Acetabular Fractures in Older Patients pp 21-28 | Cite as
Nonoperative Treatment of the Geriatric Acetabular Fracture
Abstract
The treatment of displaced acetabular fractures in the geriatric population is controversial. Each form of operative and nonoperative treatment has its advantages and disadvantages. The treatment plan should be individualized, based on patient factors and fracture characteristics. Because of the lack of current data on functional outcomes of nonoperative treatment, one cannot assume that results of nonoperative treatment in this patient population are poor. In fact, available evidence suggests that, among infirm elderly patients with acetabular fractures, nonoperative treatment may be associated with functional outcomes comparable to those seen in healthier patients who undergo surgery, with similar mortality and lesser need for late conversion to total hip arthroplasty. Future prospective studies on treatment of these injuries in this patient population should include a nonoperative group because the results may not be as suboptimal as once thought.
Keywords
Acetabular fracture Nonoperative Elderly Geriatric Functional outcomesReferences
- 1.Archdeacon MT, Kazemi N, Collinge C, Budde B, Schnell S. Treatment of protrusio fractures of the acetabulum in patients 70 years and older. J Orthop Trauma. 2013;27:256–61.CrossRefGoogle Scholar
- 2.Boraiah S, Ragsdale M, Achor T, Zelicof S, Asprinio DE. Open reduction internal fixation and primary total hip arthroplasty of selected acetabular fractures. J Orthop Trauma. 2009;23:243–8.CrossRefGoogle Scholar
- 3.Borg T, Berg P, Larsson S. Quality of life after operative fixation of displaced acetabular fractures. J Orthop Trauma. 2012;26:445–50.CrossRefGoogle Scholar
- 4.Carroll EA, Huber FG, Goldman AT, Virkus WW, Pagenkopf E, Lorich DG, Helfet DL. Treatment of acetabular fractures in an older population. J Orthop Trauma. 2010;24:637–44.CrossRefGoogle Scholar
- 5.Cornell CN. Management of acetabular fractures in the elderly patient. HSS J. 2005;1:25–30.CrossRefGoogle Scholar
- 6.Forster R, Stewart M. Anticoagulants (extended duration) for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair. Cochrane Database Syst Rev. 2016;3:CD004179.PubMedGoogle Scholar
- 7.Gary JL, Lefaivre KA, Gerold F, Hay MT, Reinert CM, Starr AJ. Survivorship of the native hip joint after percutaneous repair of acetabular fractures in the elderly. Injury. 2011;42:1144–51.CrossRefGoogle Scholar
- 8.Gary JL, Paryavi E, Gibbons SD, Weaver MJ, Morgan JH, Ryan SP, Starr AJ, O'Toole RV. 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.CrossRefGoogle Scholar
- 9.Gary JL, VanHal M, Gibbons SD, Reinert CM, Starr AJ. Functional outcomes in elderly patients with acetabular fractures treated with minimally invasive reduction and percutaneous fixation. J Orthop Trauma. 2012;26:278–83.CrossRefGoogle Scholar
- 10.Helfet DL, Borrelli J Jr, DiPasquale T, Sanders R. Stabilization of acetabular fractures in elderly patients. J Bone Joint Surg Am. 1992;74:753–65.CrossRefGoogle Scholar
- 11.Jeffcoat DM, Carroll EA, Huber FG, Goldman AT, Miller AN, Lorich DG, Helfet DL. Operative treatment of acetabular fractures in an older population through a limited ilioinguinal approach. J Orthop Trauma. 2012;26:284–9.CrossRefGoogle Scholar
- 12.Judet R, Judet J, Letournel E. Fractures of the acetabulum: classification and surgical approaches for open reduction. Preliminary Report. J Bone Joint Surg Am. 1964;46:1615–46.CrossRefGoogle Scholar
- 13.Lin C, Caron J, Schmidt AH, Torchia M, Templeman D. Functional outcomes after total hip arthroplasty for the acute management of acetabular fractures: 1- to 14-year follow-up. J Orthop Trauma. 2015;29:151–9.CrossRefGoogle Scholar
- 14.Lucas J, Chako AT, Rodriguez EK, Appleton P. Comparison of outcomes of operative versus nonoperative treatment of acetabular fracures in the elderly and severely comorbid patient. Boston: Annual Meeting of the Orthopaedic Trauma Association; 2008.Google Scholar
- 15.Manson T, Schmidt AH. Acetabular fractures in the elderly: a critical analysis review. JBJS Rev. 2016;4.CrossRefGoogle Scholar
- 16.Manson TT, Reider L, O'Toole RV, Scharfstein DO, Tornetta P 3rd, Gary JL, Major Extremity Trauma Research C. Variation in treatment of displaced geriatric acetabular fractures among 15 level-I trauma centers. J Orthop Trauma. 2016;30:457–62.CrossRefGoogle Scholar
- 17.Matta JM, Anderson LM, Epstein HC, Hendricks P. Fractures of the acetabulum. A retrospective analysis. Clin Orthop Relat Res. 1986:230–40.Google Scholar
- 18.Mears DC. Surgical treatment of acetabular fractures in elderly patients with osteoporotic bone. J Am Acad Orthop Surg. 1999;7:128–41.CrossRefGoogle Scholar
- 19.Mears DC, Velyvis JH. Acute total hip arthroplasty for selected displaced acetabular fractures: two to twelve-year results. J Bone Joint Surg Am. 2002;84-A:1–9.CrossRefGoogle Scholar
- 20.Mouhsine E, Garofalo R, Borens O, Wettstein M, Blanc CH, Fischer JF, Moretti B, Leyvraz PF. Percutaneous retrograde screwing for stabilisation of acetabular fractures. Injury. 2005;36:1330–6.CrossRefGoogle Scholar
- 21.Pagenkopf E, Grose A, Partal G, Helfet DL. Acetabular fractures in the elderly: treatment recommendations. HSS J. 2006;2:161–71.CrossRefGoogle Scholar
- 22.Rickman M, Young J, Trompeter A, Pearce R, Hamilton M. Managing acetabular fractures in the elderly with fixation and primary arthroplasty: aiming for early weightbearing. Clin Orthop Relat Res. 2014;472:3375–82.CrossRefGoogle Scholar
- 23.Ruesch PD, Holdener H, Ciaramitaro M, Mast JW. A prospective study of surgically treated acetabular fractures. Clin Orthop Relat Res. 1994:38–46.CrossRefGoogle Scholar
- 24.Ryan S, Manson TT, Lebrun CT, Nascone JW, Sciadini MF, Castillo RC, O'Toole RV. Functional outcomes of nonoperative treatment of geriatric acetabular fractures meeting operative criteria. San Antonio: Annual Meeting of the Orthopaedic Trauma Association; 2011.Google Scholar
- 25.Schnaser E, Scarcella NR, Vallier HA. Acetabular fractures converted to total hip arthroplasties in the elderly: how does function compare to primary total hip arthroplasty? J Orthop Trauma. 2014;28:694–9.CrossRefGoogle Scholar
- 26.Sen RK, Veerappa LA. Long-term outcome of conservatively managed displaced acetabular fractures. J Trauma. 2009;67:155–9.CrossRefGoogle Scholar
- 27.Spencer RF. Acetabular fractures in older patients. J Bone Joint Surg Br. 1989;71:774–6.CrossRefGoogle Scholar
- 28.Tile M. Fractures of the acetabulum. Orthop Clin North Am. 1980;11:481–506.PubMedGoogle Scholar
- 29.Tornetta P 3rd. Non-operative management of acetabular fractures. The use of dynamic stress views. J Bone Joint Surg Br. 1999;81:67–70.CrossRefGoogle Scholar
- 30.Tornetta P 3rd. Displaced acetabular fractures: indications for operative and nonoperative management. J Am Acad Orthop Surg. 2001;9:18–28.CrossRefGoogle Scholar