1
|
Fallatah MH, Sabr M. Combined Hip Procedure in a 74-Year-Old Patient with Acetabulum Fracture. Cureus 2024; 16:e62714. [PMID: 39036160 PMCID: PMC11259234 DOI: 10.7759/cureus.62714] [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] [Accepted: 06/07/2024] [Indexed: 07/23/2024] Open
Abstract
In elderly individuals, low-energy trauma can cause acetabular fractures. Many surgical options have been described, including open reduction and internal fixation (ORIF), arthroplasty, and combined hip procedure. We present a 74-year-old man with a fall-related acetabular fracture with an unusual pattern, which was managed by ORIF and total hip arthroplasty. The patient experienced a hip dislocation at three weeks post-operation that was reduced in the emergency department. At 12 months post-operation, the patient resumed the same level of function he had before falling, using a cane while outside his home and sometimes inside. The combined hip procedure is associated with early weight bearing and excellent Harris hip scores, but proper preoperative planning and patient optimization are needed.
Collapse
Affiliation(s)
| | - Mohammed Sabr
- Department of Orthopedic Surgery, Ministry of the National Guard - Health Affairs, Prince Mohammed Bin Abdulaziz Hospital, Al-Madinah, SAU
| |
Collapse
|
2
|
Nilssen P, McKelvey K, Lin C. Revision Surgery Risk After Open Reduction and Internal Fixation Versus Acute Total Hip Arthroplasty in Geriatric Acetabular Fractures: A Nationwide Study. J Am Acad Orthop Surg 2024; 32:e533-e541. [PMID: 38452243 DOI: 10.5435/jaaos-d-23-00773] [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] [Received: 09/01/2023] [Accepted: 01/26/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The aging population has contributed to a rising incidence of acetabular fractures in older patients, yet current evidence guiding surgical treatment is limited by small sample sizes. This study used a nationwide database to investigate outcomes in older patients undergoing open reduction and internal fixation (ORIF) versus acute total hip arthroplasty (THA). METHODS The PearlDiver database was queried for patients aged 60 years and older with an acute acetabular fracture who underwent ORIF or acute THA (2010 to 2021). ORIF patients were matched 1:1 to THA patients based on age, sex, US region, insurance plan, and Charlson Comorbidity Index score. Patients with less than 2 years of follow-up were excluded. The primary outcome was revision surgery. RESULTS Of 120,032 patients with an acetabular fracture, 3,768 (3.1%) underwent surgical treatment: 1,482 (39.3%) THA and 2,286 (60.7%) ORIF. Mean age was 71.0 ± 6.51 years. Mean follow-up duration was 5.2 ± 2.1 years. THA patients were slightly older (72.4 versus 70.2 years), had higher Charlson Comorbidity Index scores (3.3 versus 2.7), and had a higher percentage of female patients (62.5% versus 32.2%). After matching, 962 ORIF and 962 THA patients were included. ORIF patients had longer LOS (10.7 versus 8.1 days). ORIF patients were less likely to experience joint infections and periprosthetic fractures, but more likely to experience transfusions. The overall revision surgery rate within 10 years was 14.8% in the ORIF cohort and 6.2% in the THA cohort. In the ORIF cohort, 13.5% of patients had a delayed conversion to THA. CONCLUSIONS In this large national database, acute with or without internal fixation for geriatric acetabular fractures was associated with lower rates of revision surgery within 10 years when compared with a matched cohort undergoing ORIF. ORIF was associated with increased LOS, increased transfusion risk, and lower risk of joint infection and periprosthetic fracture. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Paal Nilssen
- From the Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA (Nilssen and Lin), and Rocky Vista University Montana College of Osteopathic Medicine, Billings, MT (McKelvey)
| | | | | |
Collapse
|
3
|
Albrektsson M, Möller M, Wolf O, Wennergren D, Sundfeldt M. Acetabular fractures: Epidemiology and mortality based on 2,132 fractures from the Swedish Fracture Register. Bone Jt Open 2023; 4:652-658. [PMID: 37652452 PMCID: PMC10471445 DOI: 10.1302/2633-1462.49.bjo-2023-0085.r1] [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] [Indexed: 09/02/2023] Open
Abstract
Aims To describe the epidemiology of acetabular fractures including patient characteristics, injury mechanisms, fracture patterns, treatment, and mortality. Methods We retrieved information from the Swedish Fracture Register (SFR) on all patients with acetabular fractures, of the native hip joint in the adult skeleton, sustained between 2014 and 2020. Study variables included patient age, sex, injury date, injury mechanism, fracture classification, treatment, and mortality. Results In total, 2,132 patients with acetabular fractures from the SFR were included in the study. The majority of the patients were male (62%) and aged over 70 years old (62%). For patients aged > 70 years, the 30-day mortality was 8% and one-year mortality 24%. For patients aged ≤ 70 years, the 30-day mortality was 0.2% and one-year mortality 2%. Low-energy injuries (63%) and anterior wall fractures (20%) were most common. Treatment was most often non-surgical (75%). Conclusion The majority of patients who sustain an acetabular fracture are elderly (> 70 years), of male sex, and the fracture most commonly occurs after a simple, low-energy fall. Non-surgical treatment is chosen in the majority of acetabular fracture patients. The one-year mortality for elderly patients with acetabular fracture is similar to the mortality after hip fracture, and a similar multidisciplinary approach to care for these patients should be considered.
Collapse
Affiliation(s)
- Madelene Albrektsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
- Institute of clinical sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Möller
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
- Institute of clinical sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olof Wolf
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - David Wennergren
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
- Institute of clinical sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Sundfeldt
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
- Institute of clinical sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
4
|
[Primary joint replacement for the treatment of acetabular fractures]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:119-124. [PMID: 36534363 DOI: 10.1007/s00113-022-01266-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 12/23/2022]
Abstract
Open reduction and internal fixation are the gold standard for the treatment of dislocated acetabular fractures. A primary joint replacement is only justified in isolated cases. The indications are merely non-reconstructable acetabular fractures, accompanying displaced fractures of the femoral neck and non-reconstructable fractures of the femoral head.Because of the difficulties in achieving sufficient cup stability, joint replacement for the treatment of acetabular fractures regularly requires implants designed for revision arthroplasty. The Kocher-Langenbeck approach provides the most versatile options, as it enables simultaneous stabilization of the dorsal acetabular structures, which are essential for the stability of the cup.For primary joint replacement as a treatment of acetabular fractures, survival of the prosthetic cup is markedly worse when compared to elective primary joint replacement. Particularly in younger patients but also in aged patients, every effort should be made to achieve a press fit of the cup. In most cases, this will include reduction and fixation of the fracture for stabilization of the acetabulum prior to joint replacement. A staged approach with an early secondary replacement intervention seems to provide better overall results than simultaneous fracture fixation and joint replacement.
Collapse
|
5
|
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).
Collapse
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
| |
Collapse
|
6
|
The acetabular roof reinforcement plate for the treatment of displaced acetabular fractures in the elderly: results in 59 patients. Arch Orthop Trauma Surg 2022; 142:1835-1845. [PMID: 33839910 PMCID: PMC9296387 DOI: 10.1007/s00402-021-03829-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/08/2021] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Open reduction and internal fixation is considered the gold standard of treatment for displaced acetabular fractures in younger patients. For elderly patients with osteoporotic bone quality, however, primary total hip arthroplasty (THA) with the advantage of immediate postoperative mobilization might be an option. The purpose of this study was to evaluate the clinical and radiological outcomes of surgical treatment of displaced osteoporotic acetabular fractures using the acetabular roof reinforcement plate (ARRP) combined with THA. MATERIALS AND METHODS Between 2009 and 2019, 84 patients were operated using the ARRP combined with THA. Inclusion criteria were displaced osteoporotic fractures of the acetabulum with or without previous hemi- or total hip arthroplasty, age above 65 years, and pre-injury ability to walk at least with use of a walking frame. Of the 84 patients, 59 could be followed up after 6 months clinically and radiographically. Forty-nine (83%) were primary fractures and 10 (17%) periprosthetic acetabular fractures. RESULTS The mean age was 80.5 years (range 65-98 years). The average time from injury to surgery was 8.5 days (range 1-28). Mean time of surgery was 167 min (range 100-303 min). Immediate postoperative full weight bearing (FWB) was allowed for 51 patients (86%). At the 6-month follow-up, all 59 patients except one showed bony healing and incorporation of the ARRP. One case developed a non-union of the anterior column. No disruption, breakage or loosening of the ARRP was seen. Additional CT scans performed in 18 patients confirmed bony healing. Twenty-six patients (44%) had regained their pre-injury level of mobility. Complications requiring revision surgery occurred in 8 patients. Five of them were suffering from a prosthetic head dislocation, one from infection, one from hematoma and one from a heterotopic ossification. CONCLUSIONS The ARRP has proven to provide sufficient primary stability to allow for immediate FWB in most cases and represents a valuable option for the surgical management of displaced acetabular fractures in this challenging patient group.
Collapse
|
7
|
Cibura C, Yilmaz E, Straeter D, Schildhauer TA, Kruppa C. Femoral Neck Osteotomy: A Salvage Procedure for Unstable and Locked Acetabulum Fractures in Selected Frail Patients. Indian J Orthop 2021; 56:821-828. [PMID: 35542315 PMCID: PMC9043154 DOI: 10.1007/s43465-021-00584-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/26/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Purpose of the study is to present and discuss the femoral neck osteotomy as a salvage procedure for unstable, locked geriatric acetabular fractures in selected frail patients. When disadvantages and possible risks of other treatments exceed the benefits, this method may relieve pain and allow for early wheelchair mobilization in frail patients with limited mobility. MATERIALS AND METHODS We report nine patients from 2008 to 2020, which were treated with an osteotomy of the femoral neck for an unstable acetabular fracture. Indications, ASA-Score, Frailty Index, operative procedure, length of hospital stay, complications and outcomes will be discussed. RESULTS Patient's age averaged 86 years (range 81-92). Acetabular fractures were classified as six both column fractures, two anterior column posterior hemitransversal fractures and one destruction of the acetabulum by multiple metastases. Fracture dislocation with medialization plus locking of the femoral head and a superomedial dome impaction were present in all patients. All patients were classified as ASA III/ IV and the average value on the CSHA Frailty index was 7 (range 6-7). The operation time averaged 52 min (range 34-62). Immediate wheelchair mobilization in seven out of nine patients was started postoperatively. CONCLUSION The osteotomy of the femoral neck may be discussed as a salvage procedure in low functional demanding, multimorbid, frail geriatric patients with unstable acetabular fractures and impairment of mobilisation due to a locked femoral head. The procedure has the advantages of a short operation time and immediate mobilization of the patients. However, this procedure only applies as a salvage solution in selected individual cases.
Collapse
Affiliation(s)
- Charlotte Cibura
- grid.5570.70000 0004 0490 981XDepartment of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany ,Chirurgische Klinik und Poliklinik, BG-Universitätsklinikum Bergmannsheil Bochum, Ruhr-Universität Bochum, Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany
| | - Emre Yilmaz
- grid.5570.70000 0004 0490 981XDepartment of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany
| | - Dina Straeter
- grid.5570.70000 0004 0490 981XDepartment of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany
| | - Thomas A. Schildhauer
- grid.5570.70000 0004 0490 981XDepartment of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany
| | - Christiane Kruppa
- grid.5570.70000 0004 0490 981XDepartment of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
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 .
Collapse
|
10
|
Bastian JD, Tarrant SM, Buckley R. Geriatric acetabular fracture-ORIF or ORIF and acute total hip arthroplasty(aTHA). Injury 2021; 52:384-386. [PMID: 33483107 DOI: 10.1016/j.injury.2021.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Johannes D Bastian
- Head Orthogeriatric Service Department of Orthopedic Surgery and Traumatology Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Seth M Tarrant
- Dept of Traumatology, John Hunter Hospital, Locked Bag 1, Hunter Region Mail Center, Newcastle, NSW 2310, Australia
| | - Richard Buckley
- Orthopedic Trauma, University of Calgary, Foothills Medical Center, 3134 Hospital Drive NW, Calgary, Alberta T2N 5A1, Canada.
| |
Collapse
|
11
|
Becker CA, Linhart C, Bruder J, Zeckey C, Greiner A, Cavalcanti Kußmaul A, Weidert S, Suero EM, Böcker W, Kammerlander C. Cementless hip revision cup for the primary fixation of osteoporotic acetabular fractures in geriatric patients. Orthop Traumatol Surg Res 2021; 107:102745. [PMID: 33333281 DOI: 10.1016/j.otsr.2020.102745] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/11/2020] [Accepted: 08/20/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Elderly patients suffering from hip fractures are usually not able to fulfil postoperative weight-bearing restrictions. Therefore, the operative fixation construct has to be as stable as possible. Aim of the present study was to determine (1) whether a therapeutic advantage could be achieved when using hip arthroplasty to treat acetabular fractures in geriatric patients; (2) whether an acetabular revision cup would be suitable for achieving fast postoperative mobilization and full weight-bearing; and (3) when a treatment with an uncemented hip revision cup for the primary fixation of osteoporotic acetabular fractures in geriatric patients is indicated. MATERIALS AND METHODS The functional outcome of THA using a reconstruction cup for an acetabular fracture was evaluated in ten patients using standardized scoring instruments. In addition, an analysis of the preexisting literature referring to total hip replacement in geriatric acetabular fractures was conducted and an algorithm for standardizing the treatment approach for geriatric patients with acetabular fractures was developed. RESULTS The mean EQ-5D-3L quality of life score 0.7. The mean VAS Score was 58.2. The average Barthel Index was 80.0 points [range: 0-100]. The mean HHS was 72.0 points, while the MHH Score yielded an average of 63.4 points. The average AP Score was 7.5. The literature analysis showed that total hip arthroplasty could be a feasible option for geriatric acetabular fractures. CONCLUSION Primary hip arthroplasty using uncemented revision cup fixed with angular stable screws showed good results and is a feasible treatment option of acetabular fractures in geriatric patients. The approach is especially beneficial in patients with poor bone stock and allows postoperative full weight-bearing. The presented treatment algorithm could be a useful tool for identifying the most appropriate treatment option. LEVEL OF EVIDENCE IIb.
Collapse
Affiliation(s)
- Christopher A Becker
- Department of General Trauma & Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377 Munich, Germany.
| | - Christoph Linhart
- Department of General Trauma & Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377 Munich, Germany
| | - Jan Bruder
- Department of General Trauma & Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377 Munich, Germany
| | - Christian Zeckey
- Department of General Trauma & Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377 Munich, Germany
| | - Axel Greiner
- Department of General Trauma & Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377 Munich, Germany
| | - Adrian Cavalcanti Kußmaul
- Department of General Trauma & Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377 Munich, Germany
| | - Simon Weidert
- Department of General Trauma & Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377 Munich, Germany
| | - Eduardo M Suero
- Department of General Trauma & Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377 Munich, Germany
| | - Wolfgang Böcker
- Department of General Trauma & Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377 Munich, Germany
| | - Christian Kammerlander
- Department of General Trauma & Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377 Munich, Germany
| |
Collapse
|
12
|
Sen RK, Saini G, Kadam S, Raman N. Anatomical quadrilateral plate for acetabulum fractures involving quadrilateral surface: A review. J Clin Orthop Trauma 2020; 11:1072-1081. [PMID: 33192011 PMCID: PMC7656483 DOI: 10.1016/j.jcot.2020.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The management of acetabulum fractures in osteoporotic elderly, as well as comminuted fractures in younger patients is likely to be difficult. These fractures need specific fixation techniques especially when the quadrilateral plate is involved. Standard implants may not be able to adequately support the fixation, so newer pre-shaped fixation plates have been proposed with some of these already in use. The concept of anatomic plates has come up for many fracture locations for providing a better buttress effect to the comminuted fragments. There has been a need to look for an anatomic buttress plates being developed for acetabulum fractures involving the quadrilateral surface. MATERIALS AND METHODS The literature has been reviewed to find the various newer designs that have been used for buttressing the quadrilateral surface in comminuted acetabular fractures. An attempt has been made to study their design characteristics and clinical outcomes. The review also includes the analysis of Anatomic Quadrilateral plate (AQP) used in fixation of acetabulum fracture involving quadrilateral surface in a series of 33 patients. RESULTS There has been few anatomical plates developed for the stabilization of acetabular quadrilateral surface fractures. Some of these plates have been successfully used in management of acetabular fractures primarily in young patients. Issues however remain in their application and outcomes in osteoporotic fractures of the acetabulum, as these plates support the pelvic brim fragments either from superior or medial surface. The newer development i.e. 'Anatomical Quadrilateral Plate' is optimized to counter the displacement forces due to its positioning on the pelvic brim rather than its superior or medial surface. Other special features include the possibility of longer screws across bone due to oblique position of holes, the typical location of a locking hole on the plate beam which permits dual cortical compression fixation either by using a bigger screw or a specially designed screw in screw construct across the supra-acetabular corridor. The option of using hybrid fixation of both locking and unlocked screws in AQP allows proper stress distribution on the underlying bone, aiding both primary as well as secondary stability. The minimum of one year post surgery outcome of patients having acetabular fixation using this Anatomic quadrilateral plate has been analyzed in 33 patients. Twenty three of these were aged more than 50 years and 28 out of total 33 were males. Associated injuries included Ipsilateral lower limb injury in 2 patients and distal radius fracture in 5 patients. The fracture pattern included 'Anterior column posterior hemi-transverse' in 10 patients,' Associated Both Column' injury in 9 and 'T type' acetabular fractures in 8 patients. Isolated 'Anterior column' was fractured in 6 patients. The surgical approach was 'Anterior Intra-pelvic' (AIP) in 23 patients and 'Modified Ileo-femoral' in other 10 patients. One patient had additional K L approach. Among the implants, the AQP plate was used without its pubic arm in 6 patients. The post-operative x rays showed anatomical reduction in 28 patients, while other 5 had gaps and/or steps up to 2 mm size. In subsequent car, one of these patients needed hip arthroplasty for problem arising due to collapse in fixation within six months. EQ 5D 5L telephonic score was used to know the outcome at minimum of one year follow up in 33 patients. As per this score, only 3 patients had an issue with mobility, with only one having problem in self-care activity. Six patients complained of minor limitations in carrying out their usual activities and only one patient had anxiety affecting him. In their self-assessment of overall health status, 22 patients marked it 100, 7 made it 90, 3 as 80 and 1 had marked it as 70 in a score range of 0-100. Considering the predominant elderly profile in this series of patients, the acetabular reconstruction using 'Anatomic quadrilateral plate' has shown encouraging results. CONCLUSION For stabilization of acetabular fractures involving quadrilateral surface area and pelvic brim, various new implants have been used. The Anatomic quadrilateral plate due to its anatomical shape, the various options in fracture fixation is best optimized for management of comminuted acetabulum fractures especially in poor quality bones. It has been successful in achieving good outcome in elderly group of patients having these complex injuries.
Collapse
Affiliation(s)
- Ramesh K. Sen
- Institute of Orthopaedics, Max Hospital, 5439,38 West Chandigarh, Mohali, 160014, Punjab, India
| | - Gaurav Saini
- Institute of Orthopaedics, Max Hospital, 5439,38 West Chandigarh, Mohali, 160014, Punjab, India
| | - Sagar Kadam
- Institute of Orthopaedics, Max Hospital, 5439,38 West Chandigarh, Mohali, 160014, Punjab, India
| | - Neha Raman
- Institute of Orthopaedics, Max Hospital, 5439,38 West Chandigarh, Mohali, 160014, Punjab, India
| |
Collapse
|
13
|
Aprato A, Giachino M, Messina D, Massé A. Fixation plus acute arthroplasty for acetabular fracture in eldery patients. J Orthop 2020; 21:523-527. [PMID: 32999541 PMCID: PMC7516170 DOI: 10.1016/j.jor.2020.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/05/2020] [Accepted: 09/13/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE in elderly patients reduction and fixation of acetabular fractures showed poor outcomes in fracture patterns where cartilage comminution/impaction and/or femoral head dislocation are present; acute arthroplasty with standard uncemented hemispherical cups and posterior plating has been recently proposed, we report on its safety and effectiveness. METHODS we used this technique to manage 67 displaced acetabular fracture but both column in patients older than 65 years old. RESULTS fractures of posterior column and/or wall with severe cartilage involvement may be treated safely with acute THA. CONCLUSIONS Good results in complex fracture patterns may also be achieved.
Collapse
|
14
|
|
15
|
Dyskin E, Hill BW, Torchia MT, Cole PA. A Survey of High- and Low-Energy Acetabular Fractures in Elderly Patients. Geriatr Orthop Surg Rehabil 2019; 10:2151459319870426. [PMID: 31456902 PMCID: PMC6702768 DOI: 10.1177/2151459319870426] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/05/2019] [Accepted: 07/16/2019] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Geriatric patients represent 14% of acetabular fractures and are the fastest growing subset of patients affected by this injury in the US. Treatment outcomes have been reported as inferior to those achieved in younger patients after high-energy (HE) acetabular trauma. This study aimed to compare detailed demographic characteristics and clinical outcomes in elderly patients (≥65 years of age) treated in a tertiary North American trauma center for acetabular fractures after both high- and low-energy mechanisms of injury. METHODS Patients (≥65 years of age) diagnosed with an acetabular fracture were identified over a 7-year period. Patient and injury characteristics were extracted from our institutional trauma database. Length of stay, intervention, operative details, disposition, complications, readmissions, and mortality were analyzed. RESULTS One hundred nine patients were identified for inclusion. Low-energy mechanisms (simple falls) were found in 64 (58.7%) and HE mechanisms in 45 (41.3%) patients. The HE cohort was younger (74.6 vs 80.7 years; P < .001), had a higher male predominance (76% vs 56%; P = .10), a lower Charlson comorbidity index (1.29 ± 1.49 vs 2.16 ± 1.76; P = .01), and a higher injury severity score (19.90 ± 15.33 vs 6.46 ± 3.57; P < .001). Fracture patterns, described according to the Letournel-Judet classification, were similar between the 2 groups. Thirty-day mortality was significantly higher in the HE group (26.7% vs 3.1%; P < .001); however, the 1-year mortality rates were not statistically different (31.1% vs 25.0%; P = .20). DISCUSSION Patients with acetabular fractures sustained due to HE accidents demonstrate significantly higher 30-day mortality rate than patients with low-energy fractures, but similar mortality 1 year after the injury, despite having a much lower mean age and fewer comorbidities. CONCLUSION Medical efforts made during initial hospital admission may have the biggest impact on survivorship following acetabular fracture.
Collapse
Affiliation(s)
- Evgeny Dyskin
- Department of Orthopaedics, University at Buffalo, NY, USA
| | - Brian W. Hill
- Department of Orthopaedic Surgery, Saint Louis University, MO, USA
| | - Michael T. Torchia
- Department of Orthopaedic Surgery, Dartmouth-Hitchcock Health System, Lebanon, NH, USA
| | - Peter A. Cole
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
- Orthopaedics, HealthPartners Medical Group, Bloomington, MN, USA
- Department of Orthopaedics, Regions Hospital, St Paul, MN, USA
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
3D surgical printing for preoperative planning of trabecular augments in acetabular fracture sequel. Injury 2018; 49 Suppl 2:S36-S43. [PMID: 30219146 DOI: 10.1016/j.injury.2018.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/04/2018] [Accepted: 07/23/2018] [Indexed: 02/02/2023]
Abstract
We describe the methodical and possibilities of 3D surgical printing in preoperative planning for a total hip arthroplasty in acetabular deformity after acetabular fractures, showing a case of a 43-year-old with posttraumatic arthritis after both column fracture of the left acetabulum that was treated non operatively, supporting the do it yourself mode.
Collapse
|
18
|
Stibolt RD, Patel HA, Huntley SR, Lehtonen EJ, Shah AB, Naranje SM. Total hip arthroplasty for posttraumatic osteoarthritis following acetabular fracture: A systematic review of characteristics, outcomes, and complications. Chin J Traumatol 2018; 21:176-181. [PMID: 29773451 PMCID: PMC6033725 DOI: 10.1016/j.cjtee.2018.02.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 11/18/2017] [Accepted: 01/24/2018] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Posttraumatic arthritis (PTA) may develop years after acetabular fracture, hindering joint function and causing significant chronic musculoskeletal pain. Given the delayed onset of PTA, few studies have assessed outcomes of delayed total hip arthroplasty (THA) in acetabular fracture patients. This study systematically reviewed the literature for outcomes of THA in patients with PTA and prior acetabular fracture. METHODS Pubmed, EMBASE, SCOPUS, and Cochrane library were searched for articles containing the keywords "acetabular", "fracture", "arthroplasty", and "post traumatic arthritis" published between 1995 and August 2017. Studies with less than 10 patients, less than 2 years of follow-up, conference abstracts, and non-English language articles were excluded. Data on patient demographics, surgical characteristics, and outcomes of delayed THA, including implant survival, complications, need for revision, and functional scores, was collected from eligible studies. RESULTS With 1830 studies were screened and data from 10 studies with 448 patients were included in this review. The median patient age on date of THA was 51.5 years, ranging from 19 to 90 years. The median time from fracture to THA was 37 months, with a range of 27-74 months. Mean follow-up times ranged from 4 to 20 years. The mean Harris hip scores (HHS) improved from 41.5 pre-operatively, to 87.6 post-operatively. The most prevalent postoperative complications were heterotopic ossification (28%-63%), implant loosening (1%-24%), and infection (0%-16%). The minimum 5-year survival of implants ranged from 70% to 100%. Revision rates ranged from 2% to 32%. CONCLUSION Despite the difficulties associated with performing THA in patients with PTA from previous acetabular fracture (including soft tissue scarring, existing hardware, and acetabular bone loss) and the relatively high complication rates, THA in patients with PTA following prior acetabular fracture leads to significant improvement in pain and function at 10-year follow-up. Further high quality randomized controlled studies are needed to confirm the outcomes after delayed THA in these patients.
Collapse
|