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. 2012 Sep;3(3):95-106.
doi: 10.1177/2151458512454661.

Management of high-energy acetabular fractures in the elderly individuals: a current review

Brian W Hill  1 , Julie A Switzer, Peter A Cole
Affiliations

Management of high-energy acetabular fractures in the elderly individuals: a current review

Brian W Hill et al. Geriatr Orthop Surg Rehabil. 2012 Sep.

Abstract

Acetabular fractures in the elderly individuals are increasing in prevalence. Although there is evidence in the literature that acetabular fractures in elderly patients sustained as a result of low-energy mechanisms can be well treated by nonoperative management, open reduction and internal fixation, or even acute arthroplasty, almost no literature exists that may appropriately guide the treatment of elderly acetabular fractures that occur as a result of high-energy mechanisms. In spite of this lack of evidence, specific principles for providing the best care in adult trauma patients may reasonably be adopted. These principles include aggressive resuscitation and medical optimization; surgical care that focuses on a patient's survival but does not sacrifice skeletal stability; and early mobilization. Best practices that guide the care of hip fracture patients, such as a team approach to care, the use of protocols to guide treatment, and the timing of surgery to occur as soon as is safely possible also should be employed to guide care in patients who have sustained acetabular fractures. Opportunity exists to better study these higher energy fractures and to, thereby, affect outcomes in patients who have sustained them.

Keywords: acetabular fracture; elderly trauma; geriatric; high-energy injuries.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The institution of one or more of the authors (BWH, JAS, PAC) has received, in any 1 year, funding for unrelated research from Synthes USA (Paoli, PA, USA) and Zimmer Inc (Warsaw, IN, USA). Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Figures

Figure 1.
Figure 1.
(A, B) Judet oblique radiographs of a 79-year-old male who fell off a ladder and suffered a both column acetabular fracture with secondary congruence as depicted by the axial computed tomography (CT) scan (C, D, E). Follow-up oblique radiographs (F, G) demonstrated fracture healing and a good overall result after nonoperative management.
Figure 2.
Figure 2.
Preoperative (A, B) Judet oblique injury radiographs of an anterior column fracture of a elderly patient struck by a motor vehicle. Intraoperative (C, D) oblique and hip (E) images after open reduction and internal fixation through an ilioinguinal approach. Postoperative (F, G) oblique radiographs.
Figure 3.
Figure 3.
Preoperative 3-dimensional (3D) computed tomography (CT) reconstruction (A, B) oblique and posterior (C) images of a 67-year-old male that fell >10 feet from a deer stand. 3D reconstruction allowed for clear delineation of the transverse acetabular fracture and massive posterior wall impaction, which was instrumental for preoperative planning. Postoperative (D, E) oblique radiographs after open reduction and internal fixation (ORIF).
Figure 4.
Figure 4.
(A, B) Judet oblique radiographs depicting a minimally displaced acetabular fracture. Postoperative judet oblique radiographs (C, D) after treatment with percutaneous screws allowing for immediate touchdown weight bearing.
Figure 5.
Figure 5.
Anteroposterior (AP) preoperative (A) and postoperative (B) radiographs of a patient who underwent primary open reduction and internal fixation (ORIF) for an acetabular fracture and subsequently had a left total hip arthroplasty after subcapital femoral neck fracture and posterior hip dislocation.
Figure 6.
Figure 6.
The regions hospital treatment algorithm for high-energy acetabular fractures in an older population.
See this image and copyright information in PMC

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