Functional Outcomes of Elderly Patients With Nonoperatively Treated Acetabular Fractures That Meet Operative Criteria

Ryan, Scott P.; Manson, Theodore T.; Sciadini, Marcus F.; Nascone, Jason W.; Lebrun, Christopher; Castillo, Renan C.; Muppavarapu, Ragu; Schurko, Brian; O’Toole, Robert V.

doi:10.1097/bot.0000000000000990

Cited by 38 publications

(41 citation statements)

References 29 publications

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“…This finding is consistent with a previous studies that conclude that there is no difference in 1- year mortality between operative and non-operative management, once comorbidities are taken into account [4,10]. Existing literature states 1-year mortality rates of 16 to 35% for non-operative treatment [10,[12][13][14] and of 4 to 21% for operative treatment [10,12,13]. Reasons for the higher mortality in the present study include the fact that a follow-up of 100% was achieved for mortality data by the use of the national social insurance database.…”

Section: Discussionsupporting

confidence: 91%

“…The average duration of hospital stay was long (14 days, SD 10 days), compared to other studies that state a median hospitalisation of 8 to 11 days [10,14,15].Operatively treated patients had a longer average hospitalisation time, which is consistent with the findings of one previous publication on this topic [15].…”

Section: Discussionsupporting

confidence: 87%

“…Secondary conversion rate to THA was 12.4% in the whole cohort and there was no significant difference between the operative and the non-operative group. Secondary conversion rates to THA have been reported to range from 10 to 37% [16] for patients in this age group when treated by open reduction and internal fixation and 15% when treated non-operatively [14]. A recent registry analysis of 678 acetabular fractures among all age groups reported that 19.8% of the patients required secondary THA [19].…”

Section: Discussionmentioning

confidence: 99%

“…While there seems to be consensus that good functional outcomes can be achieved by operative treatment of acetabular fractures in the elderly [12,[16][17][18], there is little data available on functional outcome after non-operative treatment. A recent retrospective case series of elderly patients with acetabular fractures that met criteria for surgery found that these patients can have good functional outcome also with non-operative treatment [14].…”

Section: Discussionmentioning

confidence: 99%

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Mortality, complications and long-term functional outcome in elderly patients with fragility fractures of the acetabulum

et al. 2020

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Background: Early operative treatment of acetabulum fractures in geriatric patients has been suggested to reduce pain and allow for earlier mobilization. The aim of this study was to determine mortality, complications and functional outcome after operative and non-operative treatment. Methods: Patients aged ≥60 years with operative treatment of low-energy fragility fracture of the acetabulum from 2009 to 2016 and a follow-up of at least 24 months were identified. The patients were contacted by phone and a modified Merle d'Aubigné score was obtained. If patients or their relatives were not available for follow-up, mortality data was assessed using a national social insurance database. Results: One hundred seventy-six patients (mean age 78, SD 10 years; 73 female) were available for analysis of mortality data. At final follow-up (68 months, SD 26, range, 24 to 129), 99/176 patients (56.3%) had deceased. Oneyear-mortality was 25.0% and 2-year mortality 35.8%. Type of treatment (non-operative vs. operative) did not affect mortality at 1 and 2 years (p = .65 and p = .10). Hospital-acquired infections were observed in 31/176 cases (17.6%), thromboembolic events and delirium in 6 patients (3.4%). In-hospital mortality was 5.7%. Patients who underwent operative treatment were more likely to have an in-hospital infection (p = .02) but less likely to sustain thromboembolic events (p = .03). The mean hospital stay was 14 days (SD 10 days, range, 1 to 66). Patients with operative treatment were longer hospitalized than patients with non-operative treatment (p < .001). The rate of secondary conversions to THA was 12.4%, this was not affected by initial treatment. The mean modified Merle d'Aubigné Score of those patients available for a final follow-up (n = 47; follow-up 56 months, SD 28, range, 24 to 115) was 14/18 points, SD 3 (range 7 to 18). Functional results at final follow-up between operatively and non-operatively treated patients were without difference. Conclusions: All-cause mortality and in-hospital complications are high among geriatric patients with low-energy fractures of the acetabulum even when treated operatively. Secondary conversion rates to THA are similar to those seen in younger patients. Mid-term functional outcome in those surviving is fair.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Mortality, complications and long-term functional outcome in elderly patients with fragility fractures of the acetabulum

et al. 2020

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“…Joint congruence is not obtainable unless the fracture is not displaced or shows secondary congruence. Some authors prefer non-operative management in specific conditions [13,14]. Stable cup fixation in primary THA may be challenging in displaced fractures [15].…”

Section: Introductionmentioning

confidence: 99%

Open reduction and internal fixation of acetabular fractures in patients of old age

Rommens

Schwab

Handrich

et al. 2020

International Orthopaedics (SICOT)

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Material and methods There is an ongoing debate on which treatment for acetabular fractures in elderly patients is the most appropriate. This study was set up to identify the role of open reduction and internal fixation of acetabular fractures in persons of old age. We retrospectively reviewed the medical charts and radiological data of all patients older than 65 years, who suffered an isolated acetabular fracture and were admitted in our Department between 2010 and 2014 (5-year period). Complications, outcome and mortality were recorded. Of all surviving patients, quality of life (QoL), mobility and independence were graded with European Quality of Life 5 Dimensions 3 Level (EQ-5D-3L), European Quality of Life 5 Dimensions Visual Analogue Scale (EQ-5D-VAS), Numeric Rating Scale (NRS), Elderly Mobility Scale (EMS) and Tinetti Mobility Test (TMT). Results Seventy patients could be identified. There were 52 men (74%) and 18 women (26%) with a median age of 79.0 years (range: 65–104 years). Forty-six patients (66%) had been treated with open reduction and internal fixation (ORIF), 24 (34%) conservatively. There were negative predictive factors—subchondral impaction, damage to the femoral head and multiple fragments—in 54% of the operative group. With ORIF, an anatomical reduction could be achieved in 27 patients (59%), an acceptable in 18 (39%) and a poor in one (2%). At follow-up, 18 patients (26%) had died and 23 (33%) were not able to participate. The follow-up rate of the surviving operatively treated patients was 77%. Eleven of 46 operated patients (24%) needed a conversion to a total hip arthroplasty (THA). All patients undergoing conversion had imperfect reduction after surgery. No patient in the non-operative group underwent conversion to THA during follow-up. The median follow-up time of operatively treated patients without conversion (n = 17) was 30 months (range, 16–73 months), of patients with THA (n = 9) 30 months after conversion (range, 17–55 months). Quality of reduction correlated to QoL, mobility and independence in all recorded parameters. Patients with secondary THA had similar good outcomes as patients after ORIF without later conversion. Men had better outcome than women. Conclusion ORIF of acetabular fractures in patients of old age results in excellent outcomes at short-term follow-up when anatomical reduction can be achieved. In case of negative predictive factors, ORIF cannot be regarded as a definitive solution, rather as the construction of a stable socket for secondary THA. The decision of therapy should be made dependent on pre-operative radiographic parameters.

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Acetabular Fractures

Vázquez

Guerra-Farfán

2021

Evidence‐Based Orthopedics

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Functional Outcomes of Elderly Patients With Nonoperatively Treated Acetabular Fractures That Meet Operative Criteria

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 38 publications

References 29 publications

Mortality, complications and long-term functional outcome in elderly patients with fragility fractures of the acetabulum

Mortality, complications and long-term functional outcome in elderly patients with fragility fractures of the acetabulum

Open reduction and internal fixation of acetabular fractures in patients of old age

Acetabular Fractures

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