Fri., 10/17/08 Geriatrics/Reconstruction, Paper #39, 4:34 pm OTA-2008
Percutaneous Reduction and Fixation of Acetabulum Fractures in Elderly Patients: Results at Ten Years
Joshua L. Gary, MD1 (n); Frank Gerold, MS2 (n);
Kelly A. Lefaivre, MD1 (a-AO North America, Zimmer); Adam J. Starr, MD1 (n);
Charles M. Reinert, MD1 (n);
1University of Texas Southwestern Medical Center, Dallas, Texas, USA;
2University of Texas Health Science Center at Houston, Houston, Texas, USA
Purpose: Treatment of acetabular fractures in the elderly is controversial. However, one goal of surgical treatment is preservation of a functioning hip. The purpose of this report is to provide intermediate follow-up on elderly patients who underwent percutaneous screw fixation, and to determine the rate of conversion to total hip arthroplasty.
Methods: We retrospectively reviewed data on patients 60 years of age or older treated with percutaneous fixation of an acetabular fracture at a Level 1 trauma center from 1994-2007. Demographic data and perioperative records were reviewed. Dates of conversion to total hip arthroplasty and death were recorded from medical records, and additional information was obtained from patients and/or family members by physical examination or by telephone when necessary. Kaplan-Meier survival analysis to hip arthroplasty was performed.
Results: In our group of 79 patients, the mean age was 73.53 ± 0.93 years. One patient had bilateral acetabular fractures. There were 26 women and 53 men. The mean time to surgery from admission was 4.12 ± 0.39 days. The fractures included 23 simple patterns and 57 associated patterns. Twenty patients underwent percutaneous fixation alone, and 59 also had a minimal open reduction through a 3-cm incision for a subiliacus approach. Average blood loss was 69.21 ± 9.18 mL. There were no postoperative wound infections and 5 losses of fixation. The mean age in the loss of fixation group was 79.26 ± 3.88 years, and in the remaining group 73.14 ± 0.95, which neared statistical significance (P = 0.111). There was one in-hospital death due to stroke. Seven patients were lost to follow-up, including the patient with bilateral fractures. Fixation survival analysis showed revision to hip arthroplasty in 17 patients, and an overall survival of fixation to death or last follow-up of 76%. The cumulative survival of the hips at years 1, 2, 4, 6, and 10 were 87%, 85%, 76%, 76%, and 76%, respectively. The mean time to hip arthroplasty was 515.06 ± 108.91 days. There have been no revisions to hip arthroplasty beyond 4 years.
Conclusion and Significance: Acetabular fractures in the elderly treated with percutaneous fixation have minimal blood loss and low rates of in-hospital death and infection. Although easily converted to a primary total hip arthroplasty, this was only necessary in a minority of cases, with the majority requiring no further surgery.
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. Δ OTA Grant.