rickman
- Royal Adelaide Hospital and University
of Adelaide, Level 4, Bice
Building, North Terrace, Adelaide
SA5000, Australia
| | - V. D. Varghese
- Royal Adelaide Hospital and University
of Adelaide, Level 4, Bice
Building, North Terrace, Adelaide
SA5000, Australia
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Abstract
The incidence of acetabular fractures in the elderly population is increasing. Fractures in this population differ from those in younger patients, with more frequent involvement of the anterior column, more comminution, and more severe articular impaction in elderly patients. Although acetabular fractures in geriatric patients are more likely the result of low-energy trauma, outcomes are generally poorer than those in young patients. Multiple management options have been proposed, but no intervention has become the standard of care for these fractures in the elderly. Patient characteristics (eg, prior ambulation status, functional capacity, bone quality), the nature of the fracture, and the experience of the treating orthopaedic surgeon all must be considered when choosing among nonsurgical treatment, percutaneous fixation, open reduction and internal fixation, and immediate or delayed arthroplasty. Each treatment option has the potential for satisfactory results in properly selected patients.
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Murphy CG, Carrothers AD. Fix and replace; an emerging paradigm for treating acetabular fractures. ACTA ACUST UNITED AC 2017; 13:228-233. [PMID: 28228787 DOI: 10.11138/ccmbm/2016.13.3.228] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Although technically challenging even for the experienced surgeon, simultaneous open reduction and internal fixation (ORIF) of acetabular fracture and total hip replacement (THR) have some potential advantages over the more traditional treatment options in specific patient subgroups; theoretically allowing immediate weight bearing and faster rehabilitation, reducing the cost of inpatient stay, and reducing the risks of early and late local complications associated with standard treatment for this type of injury. We review the evolution of the indications and techniques, outline the surgical challenges, and discuss implant options and outcomes for this treatment paradigm.
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Affiliation(s)
- Colin G Murphy
- Department of Trauma and Orthopaedics, Addenbrooke's Cambridge University Hospital, Cambridge, UK
| | - Andrew D Carrothers
- Department of Trauma and Orthopaedics, Addenbrooke's Cambridge University Hospital, Cambridge, UK
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Acetabular Fractures in the Elderly: Midterm Outcomes of Column Stabilisation and Primary Arthroplasty. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4651518. [PMID: 28194414 PMCID: PMC5282405 DOI: 10.1155/2017/4651518] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/15/2016] [Accepted: 12/12/2016] [Indexed: 11/18/2022]
Abstract
Background. Interest in arthroplasty techniques for periarticular or intra-articular fractures in the elderly/osteoporotic patient continues to rise, including for geriatric acetabular fractures. In line with this, many acetabular fracture surgeons are now undertaking acute total hip arthroplasty in elderly/osteoporotic patients. Little is known however of the outcomes of this procedure, beyond the first year after surgery. Questions/Purposes. We determined the clinical outcomes of a series of elderly osteoporotic patients (mean age at surgery 77.4 years) treated for acetabular fractures with column fixation and simultaneous total hip arthroplasty, at a mean of 49 months after surgery. Methods. 24 patients (25 hips) were reviewed at a mean of 49 months after surgery. The surgical technique employed has previously been described. Radiographs were obtained, and clinical outcomes were assessed using Harris Hip Scores and the Merle d'Aubigné score. Results. 14 hips were available for assessment (9 deceased, 2 lost to follow-up). No patient suffered any complications beyond the perioperative period, no acetabular components were loose clinically or on latest radiographs, and the mean Harris Hip Score was 92. All but one patient scored good or excellent on the Merle d'Aubigné score. Conclusions. Column fixation and simultaneous total hip arthroplasty are a viable option for complex geriatric acetabular fractures, with encouraging midterm results. We conclude that THR is a viable long-term solution in this situation provided that the acetabular columns are stabilised prior to implantation, but more research is needed to aid in overall management decision making.
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Abstract
OBJECTIVES To document the initial treatment of displaced acetabular fractures among older adults across multiple trauma centers and to investigate the factors that influence the decision to operate and the choice of operative procedure [open reduction internal fixation (ORIF) vs. total hip arthroplasty (THA)]. DESIGN Retrospective observational study. SETTING Fifteen US level-I trauma centers participating in the Major Extremity Trauma Research Consortium. PATIENTS/PARTICIPANTS Overall, 269 patients aged 60 years or older admitted for the treatment of a displaced acetabular fracture. INTERVENTION None. MAIN OUTCOME MEASUREMENTS Treatment. RESULTS Sixty percent of fractures (n = 162) were treated operatively. Younger age (<80 years), injury from high-energy mechanism, fractures with femoral head impaction, and fractures without hip congruency were significantly associated with receiving operative treatment (P < 0.05). Significant site variation in operative versus nonoperative treatment occurred even after accounting for these factors (P = 0.0044). Among operatively treated patients, 88% (n = 142) received ORIF and 12% (n = 20) received THA as the initial treatment. Women were more likely to be treated with initial THA compared with men; of the known risk factors for poor outcomes with ORIF (ie, dome or roof impaction, femoral head impaction, or posterior wall involvement), only dome impaction was significantly associated with receiving initial THA (P < 0.05). CONCLUSIONS Currently, no treatment guidelines exist for acetabular fractures in older adults, which likely explains the significant site variation in operative versus nonoperative treatment. This study identifies patient and injury factors that drive treatment decisions, which will be important in planning and designing future trials needed to determine the best treatment for these fractures.
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Osterhoff G, Amiri S, Unno F, Dodd A, Guy P, O'Brien PJ, Lefaivre KA. The "Down the PC" view - A new tool to assess screw positioning in the posterior column of the acetabulum. Injury 2015; 46:1625-8. [PMID: 25990076 DOI: 10.1016/j.injury.2015.04.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/25/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Minimal-invasive placement of screws into the posterior column of the acetabulum (PC) is challenging. Due to the saddle-shaped curvature of the medial cortical border of the PC, the standard fluoroscopic views of the pelvis cannot provide the desired safety during screw insertion. The aim of this study was to define a view tangentially to the medial cortex of the PC and to evaluate its accuracy and inter-observer reproducibility. METHODS Radio-dense markers on the medial cortex of the PC along the axis of a PC screw were brought in line and landmarks of the new "Down the PC" view were determined. Kirschner wires were placed into the PC of a pelvis composite model and five pelvic cadaver specimens in a total of 34 different correct and incorrect positions. Based on either only the "Down the PC" view, only the standard views, or a combination of both, three fellowship-trained orthopaedic surgeons had to decide if the inserted wires were in bone in the posterior column or had exited cortex, and if they penetrated the acetabulum. Sensitivity, specificity, and the intra-class correlation coefficient were calculated. RESULTS A view using three radiographic landmarks (pelvic brim, medial cortical wall of the body of the ischium, ischial spine) was found. Sensitivity and specificity to detect perforation out of the bone were 1.00 and 0.97 for the "Down the PC" view, 0.46 and 0.97 if only the standard views were used, and 1.00 and 0.95 for a combination of both. Sensitivity and specificity to detect intra-articular wire placement were 1.00 and 0.96 for the "Down the PC" view, 0.72 and 0.95 if only the standard views were used, and 0.94 and 0.99 for a combination of both. Inter-observer agreement using only the "Down the PC" view was excellent with an ICC of 0.92 for perforation and ICC of 0.82 for intra-articular wire placement. CONCLUSIONS The "Down the PC" view is a useful addendum in the orthopaedic trauma surgeon's tool box. Using simple landmarks, it is easily to reproduce and thereby shows excellent accuracy and inter-observer agreement in order to detect medial perforation or intra-articular implant position.
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Affiliation(s)
- G Osterhoff
- Department of Orthopaedics, Division of Orthopaedic Trauma, University of British Columbia, 3114 - 910 West 10th Avenue, Vancouver, British Columbia V5Z 1M9, Canada.
| | - S Amiri
- Department of Orthopaedics, Division of Orthopaedic Trauma, University of British Columbia, 3114 - 910 West 10th Avenue, Vancouver, British Columbia V5Z 1M9, Canada
| | - F Unno
- Department of Orthopaedics, Division of Orthopaedic Trauma, University of British Columbia, 3114 - 910 West 10th Avenue, Vancouver, British Columbia V5Z 1M9, Canada
| | - A Dodd
- Department of Orthopaedics, Division of Orthopaedic Trauma, University of British Columbia, 3114 - 910 West 10th Avenue, Vancouver, British Columbia V5Z 1M9, Canada
| | - P Guy
- Department of Orthopaedics, Division of Orthopaedic Trauma, University of British Columbia, 3114 - 910 West 10th Avenue, Vancouver, British Columbia V5Z 1M9, Canada
| | - P J O'Brien
- Department of Orthopaedics, Division of Orthopaedic Trauma, University of British Columbia, 3114 - 910 West 10th Avenue, Vancouver, British Columbia V5Z 1M9, Canada
| | - K A Lefaivre
- Department of Orthopaedics, Division of Orthopaedic Trauma, University of British Columbia, 3114 - 910 West 10th Avenue, Vancouver, British Columbia V5Z 1M9, Canada
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Effect of surgical treatment on mortality after acetabular fracture in the elderly: a multicenter study of 454 patients. J Orthop Trauma 2015; 29:202-8. [PMID: 25233162 DOI: 10.1097/bot.0000000000000223] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Controversy exists regarding the effect of operative treatment on mortality after acetabular fracture in elderly patients. Our hypothesis was that operative treatment would confer a mortality benefit compared with nonoperative treatment even after adjusting for comorbidities associated with death. DESIGN Retrospective study. SETTING Three University Level I Trauma Centers. PATIENTS/PARTICIPANTS All patients aged 60 years and older with acetabular fractures treated from 2002 to 2009 were included in the study. Four hundred fifty-four patients were identified with an average age of 74 years. Sixty-seven percent of the study group was male and 33% female. INTERVENTION One of 4 treatments: nonoperative management with early mobilization, percutaneous reduction and fixation, open reduction and internal fixation, acute total hip arthroplasty. MAIN OUTCOME MEASUREMENTS Kaplan-Meier survival curves were created, and Cox proportional hazards models were used to calculate unadjusted and adjusted hazard ratios (HRs) for covariates of interest. RESULTS In contrast to previous smaller studies, the overall mortality was relatively low at 16% at 1 year [95% confidence interval (CI), 13-19]. Unadjusted survivorship curves suggested higher 1-year mortality rates for nonoperatively treated patients (21% vs. 13%, P < 0.001); however, nonoperative treatment was associated with other risk factors for higher mortality. By accounting for these patient risk factors, our final multivariate model of survival demonstrated no significant difference in hazard of death for nonoperative treatment (0.92, P = 0.6) nor for any of the 3 operative treatment subgroups (P range, 0.4-0.8). As expected, we did find a significantly increased hazard for factors such as the Charlson comorbidity index [HR, 1.25 per point (95% CI, 1.16-1.34)] and age [HR, 1.08 per year of age more than 70 years (95% CI, 1.05-1.11)]. In addition, associated fracture patterns (compared with elementary patterns) significantly increased the hazard of death with a ratio of 1.51 (95% CI, 1.10-2.06). CONCLUSIONS The operative treatment of acetabular fractures does not increase or decrease mortality, once comorbidities are taken into account. The reasons for this are unknown. Regardless of the causes, the decision for operative versus nonoperative treatment of geriatric acetabular fractures should not be justified based on the concern for increased or decreased mortality alone. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Buller LT, Lawrie CM, Vilella FE. A growing problem: acetabular fractures in the elderly and the combined hip procedure. Orthop Clin North Am 2015; 46:215-25. [PMID: 25771316 DOI: 10.1016/j.ocl.2014.11.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Acetabular fractures in the elderly are most frequently the result of low-energy trauma and present unique management challenges to orthopedic surgeons. Evaluation and treatment should be performed in a multidisciplinary fashion with early involvement of internal medicine subspecialists and geriatricians. Distinct fracture patterns and pre-existing osteoarthritis and osteoporosis necessitate careful preoperative planning. The role of total hip arthroplasty should also be considered when surgical treatment is indicated. The outcomes of acetabular fractures in the elderly have improved, but complications remain higher and results less satisfactory than in younger individuals. The lack of randomized controlled trials has limited the ability to establish an evidence-based treatment algorithm.
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Affiliation(s)
- Leonard T Buller
- Department of Orthopaedic Surgery, Jackson Memorial Hospital, University of Miami, 1400 Northwest 12th Avenue, Miami, FL 33136, USA; Department of Rehabilitation, Jackson Memorial Hospital, University of Miami, 1400 Northwest 12th Avenue, Miami, FL 33136, USA
| | - Charles M Lawrie
- Department of Orthopaedic Surgery, Jackson Memorial Hospital, University of Miami, 1400 Northwest 12th Avenue, Miami, FL 33136, USA; Department of Rehabilitation, Jackson Memorial Hospital, University of Miami, 1400 Northwest 12th Avenue, Miami, FL 33136, USA
| | - Fernando E Vilella
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Ryder Trauma Center, Jackson Memorial Hospital, University of Miami, 1400 Northwest 12th Avenue, Miami, FL 33136, USA.
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Wang ZF, Hong ZH, Wang MZ, Ruan JW, Wang W, Pan WB. A reduction clamp for an aiming component in associated acetabular fractures. Indian J Orthop 2015; 49:101-4. [PMID: 25593360 PMCID: PMC4292320 DOI: 10.4103/0019-5413.143916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The treatment of acetabular fractures is complex and requires specialized equipment. However, all currently available instruments have some disadvantages. A new reduction clamp that can firmly enable reduction and not hinder subsequent fixation procedures for some special fracture types is needed. MATERIALS AND METHODS In this study, we introduce a new acetabular clamp and its preliminary clinical application in three T-shaped acetabular fractures. RESULTS This new clamp can successfully pull the posterior column back to the anterior column and firmly maintain the reduction. This clamp's aiming plate can facilitate the insertion of long lag screws. The clamp is also easy to assemble and use. CONCLUSION This reduction clamp is a useful instrument that can facilitate open reduction and internal fixation of acetabular fractures.
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Affiliation(s)
- Zhang-Fu Wang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, 317000, China
| | - Zheng-Hua Hong
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, 317000, China
| | - Mei-Zhen Wang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, 317000, China
| | - Jian-Wei Ruan
- Department of Orthopedics, Taizhou Municipal Hospital Affiliated to Taizhou University, Medical School, Taizhou, 318000, China
| | - Wei Wang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, 317000, China
| | - Wei-Bo Pan
- Department of Orthopedics, Taizhou Municipal Hospital Affiliated to Taizhou University, Medical School, Taizhou, 318000, China
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Displaced acetabular fractures in the elderly: results after open reduction and internal fixation. Injury 2014; 45:1908-13. [PMID: 25267400 DOI: 10.1016/j.injury.2014.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 06/21/2014] [Accepted: 09/05/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND The optimal management of elderly patients with displaced acetabular fractures remains controversial. This paper aims to summarize the clinical results of open reduction and internal fixation (ORIF) and the possible factors influencing them. METHODS Radiographic and clinical data on 52 elderly patients with displaced acetabular fractures that were treated by ORIF between May 2000 and May 2008 were retrospectively analysed. Data, such as fracture type (Letournel's classification system), quality of reduction, clinical outcomes (Harris hip score and modified Merle d'Aubigne-Postel score), and radiological outcomes (Matta score), were evaluated. RESULTS Good to excellent clinical and radiological outcomes were recorded in 43 (82.7%) and 37 patients (71.2%), respectively. Acetabular fractures without radiographic features, such as quadrilateral plate fracture, Gull sign, posterior dislocation of hip, posterior wall marginal impaction, comminuted posterior wall fracture, and femoral head injury, can still achieve good to excellent outcomes. However, patients with the abovementioned radiographic features tend to achieve fair or poor outcomes. When an acetabular fracture with the aforementioned features, except for femoral head injury, can achieve and maintain anatomic reduction until complete fracture healing, the difference between fractures with and without the radiographic features is no longer significant. The results indicate that the outcomes are more affected by reduction rather than radiographic features. CONCLUSION ORIF may be suggested for displaced acetabular fractures in the elderly. Good to excellent outcomes and a high degree of patient satisfaction can be achieved in majority of the patients. We recommend ORIF as the preferred treatment for displaced acetabular fractures without the abovementioned radiographic features. LEVEL OF EVIDENCE Therapeutic level IV.
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Chakravarty R, Toossi N, Katsman A, Cerynik DL, Harding SP, Johanson NA. Percutaneous column fixation and total hip arthroplasty for the treatment of acute acetabular fracture in the elderly. J Arthroplasty 2014; 29:817-21. [PMID: 24075241 DOI: 10.1016/j.arth.2013.08.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/05/2013] [Accepted: 08/07/2013] [Indexed: 02/01/2023] Open
Abstract
We used our database of primary total hip arthroplasties to identify those patients who had acetabular fractures fixed with percutaneous screws under the same anesthesia as for the arthroplasty procedure. There were 19 patients with the average follow-up of 22 months. Fourteen patients sustained the fracture secondary to a low-energy trauma, while the remaining patients were involved in a high-energy trauma accident. The mean survival time was calculated to be 2.5 ± 0.6 years for the low-energy group and 4 ± 1.4 years for the high-energy group. We believe that this unique treatment of acetabular fractures has a role in carefully selected patients and provides the necessary reduction and immediate stability of the fracture needed to ensure adequate fit for the acetabular cup in the subsequent THA.
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Affiliation(s)
- Rajit Chakravarty
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Nader Toossi
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Anna Katsman
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Douglas L Cerynik
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Susan P Harding
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Norman A Johanson
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
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Daurka JS, Pastides PS, Lewis A, Rickman M, Bircher MD. Acetabular fractures in patients aged > 55 years: a systematic review of the literature. Bone Joint J 2014; 96-B:157-63. [PMID: 24493178 DOI: 10.1302/0301-620x.96b2.32979] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The increasing prevalence of osteoporosis in an ageing population has contributed to older patients becoming the fastest-growing group presenting with acetabular fractures. We performed a systematic review of the literature involving a number of databases to identify studies that included the treatment outcome of acetabular fractures in patients aged > 55 years. An initial search identified 61 studies; after exclusion by two independent reviewers, 15 studies were considered to meet the inclusion criteria. All were case series. The mean Coleman score for methodological quality assessment was 37 (25 to 49). There were 415 fractures in 414 patients. Pooled analysis revealed a mean age of 71.8 years (55 to 96) and a mean follow-up of 47.3 months (1 to 210). In seven studies the results of open reduction and internal fixation (ORIF) were presented: this was combined with simultaneous hip replacement (THR) in four, and one study had a mixture of these strategies. The results of percutaneous fixation were presented in two studies, and a single study revealed the results of non-operative treatment. With fixation of the fracture, the overall mean rate of conversion to THR was 23.1% (0% to 45.5%). The mean rate of non-fatal complications was 39.8% (0% to 64%), and the mean mortality rate was 19.1% (5% to 50%) at a mean of 64 months (95% confidence interval 59.4 to 68.6; range 12 to 143). Further data dealing with the classification of the fracture, the surgical approach used, operative time, blood loss, functional and radiological outcomes were also analysed. This study highlights that, of the many forms of treatment available for this group of patients, there is a trend to higher complication rates and the need for further surgery compared with the results of the treatment of acetabular fractures in younger patients.
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Affiliation(s)
- J S Daurka
- St Mary's Hospital, Imperial Hospitals NHS Trust, Praed Street, London W2 1NY, UK
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Percutaneous retrograde posterior column acetabular fixation: is the sciatic nerve safe? A cadaveric study. J Orthop Trauma 2014; 28:37-40. [PMID: 24361807 DOI: 10.1097/bot.0b013e318299c8fb] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The purpose of this cadaveric study was to determine the proximity of the neurologic structures to the path of the screw inserted percutaneously into the ischial tuberosity. DESIGN Cadaver study. INTERVENTION Ten screws were inserted in 10 limbs (5 cadavers) under fluoroscopic guidance. Dissection was then performed to expose the head of the screw and was extended laterally to expose the sciatic nerve, the posterior cutaneous nerve of the thigh, and its inferior cluneal branches. MAIN OUTCOME MEASURE The distance from the screw head to the sciatic nerve, posterior cutaneous nerve of the thigh, and the inferior cluneal nerves. RESULTS The distance from the center of the screw head to the sciatic nerve averaged 58 mm (range, 40-70 mm). The average distance between the screw head and the posterior cutaneous nerve of the thigh was 42 mm (range, 30-60 mm). The inferior cluneal branches were the closest to the path of the screw with an average distance of 3.5 mm in 6 specimens (range, 1-6 mm) and were injured by the screw in 3 and could not be located in another specimen. CONCLUSIONS The sciatic nerve and the posterior cutaneous nerve of the thigh appear to be safe during retrograde percutaneous screw fixation of a posterior column acetabular fracture through a central entry point in the ischial tuberosity. However, the inferior cluneal nerves that are responsible for the cutaneous sensitivity of the lower half of the gluteal region are at risk of injury.
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Hill BW, Switzer JA, Cole PA. Management of high-energy acetabular fractures in the elderly individuals: a current review. Geriatr Orthop Surg Rehabil 2013; 3:95-106. [PMID: 23569703 DOI: 10.1177/2151458512454661] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Acetabular fractures in the elderly individuals are increasing in prevalence. Although there is evidence in the literature that acetabular fractures in elderly patients sustained as a result of low-energy mechanisms can be well treated by nonoperative management, open reduction and internal fixation, or even acute arthroplasty, almost no literature exists that may appropriately guide the treatment of elderly acetabular fractures that occur as a result of high-energy mechanisms. In spite of this lack of evidence, specific principles for providing the best care in adult trauma patients may reasonably be adopted. These principles include aggressive resuscitation and medical optimization; surgical care that focuses on a patient's survival but does not sacrifice skeletal stability; and early mobilization. Best practices that guide the care of hip fracture patients, such as a team approach to care, the use of protocols to guide treatment, and the timing of surgery to occur as soon as is safely possible also should be employed to guide care in patients who have sustained acetabular fractures. Opportunity exists to better study these higher energy fractures and to, thereby, affect outcomes in patients who have sustained them.
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Affiliation(s)
- Brian W Hill
- Department of Orthopaedic Surgery, University of Minnesota, St Paul, MN, USA
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Abstract
Fractures of the acetabulum are some of the most challenging fractures that face orthopedic surgeons. In geriatric patients, these challenges are enhanced by the complexity of fracture patterns, the poor biomechanical characteristics of osteoporotic bone, and the comorbidities present in this population. Nonsurgical management is preferable when the fracture is stable enough to allow mobilization, and healing in a functional position can be expected. When significant displacement and/or hip instability are present, operative management is preferred in most patients, which may include open reduction and internal fixation with or without total hip arthroplasty.
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Affiliation(s)
- Patrick D G Henry
- Division of Orthopaedics, Department of Surgery, Sunnybrook Health Science Center, University of Toronto, Toronto, Ontario, Canada.
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Abstract
The incidence of acetabular fractures in elderly patients is increasing. Poor bone quality and concomitant diseases are the main features of these patients. Fracture patterns are marked by a high degree of variability in terms of patient and fracture characteristics. Preoperative planning with plain radiographs and computed tomography, including 3-dimensional reconstructions, is recommended. Treatment remains challenging because of precarious general health, severe osteopenia, comminution, and associated femoral head damage. Treatment options available include closed management, open reduction with internal fixation, percutaneous fixation in situ, and acute or staged total hip arthroplasty (THA) whether alone or combined with osteosynthesis. In the case of significant destruction of the articular cartilage, primary THA may provide the best solution. Whichever surgical method is chosen, the objective is rapid mobilisation of the patient on a walker or crutches. Late local complications that may occur after nonoperative or operative treatment include posttraumatic arthritis, nonunion, malunion, wound infection, dislocation, intrusive hardware, nerve palsy, and heterotopic bone formation. In this article an overview of the current trends in the management of acetabulum fractures in the elderly is presented.
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Affiliation(s)
- E Guerado
- Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol, University of Malaga, Marbella (Malaga), Spain.
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Functional outcomes in elderly patients with acetabular fractures treated with minimally invasive reduction and percutaneous fixation. J Orthop Trauma 2012; 26:278-83. [PMID: 22198651 DOI: 10.1097/bot.0b013e31823836d2] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To present the functional outcomes of elderly patients treated with percutaneous acetabular surgery and compare them with those treated with traditional open reduction and internal fixation in previously published series. DESIGN Retrospective. SETTING University level I trauma center. PATIENTS All patients aged 60 and older treated with percutaneous screw fixation for acetabular fractures from 1994 to 2007 were included. Seventy-nine consecutive patients were identified. Thirty-six patients died before functional outcomes were obtained, leaving 43 patients and fractures in our study group. Functional outcomes were obtained in 35 of 43 (81.3%) patients at an average of 6.8 years after the index surgery. INTERVENTION Minimally invasive reduction and percutaneous fixation of acetabular fractures. MAIN OUTCOME MEASUREMENT Short musculoskeletal functional assessment and Harris Hip Score. RESULTS One-year mortality was 13.9% (11 of 79). Average short musculoskeletal functional assessment dysfunction and bother indices were 23.3 and 21.3, respectively, in 24 patients who maintained their native hip. When compared with Short Musculoskeletal Functional Assessment data from 2 other series of patients treated with formal open reduction and internal fixation, no differences existed in the dysfunction (P = 0.49) or bother (P = 0.55) indices. Conversion to total hip arthroplasty occurred in 11 of 36 patients (30.6%). Average Harris Hip Scores in patients with their native hip was 77 (range, 33-100). In the 11 patients converted to total hip arthroplasty, average Short Musculoskeletal Functional Assessment dysfunction and bother indices were 24.3 and 23.9, respectively. No differences were found in the dysfunction (P = 0.93) or bother (P = 0.16) indices when compared with patients converted from open reduction and internal fixation to total hip arthroplasty. Average Harris Hip Score in patients converted to total hip arthroplasty was 83 (range, 68-92), and this was not significantly different from the best scores reported with acute total hip arthroplasty. CONCLUSIONS Functional outcomes and rates of conversion to total hip arthroplasty of acetabular fractures in elderly patients treated with percutaneous reduction and fixation show no significant differences when compared with published series of patients treated with formal open reduction and internal fixation. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Zelle BA, Cole PA. Open Reduction and Internal Fixation of Complex Geriatric Acetabular Fracture. ACTA ACUST UNITED AC 2011. [DOI: 10.1053/j.oto.2011.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bukata SV, Digiovanni BF, Friedman SM, Hoyen H, Kates A, Kates SL, Mears SC, Mendelson DA, Serna FH, Sieber FE, Tyler WK. A guide to improving the care of patients with fragility fractures. Geriatr Orthop Surg Rehabil 2011; 2:5-37. [PMID: 23569668 PMCID: PMC3597301 DOI: 10.1177/2151458510397504] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Susan V Bukata
- Corresponding Author: Associate Professor, Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY
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