Session I - Geriatrics

Thurs., 10/20/05 Geriatrics, Paper #3, 3:12 pm

Medium-term Results after Operative Treatment of Acetabular Fractures in Elderly Patients

Thomas C. Stoll, MD1; John T. Gorczyca, MD1; Arthur L. Malkani, MD2;
Kevin J. Pugh, MD3; (n-all authors)
1University of Rochester Medical Center, Rochester, Minnesota, USA;
2University of Louisville Medical Center, Louisville, Kentucky, USA;
3Ohio State University Medical Center, Columbus, Ohio, USA

Purpose: This study evaluates the results of open reduction and internal fixation (ORIF) of displaced acetabular fractures in elderly patients treated at three level 1 trauma centers. During a 10-year period, a total of 63 patients age 60 years or older were treated with ORIF of displaced acetabular fractures. 54 patients had follow-up of more than 1 year. The average age was 68 years (range, 60 to 85), and there were 33 males and 21 females. 47 fractures (87%) resulted from motor vehicle accidents. 29 fractures were complex types and 25 were simple.

Methods: Patients were evaluated using the Merle d'Aubigné rating system and the Harris hip score. Pre- and postoperative radiographs were evaluated for fracture type, bone quality, marginal impaction, comminution, femoral head injury, healing, and posttraumatic degeneration.

Results: 54 patients were available for follow-up, at an average of 3.1 years. All fractures united within 6 months of surgery. 34 patients (63%) had good to fair results. 20 patients (37%) had severe postoperative degenerative changes necessitating total hip arthroplasty. Other complications included early loss of reduction in 7 patients (13%), acute renal failure, osteonecrosis, and 2 postoperative deaths.

Conclusion/Significance: ORIF of acetabulum fractures may have a higher incidence of posttraumatic degeneration necessitating total hip arthroplasty than previously recognized. The posttraumatic degeneration has multiple causes, including osteopenic bone, complex injuries, fracture comminution, articular cartilage injury, osteonecrosis, and the inability of elderly patients to comply with postoperative weight-bearing restrictions. This information is of prognostic significance.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.