Sat., 10/20/07 Geriatrics/Injury Prevention, Paper #51, 9:43 am OTA-2007
Combined Open Reduction and Internal Fixation and Total Hip Arthroplasty for Acute Management of Acetabular Fractures in the Elderly
Jason Caron, MD (n);
Andrew Schmidt, MD (a-Synthes; a,e-Smith+Nephew; b-FH Orthopaedics);
David Templeman, MD (c-Zimmer; e-Stryker);
University of Minnesota–Hennepin County Medical Center, Minneapolis, Minnesota, USA
Purpose: Acetabular fractures with osteoporosis, articular impaction, and comminution have a poor prognosis following open reduction and internal fixation (ORIF). Some suggest that in elderly patients with such injuries, acute total hip arthroplasty (THA) may facilitate recovery and avoid reoperation for arthritis. This study reports the complications and functional outcomes of a series of elderly patients treated acutely with combined ORIF and THA for displaced acetabular fractures.
Methods: A retrospective review was performed of one surgeon’s experience from 1996 to 2007 in treating selected acetabular fractures judged to have a high likelihood of a poor outcome if treated with traditional ORIF. 29 patients treated with combined ORIF and THA were identified. There were 13 male and 16 female patients. The average patient age was 66 years. Fractures were classified as posterior wall in 12, anterior wall in 2, anterior column in 1, anterior column-posterior hemitransverse in 5, posterior column in 1, posterior column-posterior wall in 3, T-type in 1, and transverse-posterior wall in 4. 2 patients had an anterolateral approach, 2 had a combined ilioinguinal and posterior approach, and 25 a posterior approach. Three patients had a cemented acetabular cup with the remaining uncemented. Most patients had autologous bone grafting using the resected femoral head (20/29). Patients were assessed clinically, radiographically, and with the Short Form-12 (SF-12) and Oxford Hip Scores.
Results: Average follow-up was 31 months (range, 0-116 months). At the most recent follow-up, 6 patients had died from unrelated causes. At latest radiographic follow-up, all fractures were united. There were four early complications and no late complications, including one deep wound infection and one hematoma both requiring irrigation and débridement, one episode of pulmonary compromise requiring a brief ICU stay, and one early cup loosening that was successfully revised to a larger cup at 8 weeks and has been stable since. There were no neurovascular injuries and no cases of clinically significant heterotopic ossification. The average SF-12 physical component score was 43.6 (range, 10-62) and the average Oxford Hip Score was 16.7 (range, 13-29) indicating good to excellent results. The SF-12 score was affected by additional lower extremity injuries in two patients.
Conclusion and Significance: Plate fixation of the anterior and/or posterior columns combined with acute THA for selected acetabular fractures in elderly patients is a safe, viable treatment option with good to excellent functional outcomes and obviates the need for two separate operations. Functional outcome scores are equivalent to those after primary THA for osteoarthritis.
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.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing.