Fri., 10/5/12 Pelvis & Acetabulum, PAPER #66, 4:14 pm OTA-2012
Senior Patients With Acetabular Fractures: Surprising Epidemiology and Mortality
William W. Cross III, MD1; Milton L. “Chip” Routt Jr, MD2; Sean E. Nork, MD2;
James C. Krieg, MD2;
1Mayo Clinic, Rochester, Minnesota, USA;
2Harborview Medical Center, Seattle, Washington, USA
Purpose: We sought to identify critical epidemiology and mortality information in senior patients with acetabular fractures by reviewing a recent consecutive 5-year experience at a regional Level I trauma center.
Methods: All patients aged 65 years or older with an acetabular fracture treated at our hospital from 2004 through 2009 were identified through an institutional fracture database. The patients’ demographic data, comorbidities, mechanism of injury, associated injuries, fracture type, treatment, and mortality information were assessed. Data were analyzed with SPSS 17.0 statistical software.
Results: From a prospectively collected fracture database, there were 1123 acetabular fractures treated between 2004 and 2009. There were 156 patients (14%) aged 65 years or older. In these senior patients, 70% had either an associated both-column or anterior column/ posterior hemitransverse (AC/PHT) fracture pattern. Not surprisingly, 82% of the patients had significant medical comorbidities, with the two most common being hypertension and diabetes. Additional primary organ system injuries occurred in 36% of these senior patients. Mechanisms of injury in this cohort included 70.5% falls and 23.1% motor vehicle accidents. 57 patients (36.5%) underwent open reduction and internal fixation using standard reduction techniques and surgical implants via two main surgical exposures: the ilioinguinal (69%) and Kocher-Langenbeck (29%). Skilled nursing facilities were used after their initial hospitalization in 77% of patients. 51 patients (33%) died within 1 year, and 75% of those were dead within 90 days of their acetabular fracture. Of the 51 who died during the study period, 84% had nonoperative treatment. For those patients treated with traction alone, there was a 79% 1-year mortality and a nearly 50% mortality rate at 90 days. Of the 105 surviving patients, 91% underwent operative treatment.
Conclusion: Acetabular fractures in senior patients occur uncommonly, but when they do occur there is a very high incidence of associated both-column and AC/PHT fracture patterns. Routine fixation constructs and implants can be used effectively. In these senior patients, medical comorbid conditions are common and usually impact clinical decision-making. The 90-day and 1-year mortality rates are surprisingly high, especially in those senior patients treated without surgery.
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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.