A Survey of High- and Low-Energy Acetabular Fractures in Elderly Patients

Abstract

Introduction: Geriatric patients represent 14% of acetabular fractures and are the fastest growing subset of patients affected by this injury in the US. Treatment outcomes have been reported as inferior to those achieved in younger patients after high-energy (HE) acetabular trauma. This study aimed to compare detailed demographic characteristics and clinical outcomes in elderly patients (≥65 years of age) treated in a tertiary North American trauma center for acetabular fractures after both high- and low-energy mechanisms of injury. Methods: Patients (≥65 years of age) diagnosed with an acetabular fracture were identified over a 7-year period. Patient and injury characteristics were extracted from our institutional trauma database. Length of stay, intervention, operative details, disposition, complications, readmissions, and mortality were analyzed. Results: One hundred nine patients were identified for inclusion. Low-energy mechanisms (simple falls) were found in 64 (58.7%) and HE mechanisms in 45 (41.3%) patients. The HE cohort was younger (74.6 vs 80.7 years; P < .001), had a higher male predominance (76% vs 56%; P = .10), a lower Charlson comorbidity index (1.29 ± 1.49 vs 2.16 ± 1.76; P = .01), and a higher injury severity score (19.90 ± 15.33 vs 6.46 ± 3.57; P < .001). Fracture patterns, described according to the Letournel-Judet classification, were similar between the 2 groups. Thirty-day mortality was significantly higher in the HE group (26.7% vs 3.1%; P < .001); however, the 1-year mortality rates were not statistically different (31.1% vs 25.0%; P = .20). Discussion: Patients with acetabular fractures sustained due to HE accidents demonstrate significantly higher 30-day mortality rate than patients with low-energy fractures, but similar mortality 1 year after the injury, despite having a much lower mean age and fewer comorbidities. Conclusion: Medical efforts made during initial hospital admission may have the biggest impact on survivorship following acetabular fracture.

High- Versus Low-Energy Acetabular Fracture Outcomes in the Geriatric Population

“…24,25 The results of this case series confirm previous findings indicating that patients in the high-energy fracture group are predominantly male, younger, and have fewer comorbidities than those who sustain low-energy fractures. 8 Higher BMI in our study was associated with surgical intervention, arthritis, and postoperative nerve palsy.…”

“…A literature search revealed few publications on both highand low-energy geriatric acetabular fracture outcomes. 4,8,[20][21][22] Two of these studies found high-energy fracture patterns to follow similar fracture patterns as the low-energy group, resulting in a majority anterior wall or both column fractures. 8,21 Also, prior studies demonstrate that posterior wall fracture patterns are found to be associated with poorer outcomes.…”

“…4,8,[20][21][22] Two of these studies found high-energy fracture patterns to follow similar fracture patterns as the low-energy group, resulting in a majority anterior wall or both column fractures. 8,21 Also, prior studies demonstrate that posterior wall fracture patterns are found to be associated with poorer outcomes. 21,23 Our study found that high-and low-energy mechanisms of fracture resulted in differing fracture patterns, with 50% of the high-energy fractures demonstrating a posterior wall pattern, while the low-energy mechanisms primarily demonstrated an anterior wall fracture.…”

“…Researchers continue to debate if operative management will deliver the best outcome for the patient. 7,8 Increased age is also associated with heterotopic bone formation, hip avascular necrosis, and post-traumatic arthritis, which may ultimately require total hip arthroplasty. 8,9 Additionally, researchers found presurgical factors such as surgical delay to be significant predictors for patient outcome and major systemic complications.…”

“…10,11 With an increasing incidence of geriatric acetabular fractures and limited research on highenergy geriatric acetabular trauma, identifying predictors of poor outcome is essential to inform treatment and management of an older adult with an acetabular fracture. 8,12 To this end, we reviewed 4 years of acetabular fracture data from a busy level-I trauma center. We collected patient demographics, comorbidities, and treatment outcomes for high-and low-energy acetabular fracture mechanisms in patients older than 65 years.…”