Acute treatment of elderly patients with acetabular fractures by open reduction, internal fixation, and total hip arthroplasty: a 1-10-year follow-up of 48 patients

• Published in: Acta orthopaedica 2024-11, Vol.95, p.661-666
• Main Authors: Kirkeboe, Ragnhild Loven, Madsen, Jan Erik, Nordsletten, Lars, Clarke-Jenssen, John
• Format: Article
• Language: English
• Subjects: Acetabulum - injuries; Acetabulum - surgery; Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - methods; Female; Follow-Up Studies; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Internal - methods; Fractures, Bone - surgery; Hip; Humans; Male; Middle Aged; Open Fracture Reduction - adverse effects; Open Fracture Reduction - methods; Osteoporosis; Pelvis and acetabulum; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Retrospective Studies
• ISSN: 1745-3674; 1745-3682; 1745-3682
• DOI: 10.2340/17453674.2024.42113

 Acetabular fractures in osteoporotic bone are associated with substantial joint impaction and comminution, previously shown to be prognostic for a poor result. A combined procedure of open reduction, internal fixation (ORIF), and total hip arthroplasty (THA) can be a good option, allowing for immediate weightbearing as tolerated. We report short- to medium-term outcome and complications of the results of patients treated with this combined procedure.  48 cases treated with ORIF and acute THA from 2000 to 2019 were identified from our local pelvic fracture registry, from which follow-up data was extracted. Descriptive statistics were used and Kaplan-Meier survival curves were calculated. Primary outcome was HHS at 1 year. Secondary outcomes were implant survival, complications requiring surgery, and mortality at 3 months.  There were 37 men and 11 women treated in the study period. Mean age was 68 (37-87) years. 6 patients died within 3 months of surgery, leaving 42 cases available for follow-up. Mean follow-up (FU) was 2.8 (1-16) years. The most common mechanism of injury was fall from standing height (n = 36). Medical comorbidities were common. Mean Harris Hip Score (HHS) was 83 (51-100) at 1-year follow-up. There were 7 reoperations: 6 for postoperative infection and 1 closed reduction of implant dislocation. 38 had their implant intact at latest FU. At the latest FU, 28 patients were ambulatory without a walking aid.  Our results indicate that ORIF and acute THA can be performed with good functional results in patients with unreconstructable displaced acetabular fractures, but with a significant risk of infection and revision.