HSS Journal

, Volume 2, Issue 2, pp 161–171 | Cite as

Acetabular Fractures in the Elderly: Treatment Recommendations

  • Eric Pagenkopf
  • Andrew Grose
  • George Partal
  • David L. Helfet
Original Article


Acetabular fractures in the elderly population are marked by a high degree of variability in terms of patient and fracture characteristics. Successful outcomes depend on application of highly individualized management principles by experienced teams. Reviewed are indications and outcomes associated with various management options, including closed treatment, open reduction internal fixation, and acute or staged total hip arthroplasty. Proper initial management choices are critical, as early failures and subsequent salvage surgery can be accompanied by significant morbidity. Clinical results after ORIF closely follow the quality of articular reduction and the ability to maintain a congruent reduction of the hip joint. Fracture characteristics predictive of anatomic articular reduction should be treated with ORIF. Fracture characteristics predictive of early post-traumatic arthritis should be treated with simultaneous ORIF and THA. Presented is one referral institution’s treatment algorithm and management approach.

Key words

acetabulum fracture elderly osteoporosis total hip arthroplasty 


  1. 1.
    An YH (2002) Internal fixation in osteoporotic bone. Thieme, New YorkGoogle Scholar
  2. 2.
    Anglen JO, Burd TA, Hendricks KJ, Harrison P (2003) The “Gull Sign”: a harbinger of failure for internal fixation of geriatric acetabular fractures. J Orthop Trauma 17:625–634, OctPubMedCrossRefGoogle Scholar
  3. 3.
    Beaule PE (2002) Open reduction and internal fixation versus total hip arthroplasty for the treatment of acute displaced acetabular fractures. J Bone Jt Surg Am 84-A:2103–2104, NovGoogle Scholar
  4. 4.
    Beaule PE, Griffin DB, Matta JM (2004) The Levine anterior approach for total hip replacement as the treatment for an acute acetabular fracture. J Orthop Trauma 18:623–629, OctPubMedCrossRefGoogle Scholar
  5. 5.
    Bellabarba C, Berger RA, Bentley CD, Quigley LR, Jacobs JJ, Rosenberg AG, Sheinkop MB, Galante JO (2001) Cementless acetabular reconstruction after acetabular fracture. J Bone Jt Surg Am 83-A:868–876, JunGoogle Scholar
  6. 6.
    Boardman KP, Charnley J (1978) Low friction arthroplasty after fracture dislocations of the hip. J. Bone Jt Surg 60(B):495–497Google Scholar
  7. 7.
    Cornell CN (2005) Management of acetabular fractures in the elderly patient. HSS J 1:25–30CrossRefPubMedGoogle Scholar
  8. 8.
    Giannoudis PV, Grotz MR, Papakostidis C, Dinopoulos H (2005) Operative treatment of displaced fractures of the acetabulum. A meta-analysis. J Bone Jt Surg Br 87:2–9, JanGoogle Scholar
  9. 9.
    Helfet DL, Borrelli J, Di Pasquale T, Sanders R (1992) Stabilization of acetabular fractures in elderly patients. J Bone Jt Surg Am 74:753–765, JunGoogle Scholar
  10. 10.
    Helfet DL, Shonnard P (1996) Mini-symposium: Acetabular fractures (I) classification. Curr Orthop 10:69–73CrossRefGoogle Scholar
  11. 11.
    Helfet DL, Virkus W (2002) Acetabular fractures in the elderly. unpublished dataGoogle Scholar
  12. 12.
    Holbrook TL, Grazier K, Kelsey JL, Stauffer RN (1984) The frequency of occurrence, impact, and cost of selected musculoskeletal conditions in the United States. American Academy of Orthopedic Surgeons, ChicagoGoogle Scholar
  13. 13.
    Jimenez ML, Tile M, Schenk RS (1997) Total hip replacement after acetabular fracture. Orthop Clin North Am 28:435–446PubMedCrossRefGoogle Scholar
  14. 14.
    Johansson T, Jacobsson SA, Ivarsson I, Knutsson A, Wahlstrom O (2000) Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures: a prospective randomized study of 100 hips. Acta Orthop Scand 71:597–602, DecPubMedCrossRefGoogle Scholar
  15. 15.
    Letournel E (1980) Acetabulum fractures: classification and management. Clin Orthop 151:81–106PubMedGoogle Scholar
  16. 16.
    Letournel E, Judet R (1993) Fractures of the acetabulum, 2nd edn. Springer-Verlag, BerlinGoogle Scholar
  17. 17.
    Matta JM (1996) Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks of the injury. J Bone Jt Surg 78(A):1632–1645Google Scholar
  18. 18.
    Matta JM, Anderson LM, Epstein HC, Hendricks P (1986) Fractures of the acetabulum: a retrospective analysis. Clin Orthop 205:241–250PubMedGoogle Scholar
  19. 19.
    Mears DC (1999) Surgical treatment of acetabular fractures in elderly patients with osteoporotic bone. J Am Acad Orthop Surg 7:128–141, Mar–AprPubMedGoogle Scholar
  20. 20.
    Mears DC, Shirahama M (1998) Stabilization of an acetabular fracture with cables for acute total hip arthroplasty. J Arthroplasty 13:104–107, JanPubMedCrossRefGoogle Scholar
  21. 21.
    Mears DC, Velyvis JH (2002) Acute total hip arthroplasty for selected displaced acetabular fractures: two to twelve-year results. J Bone Jt Surg Am 84-A:1–9, JanGoogle Scholar
  22. 22.
    Mears DC, Velyvis JH, Chang CP (2003) Displaced acetabular fractures managed operatively: indicators of outcome. Clin Orthop 173–186, FebGoogle Scholar
  23. 23.
    Montgomery KD, Potter HG, Helfet DL (1995) Magnetic resonance venography to evaluate the deep venous system of the pelvis in patients who have an acetabular fracture. J Bone Jt Surg Am 77:1639–1649, NovGoogle Scholar
  24. 24.
    Mouhsine E, Garofalo R, Borens O, Blanc CH, Wettstein M, Leyvraz PF (2004) Cable fixation and early total hip arthroplasty in the treatment of acetabular fractures in elderly patients. J Arthroplasty 19:344–348, AprPubMedCrossRefGoogle Scholar
  25. 25.
    Murray MM, Zurakowski D, Vrahas MS (2004) The death of articular chondrocytes after intra-articular fracture in humans. J Trauma 56:128–131, JanPubMedCrossRefGoogle Scholar
  26. 26.
    Padgett DE, Kull L, Rosenberg A (1993) Revision of the acetabular component without cement after total hip arthroplasty. J Bone Jt Surg 75:663–673Google Scholar
  27. 27.
    Rogan IM, Weber FA, Solomon L (1979) Total hip replacement following fracture dislocation of the acetabulum. J Bone Jt Surg 61:252Google Scholar
  28. 28.
    Romness DW, Lewallen DG (1990) Total hip arthroplasty after fracture of the acetabulum. J Bone Jt Surg 72-B:761–764Google Scholar
  29. 29.
    Saterbak AM, Marsh JL, Nepola JV, Brandser EA, Turbett T (2000) Clinical failure after posterior wall acetabular fractures: the influence of initial fracture patterns. J Orthop Trauma 14:230–237, MayPubMedCrossRefGoogle Scholar
  30. 30.
    Schreurs BW, Zengerink M, Welten ML, van Kampen A, Slooff TJ (2005) Bone impaction grafting and a cemented cup after acetabular fracture at 3–18 years. Clin Orthop Relat Res 145–151, AugGoogle Scholar
  31. 31.
    Singh M, Nagrath AR, Maini PS, Haryana R (1970) Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Jt Surg 52(A):457–467Google Scholar
  32. 32.
    Spencer RF (1989) Acetabular fractures in older patients. J Bone Jt Surg [Br] 71B:774–776Google Scholar
  33. 33.
    Stauffer RN (1982) Ten-year follow-up study of total hip replacement with particular reference to roentgenographic loosening of the components. J Bone Jt Surg 64:983–990Google Scholar
  34. 34.
    Tidermark J, Blomfeldt R, Ponzer S, Soderqvist A, Tornkvist H (2003) Primary total hip arthroplasty with a Burch–Schneider antiprotrusion cage and autologous bone grafting for acetabular fractures in elderly patients. J Orthop Trauma 17:193–197, MarPubMedCrossRefGoogle Scholar
  35. 35.
    Tile M, Helfet DL, Kellam JF (2003) Fractures of the pelvis and acetabulum, 3rd edn. Lippincott, PhiladelphiaGoogle Scholar
  36. 36.
    Tornkvist H, Schatzker J (1993) Acetabular fractures in the elderly: an easily missed diagnosis. J Orthop Trauma 7:233–235PubMedCrossRefGoogle Scholar
  37. 37.
    Toro JB, Hierholzer C, Helfet DL (2004) Acetabular fractures in the elderly. Bull Hosp Jt Dis 62:53–57PubMedGoogle Scholar
  38. 38.
    Weber M, Berry DJ, Harmsen WS (1998) Total hip arthroplasty after operative treatment of an acetabular fracture. J Bone Jt Surg Am 80:1295–1305, SepGoogle Scholar

Copyright information

© Hospital for Special Surgery 2006

Authors and Affiliations

  • Eric Pagenkopf
    • 1
  • Andrew Grose
    • 1
  • George Partal
    • 1
  • David L. Helfet
    • 1
    • 2
  1. 1.Orthopaedic Trauma ServiceHospital for Special SurgeryNew YorkUSA
  2. 2.Orthopaedic Trauma Service, Department of Orthopaedic SurgeryWeill Medical College of Cornell University/ Hospital for Special SurgeryNew YorkUSA

Personalised recommendations