Sat., 10/15/11 Peds, Ger, Hip, Femur & IP, Paper #72, 10:40 am OTA-2011
Functional Outcomes in Elderly Patients With Acetabular Fractures Treated With Minimally Invasive Reduction and Percutaneous Fixation
Joshua L. Gary, MD; Michael VanHal, MD; Steven D. Gibbons;
Charles M. Reinert, MD; Adam J. Starr, MD;
University of Texas Southwestern Medical Center, Dallas, Texas, USA
Purpose: The incidence of osteopenic geriatric fractures continues to rise as the population ages. There has been much recent interest in the treatment of acetabular fractures in geriatric patients, and no consensus exists in the optimal treatment of these difficult injuries. We seek to present the functional outcomes of elderly patients treated with percutaneous reduction and fixation and compare them to those treated with traditional open reduction and internal fixation in previously reported series.
Methods: Our institutional trauma database was searched for all patients ≥60 years of age who had been treated with percutaneous screw fixation for an acetabular fracture from 1994 to 2007. Survivorship to present day and conversion to total hip arthroplasty were determined with patient and/or family contact; the Social Security Death Index was used to determine mortality when no one could be contacted. Living patients were evaluated using the SMFA (Short Musculoskeletal Function Assessment) and Harris hip score; radiographs were obtained if the patient was able to visit the office. Our functional outcomes were then analyzed against data from other published series with similar outcome measures.
Results: 79 consecutive patients with 80 fractures were identified. 36 patients (including the patient with bilateral fractures) died before functional outcomes were obtained, leaving 43 patients and fractures in our study group. Follow-up was obtained in 36 of 43 patients (83.7%) and functional outcomes were obtained in 35 of 43 patients (81.3%) at an average of 6.8 years after the index surgery. One patient could not complete surveys due to severe dementia. Average age at time of injury was 69.9 years, with 25 males and 10 females. 11 of these 36 (30.5%) patients had undergone conversion to total hip arthroplasty at time of latest follow-up. Average SMFA dysfunction and bother indices were 23.3 and 21.3, respectively, in 24 patients who maintained their native hip. When compared with SMFA data from 2 other series of patients treated with formal open reduction and internal fixation, no differences existed in the dysfunction (P = 0.49) or bother (P = 0.55) indices. Average Harris hip scores in patients with their native hip was 77 (range, 33-100). In the 11 patients converted to total hip arthroplasty, average SMFA dysfunction and bother indices were 24.3 and 23.9, respectively. No differences were found in the dysfunction (P = 0.93) or bother (P = 0.16) indices when compared to patients converted from open reduction and internal fixation to total hip arthroplasty. Average Harris hip score in patients converted to total hip arthroplasty was 83 (range, 68-92).
Conclusion: Functional outcomes and rates of conversion to total hip arthroplasty of acetabular fractures in elderly patients treated with percutaneous reduction and fixation show no significant differences when compared with published series of patients treated with formal open reduction and internal fixation.
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• 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.