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

Abstract

Introduction: High-energy mechanisms of acetabular fracture in the geriatric population are becoming increasingly common as older adults remain active later in life. This study compared outcomes for high- versus low-energy acetabular fractures in older adults. Materials and Methods: We studied outcomes of 22 older adults with acetabular fracture who were treated at a level-I trauma center over a 4-year period. Fourteen patients were categorized as low-energy mechanism of injury, and 8 were identified as a high-energy mechanism. We analyzed patient demographics with univariate logistic regressions performed to assess differences in high- and low-energy group as well as patient characteristics compared with surgical outcomes. Results: Most high-energy mechanisms were caused by motor vehicle collision (n = 4, 50.0%), with most having posterior wall fractures (50.0%). Among patient characteristics, the mechanism of injury, hip dislocation, fracture types, and fracture gap had the largest differences between energy groups effect size (ES: 2.45, 1.43, 1.36, and 0.83, respectively). The high-energy group was more likely to require surgery (odds ratio [OR] = 2.80, 95% CI: 0.26-30.70), develop heterotopic bone (OR = 4.33, 95% CI: 0.33-57.65), develop arthritis (OR = 3.60, 95% CI: 0.45-28.56), and had longer time to surgery (mean = 4.8 days, standard deviation [SD] = 5.8 days) compared to low-energy group (mean = 2.5 days, SD = 2.3 days). Discussion: The results of this case series confirm previous findings that patients with high-energy acetabular fractures are predominantly male, younger, and have fewer comorbidities than those who sustained low-energy fractures. Our results demonstrate that the majority of the high-energy fracture patients also suffered a concurrent hip dislocation with posterior wall fracture and experienced a longer time to surgery than the low-energy group. Conclusion: Geriatric patients who sustained high-energy acetabular fractures tend to have higher overall rates of complications, including infection, traumatic arthritis, and heterotopic bone formation when compared with patients with a low-energy fracture mechanism.

Effect of Impact Velocity, Flooring Material, and Trochanteric Soft-Tissue Quality on Acetabular Fracture during a Sideways Fall: A Parametric Finite Element Approach

“…A higher V Impact is associated with a bigger impact force exerted in a shorter time (a higher strain rate), which makes the bone prone to fracture during falls [78]. In a recent study, Cecil et al [79] concluded that by increasing the impact energy (velocity), the type of acetabular fracture changes. Also, they stated that the anterior wall fracture is common among elderly people who experience low-energy event trauma.…”

Comparison of Patient Demographics and Patient-Related Risk Factors for Infections After Primary Total Hip Arthroplasty for Acetabular Fractures

“…1,2 Because of the increasing prevalence of high-energy trauma cases in our society, surgical interventions for the treatment of acetabular fractures are becoming increasingly common in trauma centers. 1,3 Currently, open reduction and internal fixation (ORIF) is considered the mainstay treatment of displaced acetabular fractures; however, a subset of patients with these traumatic injuries are not amenable to ORIF because they may be predisposed to early posttraumatic arthritis. 1,4,5 Recently, studies have shown that the use of primary total hip arthroplasty (THA) for these injuries provides sufficient stability and is considered as a suitable substitute for these injury patterns.…”