Skip to main content
SpringerLink
Log in

Operative versus non-operative treatment of displaced acetabular fractures in elderly patients

  • Original Article
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background

Acetabular fracture treatments in elderly patients are not well codified.

Purpose

The aim of the study was to determine if, for active elderly patients, the clinical results after surgical treatment of displaced acetabular fractures are better than for non-operative treatment.

Methods

All active patients over 60 years with a Parker score higher than 6, managed for displaced acetabular fracture between 2005 and 2014, were included in this single-center retrospective study. Clinical outcomes were compared according to the therapeutic option (operative or non-operative) and the fracture pattern (anterior fracture that requires open reduction and internal fixation or posterior fracture that requires total hip arthroplasty).

Results

Among the 82 patients with Parker score higher than 6, 44 were treated non-operatively and 38 were operated. Forty-seven had anterior fracture (AF) and 35 had posterior fracture (PF). In the AF group, the autonomy scores were better for operative than non-operative patients (p < 0.05) with a PARKER score 7.8 (7–8) versus 5.4 (1–9); ADL score 5.7 (4–6) versus 4.4 (1–6) and IADL score 7.6 (6–8) versus 4.2 (0–8). In the PF group, the autonomy scores were better for operative than non-operative patients (p < 0.05) with a PARKER score 7.3 (4–9) versus 5.6 (2–9), ADL score 5.3 (2–6) versus 4.4 (1–6) and IADL score 5.6 (2–8) versus 4.1 (1–7). Regarding clinical outcomes, the HARRIS and PMA scores were better for operative patients (p < 0.05).

Conclusion

Surgical treatment in elderly patients with displaced acetabular fractures is associated with better clinical outcomes than non-operative treatment when the autonomy level is comparable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ferguson TA, Patel R, Bhandari M et al (2010) Fractures of the acetabulum in patients aged 60 years and older: an epidemiological and radiological study. J Bone Joint Surg Br 92:250–257. https://doi.org/10.1302/0301-620X.92B2.22488

    Article  CAS  PubMed  Google Scholar 

  2. Boudissa M, Francony F, Kerschbaumer G et al (2017) Epidemiology and treatment of acetabular fractures in a level-1 trauma centre: retrospective study of 414 patients over 10 years. Orthop Traumatol Surg Res 103:335–339. https://doi.org/10.1016/j.otsr.2017.01.004

    Article  CAS  PubMed  Google Scholar 

  3. Guerado E, Cano JR, Cruz E (2012) Fractures of the acetabulum in elderly patients: an update. Injury 26:278–283. https://doi.org/10.1016/S0020-1383(13)70177-3

    Article  Google Scholar 

  4. Manson T, Schmidt AH (2016) Acetabular fractures in the elderly: a critical analysis review. JBJS Rev. https://doi.org/10.2106/JBJS.RVW.15.00090

    Article  PubMed  Google Scholar 

  5. Butterwick D, Papp S, Gofton W et al (2015) Acetabular fractures in the elderly: evaluation and management. J Bone Joint Surg Am 97:758–768. https://doi.org/10.2106/JBJS.N.01037

    Article  PubMed  Google Scholar 

  6. Volpin A, Konan S, Biz C et al (2019) Reconstruction of failed acetabular component in the presence of severe acetabular bone loss: a systematic review. Musculoskelet Surg 103:1–13. https://doi.org/10.1007/s12306-018-0539-7

    Article  CAS  PubMed  Google Scholar 

  7. Ryan SP, Manson TT, Sciadini MF et al (2017) Functional outcomes of elderly patients with non-operatively treated acetabular fractures that meet operative criteria. J Orthop Trauma 31:644–649. https://doi.org/10.1097/BOT.0000000000000990

    Article  PubMed  Google Scholar 

  8. Gary JL, Paryavi E, Gibbons SD et al (2015) Effect of surgical treatment on mortality after acetabular fracture in the elderly: a multicenter study of 454 patients. J Orthop Trauma 29:202–208. https://doi.org/10.1097/BOT.0000000000000223

    Article  PubMed  Google Scholar 

  9. Boelch SP, Jordan MC, Meffert RH et al (2017) Comparison of open reduction and internal fixation and primary total hip replacement for osteoporotic acetabular fractures: a retrospective clinical study. Int Orthop 41:1831–1837. https://doi.org/10.1007/s00264-016-3260-x

    Article  PubMed  Google Scholar 

  10. Walley KC, Appleton PT, Rodriguez EK (2017) Comparison of outcomes of operative versus non-operative treatment of acetabular fractures in the elderly and severely comorbid patient. Eur J Orthop Surg Traumatol 27:689–694. https://doi.org/10.1007/s00590-017-1949-1

    Article  PubMed  Google Scholar 

  11. Parker MJ, Palmer CR (1993) A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br 75:797–798

    Article  CAS  Google Scholar 

  12. D’Aubigne RM, Postel M (1954) Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 36:451–475

    Article  Google Scholar 

  13. Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51:737–755

    Article  CAS  Google Scholar 

  14. Boudissa M, Ruatti S, Kerschbaumer G et al (2016) Part 2: outcome of acetabular fractures and associated prognostic factors-a ten-year retrospective study of one hundred and fifty six operated cases with open reduction and internal fixation. Int Orthop 40:2151–2156

    Article  Google Scholar 

  15. Carroll EA, Huber FG, Goldman AT et al (2010) Treatment of acetabular fractures in an older population. J Orthop Trauma 24:637–644. https://doi.org/10.1097/BOT.0b013e3181ceb685

    Article  PubMed  Google Scholar 

  16. Jauregui JJ, Clayton A, Kapadia BH et al (2015) Total hip arthroplasty for acute acetabular fractures: a review of the literature. Expert Rev Med Devices 12:287–295. https://doi.org/10.1586/17434440.2015.1009828

    Article  CAS  PubMed  Google Scholar 

  17. Li YL, Tang YY (2014) Displaced acetabular fractures in the elderly: results after open reduction and internal fixation. Injury 45:1908–1913

    Article  Google Scholar 

  18. Bible JE, Wegner A, McClure DJ et al (2014) One-year mortality after acetabular fractures in elderly patients presenting to a level-1 trauma center. J Orthop Trauma 28:154–159. https://doi.org/10.1097/BOT.0b013e31829e801b

    Article  PubMed  Google Scholar 

  19. Kreder H, Rozen N, Borkhoff C et al (2006) Determinants of functional outcome after simple and complex acetabular fractures involving the posterior wall. J Bone Joint Surg Br 88:776–782

    Article  CAS  Google Scholar 

  20. Tidermark J, Blomfeldt R, Ponzer S et al (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

    Article  Google Scholar 

  21. Herscovici D Jr, Lindvall E, Bolhofner B et al (2010) The combined hip procedure: open reduction internal fixation combined with total hip arthroplasty for the management of acetabular fractures in the elderly. J Orthop Trauma 24:291–296. https://doi.org/10.1097/BOT.0b013e3181b1d22a

    Article  PubMed  Google Scholar 

  22. Rickman M, Young J, Trompeter A et al (2014) Managing acetabular fractures in the elderly with fixation and primary arthroplasty. Clin Orthop Relat Res 472:3375–3382. https://doi.org/10.1007/s11999-014-3467-3

    Article  PubMed  PubMed Central  Google Scholar 

  23. Giunta JC, Tronc C, Kerschbaumer G et al (2018) Outcomes of acetabular fractures in the elderly: a five year retrospective study of twenty seven patients with primary total hip replacement. Int Orthop. https://doi.org/10.1007/s00264-018-4204-4

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orthopaedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Boulevard de la Chantourne, 38700, La Tronche, France

    Mehdi Boudissa, Florent Francony, Sabine Drevet, Gael Kerschbaumer, Sebastien Ruatti, Michel Milaire, Philippe Merloz & Jérôme Tonetti

  2. Joseph Fourier University, Grenoble, France

    Mehdi Boudissa, Florent Francony, Sabine Drevet, Gael Kerschbaumer, Sebastien Ruatti, Michel Milaire, Philippe Merloz & Jérôme Tonetti

  3. TIMC-IMAG Lab, Univ. Grenoble Alpes, CNRS, UMR 5525, Pavillon Taillefer, 38700, La Tronche, France

    Mehdi Boudissa, Philippe Merloz & Jérôme Tonetti

Authors
  1. Mehdi Boudissa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Florent Francony
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sabine Drevet
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gael Kerschbaumer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sebastien Ruatti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michel Milaire
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Philippe Merloz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jérôme Tonetti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mehdi Boudissa.

Ethics declarations

Operative versus non-operative treatment of displaced acetabular fractures in elderly patients.

Conflict of interest

We confirm that the authors have no conflicts of interest.

Ethical approval

The local ethics committee approved this retrospective study.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Boudissa, M., Francony, F., Drevet, S. et al. Operative versus non-operative treatment of displaced acetabular fractures in elderly patients. Aging Clin Exp Res 32, 571–577 (2020). https://doi.org/10.1007/s40520-019-01231-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-019-01231-5

Keywords

Search

Navigation