Nonoperative Treatment of the Geriatric Acetabular Fracture

  • Mariano E. Menendez
  • Scott P. RyanEmail author


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.


Acetabular fracture Nonoperative Elderly Geriatric Functional outcomes 


  1. 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. 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. 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. 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. 5.
    Cornell CN. Management of acetabular fractures in the elderly patient. HSS J. 2005;1:25–30.CrossRefGoogle Scholar
  6. 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. 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. 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. 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. 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. 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. 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. 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. 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. 15.
    Manson T, Schmidt AH. Acetabular fractures in the elderly: a critical analysis review. JBJS Rev. 2016;4.CrossRefGoogle Scholar
  16. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 26.
    Sen RK, Veerappa LA. Long-term outcome of conservatively managed displaced acetabular fractures. J Trauma. 2009;67:155–9.CrossRefGoogle Scholar
  27. 27.
    Spencer RF. Acetabular fractures in older patients. J Bone Joint Surg Br. 1989;71:774–6.CrossRefGoogle Scholar
  28. 28.
    Tile M. Fractures of the acetabulum. Orthop Clin North Am. 1980;11:481–506.PubMedGoogle Scholar
  29. 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. 30.
    Tornetta P 3rd. Displaced acetabular fractures: indications for operative and nonoperative management. J Am Acad Orthop Surg. 2001;9:18–28.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryTufts Medical CenterBostonUSA

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