Acetabular Fractures in the Elderly

Abstract

Acetabular fracture patterns in the elderly, with increased involvement of the anterior column, quadrilateral plate comminution, medialization of the femoral head, and marginal impaction, differ from those noted among a younger cohort. Poor prognostic factors for open reduction and internal fixation (ORIF) are posterior wall comminution, marginal impaction of the acetabulum, a femoral head impaction fracture, a so-called gull sign, and hip dislocation. The rate of conversion to total hip arthroplasty following formal ORIF has been reported to be 22% at a mean of twenty-nine months. Total hip replacement after an acetabular fracture generally yields good clinical results; however, in the acute setting, it must be combined with proper stable fracture fixation.

Fractures and Biomechanical Characteristics of the Bone

“…A mature bone consists of two types of tissue components, compact or cortical and spongy or trabecular bone tissue [5] [6]. These two types of bone tissue are categorized on the basis of porosity level and microstructural unit of individual bone tissue type.…”

“…The basic structural unit of cortical bone tissue are osteons, whereas the spongiosa consists of network of trabeculae. Each of these tissues consists of collagen and hydroxyapatite [6]- [8]. The share of organic matter in the bone is 40%, inorganic matter 45% and cells 15% [6].…”

“…Each of these tissues consists of collagen and hydroxyapatite [6]- [8]. The share of organic matter in the bone is 40%, inorganic matter 45% and cells 15% [6]. The organization of organic polymer and mineral mass in the bone is responsible for the special bone characteristics.…”

“…A living bone in the organism is rarely exposed to only one type of force or the bone is rarely affected in one direction only. It is usually subjected to several forces in different directions [4]- [6] [9] [10].…”

Fix and replace; an emerging paradigm for treating acetabular fractures

“…Falls from standing height accounted for 50% of acetabular fractures in patients over 60 years old, while 82% of fractures in younger patients was as a result of high energy mechanisms of injury (5). The rate of other associated injury is much less for the elderly group (less than 30%) than for younger patients due to the decreased rate of RTAs (7). Although these elderly patients frequently have poor bone quality, multiple medical co-morbidities and an increased peri-operative risk profile-all of which may reduce the expectation of a favourable outcome-with prompt diagnosis, careful monitoring of the physiological parameters of injury, optimisation of pre-operative status, involvement of experienced teams, and a highly specific patient-tailored management programme (8)(9)(10)(11), successful outcomes can be achieved.…”