Session VII - Pelvis / Spine

Sat., 10/16/10 Pelvis & Spine, Paper #79, 3:42 pm OTA-2010

Operative Fixation versus Reconstruction with THA for Acute Acetabular Fractures in the Elderly Population

Michael J. Weaver, MD1,2; Micah Miller, BS2; David Lhowe, MD2;
Malcolm Smith, MD2; Mark S. Vrahas, MD1,2;
1Brigham and Women’s Hospital and Massachusetts General Hospital,
Boston, Massachusetts, USA;
2Massachusetts General Hospital, Boston, Massachusetts, USA

Purpose: The purpose of this study is to compare the short-term outcomes of open reduction and internal fixation (ORIF) and acute reconstruction with total hip arthroplasty (THA) in the management of acetabular fractures in patients over 65 years of age.

Methods: We reviewed a consecutive series of patients treated over a 7-year period at our institution with either ORIF or reconstruction with a THA for an acute acetabular fracture. All patients were at least 65 years old at the time of injury. Patients were interviewed and radiographs were examined. Validated outcome scores including the Harris hip score and Short Form 36 (SF-36) were collected.

Results: 73 patients were included in the study, 33 treated with ORIF and 40 treated with THA. Mean follow-up was 21 months. The mean age in the ORIF group was 73 years (range, 65-88). The mean age in the THA group was 79 years (range, 68-89). The most common fracture patterns included anterior column/posterior posterior wall fractures (27%), transverse/posterior wall (18%) and anterior column/posterior hemitransverse (15%). One-year mortality was similar between those treated with ORIF (15%) and THA (23%, P = 0.43). There was a trend toward a higher rate of reoperation in the ORIF group (30%) compared to the THA group (15%, P = 0.12). There were 3 (8%) deep infections in the THA group and 4 (12%, P = 0.50) in the ORIF group. Seven (21%) of the patients treated initially with ORIF went on to develop posttraumatic arthritis and underwent eventual THA. Four (10%) of the patients who underwent THA had at least 1 dislocation, and 2 (5%) went on to recurrent instability requiring further surgery. Harris hip scores of the uninjured limb were similar between those treated with ORIF (mean 82) compared to those treated with THA (81, P = 0.83). There was a trend toward improved Harris hip scores in the injured limb in those treated with THA (mean 82) compared to ORIF (63, P = 0.06). There were significantly better SF-36 bodily pain scores in the THA group (mean 48) compared to the ORIF group (39, P = 0.04). There was also a trend toward improved physical summary scores in the THA group (mean 43) compared to the ORIF group (35, P = 0.15).

Conclusion: ORIF and reconstruction with THA are options in the treatment of acute fractures of the acetabulum in the elderly population. THA appears to compare favorably to ORIF, with a similar rate of complication, but with improved pain scores. There is a significant rate of conversion of ORIF to THA. Both treatments are associated with high rates of morbidity and mortality in this population.

Alphabetical Disclosure Listing (292K PDF)

• 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.