Long-Term Outcome of Conservatively Managed Displaced Acetabular Fractures

Abstract

Acetabular fractures involving the weight-bearing dome if reduced by closed means can be maintained by heavy lateral and longitudinal traction resulting in good clinicoradiologic outcome comparable with operative management.

Management of High-Energy Acetabular Fractures in the Elderly Individuals

“…Sen et al reported on a subgroup of 14 patients with acetabular fractures displaced greater than 20 mm who were treated nonoperativley. 17 Reducibility was very poor, as only 2 (14.3%) of the 14 achieved good reduction on follow-up x-ray imaging. It should be recognized, however, that due to the decreased functional demands in the elderly individuals, that which may be considered to be an unsatisfactory result for articular reduction in a younger active patient, may yield a quite satisfactory functional result for an older patient.…”

“…A retrospective review by Heffernan et al compared 2194 geriatric patients (>65) versus 2081 younger patients (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) who presented after blunt trauma with similar ISS scores. 24 In this study, mortality increased considerably in the elderly patients with heart rates greater than 90 beats/ min, and systolic blood pressure greater than 100 mm Hg, while similar increases in mortality were not seen in the younger patients.…”

“…Patients who sustain fractures with greater than 20 mm of displacement have typically done poorly after nonoperative management, 17 and operative management should be considered for these patients. Furthermore, acetabular fractures with severe central or superior dome impaction, 18 displaced and impacted subchondral bone of the medial roof (''gull sign''), 19 posterior wall fractures with hip dislocation, 20 or those fractures with damage to the femoral head have historically done poorly with open reduction and internal fixation (ORIF) and may have more favorable outcomes with acute total hip arthroplasty (THA) in patients able to withstand the surgical insult.…”

“…32 Ligamentotaxis is not effective in achieving satisfactory realignment of displaced fragments or columns. 13,17 Complications of nonoperative care derive from prolonged recumbency. Although there is little data regarding acetabular fractures, patients with hip fracture who poorly mobilize are more likely to develop pulmonary compromise and deterioration.…”

Positron emission tomography–computed tomography in the assessment of viability of femoral head in acetabular fractures

“…The reported incidence of avascular necrosis (AVN) of femoral head following surgically managed acetabular fractures varies between 5.7 % and 30 % during followup periods that have ranged from six to 11.3 years [1][2][3][4][5]. AVN has been reported (two out of 35 patients) even following conservative management of displaced acetabular fractures using skeletal traction [6]. Delayed reduction of the fracturedislocations and severe osteochondral injuries to the acetabulum have been found to be associated with very high (30 %) incidence of AVN [4].…”