Fix and replace; an emerging paradigm for treating acetabular fractures

Abstract

SummaryAlthough technically challenging even for the experienced surgeon, simultaneous open reduction and internal fixation (ORIF) of acetabular fracture and total hip replacement (THR) have some potential advantages over the more traditional treatment options in specific patient subgroups; theoretically allowing immediate weight bearing and faster rehabilitation, reducing the cost of inpatient stay, and reducing the risks of early and late local complications associated with standard treatment for this type of injury. We review the evolution of the indications and techniques, outline the surgical challenges, and discuss implant options and outcomes for this treatment paradigm.

Management of acetabular fractures in elderly patients

“…57 Therefore, logically, if surgery is identified to be the appropriate option for the patient, one could make a case for stabilisation the fracture and performing the THA at the same time. 29,40 The concept was pioneered by Mears et al about 2 decades ago. The principles revolve around achieving stable fixation of the acetabular columns using a single or two approaches.…”

Dual mobility total hip dislocation—femoral stem loosening while attempting closed reduction: a cautionary note

“…Simultaneous fracture fixation and THA is also called ‘fix and replace’, the term first coined by Murphy and Carrothers 12. To achieve the aim of immediate mobilisation postsurgery, a radical shift is required from the prolonged immobilisation associated with non-operative treatment or operative fixation alone to surgical treatment that enables immediate weight-bearing 13.…”

Acetabular fractures in the elderly: modern challenges and the role of conservative management

“…Treatment is broadly subdivided into non-operative and operative options, with operative strategies including traditional open reduction and internal fixation (ORIF), minimally invasive stabilisation, total hip arthroplasty (THA) or a combination of approaches [30,31]. Perioperative management of these injuries across all operative options is well-studied, with the need for timing of definitive surgery to factor in patients' preoperative risk and early postoperative mobilisation described to maximise outcomes across all strategies [5,19].…”

“…Nevertheless, such an approach is associated with an added technical complexity in this patient group owing to the often unstable nature of the underlying fracture potentially limiting implant positioning [32]. Additionally, it is relevant to highlight the potentially significant perioperative risk following acute THA in this patient cohort, with increased susceptibility to complications in what is often a physiologically fragile patient group particularly prominent in a combined THA/ORIF approach as regards blood loss and anaesthetic time [2,31]. The role of conservative treatment Historically, conservative treatment of acetabular fractures has been proposed as a valid treatment strategy in the elderly [33].…”