Acetabular fractures treatment needs in the elderly and nonagenarians

Abstract

Different treatment options for acetabular fractures in the elderly and nonagenarians exist; a consistent guideline has not been established, yet. The purpose of this study is to give an overview of how those fractures can be handled and compares two different surgical treatment methods. A total of 89 patients ≥ 18 years between 2016 and 2021 with acetabular fractures in our department received a surgical intervention with plate fixation via the Stoppa approach or a total hip arthroplasty with a Burch–Schneider ring and integrated cup. 60 patients ≥ 65 were compared in two groups, 29 patients between 65 and 79 and 31 patients ≥ 80. For comparison, data on operation times, hospitalization, complications during operation and hospital stay, blood loss and postoperative mobilization were collected. Characteristics could be found for indications for operative osteosynthesis or endoprosthetics based on the X-ray analysis. There was a tendency to treat simple fractures with osteosynthesis. Patients between 65 and 79 with an osteosynthesis had benefits in almost every comparison. Patients ≥ 80 with a plate fixation had advantages in the categories of postoperative complications, blood loss and transfusion of erythrocyte concentrates. Statistical significant differences were noticed in both groups regarding the operation time. Patients between 65 and 79 with osteosynthesis had significant benefits for postoperative complications, hospitalization, number of blood transfusions and postoperative mobilization. Finding the best supportive treatment option is difficult, and decision-making must respect fracture patterns and individual risk factors. This study shows that plate fixation via the Stoppa approach has some benefits.

Indications, complications, and clinical outcomes of fixation and acute total hip arthroplasty for the treatment of acetabular fractures: A systematic review

“…Open reduction and internal fixation (ORIF) of acetabular fractures is challenging, especially in elderly patients with complex fractures and poor bone quality [ 1 – 3 ]. Unfavorable prognostic factors for ORIF in this patient population include articular impaction, comminution, preexisting osteoarthritis, severe osteopenia, or osteoporosis [ 4 ].…”

Traumogenesis of the Floating Hip in Patients With Polytrauma

“…Серед причин летальних наслідків у пацієнтів з переломами тазу на першому місці перебуває масивна крововтрата та травматичний шок. У пізніші терміни до смертельних наслідків призводять такі ускладнення, як сепсис, пневмонія, поліорганна недостатність [7]. W. He et al (2023) вказує, що наявність травматичного шоку та гострої масивної крововтрати спостерігається у 40-100% пацієнтів з поєднаною травмою таза та стегна, саме ці синдроми є основною причиною смерті, особливо у першу добу після отримання політравми [5].…”

“…Однак серед пацієнтів з флотуючим стегном з результатом летальний випадок ДТП як причина травми була у 75,0% випадків. J. Riemenschneider et al (2022) серед причин травм стегна та вертлюгової западини ДТП досягає 69,7%, а кататравма, посідаючи друге місце, -20,9% випадків [7]. Ми, як і деякі автори,…”