Outcome After Open Reduction Internal Fixation of Acetabular Fractures in the Elderly

Objectives: (1) Assess outcomes of acetabular open reduction and internal fixation (ORIF) in the elderly, (2) investigate factors influencing outcome, and (3) compare outcomes after low-energy and high-energy mechanisms of injury. Design: Retrospective case series. Setting: Level 1 trauma center. Patients: Seventy-eight patients older than 60 years (age: 70.1 6 7.4; 73.1% males). Intervention: ORIF for acetabular fractures. Main Outcome Measurements: Complications, reoperation rates, Oxford Hip Score (OHS), and joint preservation and development of symptomatic osteoarthritis. Cases with osteoarthritis, OHS, 34, and those who required subsequent total hip arthroplasty were considered as poor outcome. Results: At a mean follow-up of 4.3 6 3.7 years, 11 cases postORIF required a total hip arthroplasty. The 7-year joint survival postORIF was 80.7 6 5.7%. Considering poor outcome as failure, the 7year joint survival was 67.0 6 8.9%. The grade of reduction was the most significant factor associated with outcome post-ORIF. Female sex (P = 0.03), pre-existing osteoporosis (P = 0.03), low-energy trauma (P = 0.04), and Matta grade (P = 0.002) were associated with poor outcome. Patients with associated both-column fractures were more likely to have nonanatomic reduction (P = 0.008). After low-energy trauma, joint survivorship was 36.6 6 13.5% at 7 years compared with 75.4 6 7.4% in the high-energy group when considering poor outcome as an end point (log rank P = 0.006). The cohort's mean OHS was 37.9 6 9.3 (17-48). Conclusions: We recommend ORIF whenever an anatomic reduction is feasible. However, achievement and maintenance of anatomic reduction are a challenge in the elderly, specifically in those with low-energy fractures involving both columns, prompting consideration for alternative management strategies.

Automated summary

Objective of this study was to assess the outcomes of acetabular open reduction and internal fixation (ORIF) in elderly patients, investigate factors influencing the outcomes, and compare the outcomes after low-energy and high-energy mechanisms of injury. The results showed that the grade of reduction was the most significant factor associated with outcome post-ORIF. Female sex, pre-existing osteoporosis, low-energy trauma, and Matta grade were associated with poor outcome. Joint survivorship was lower after low-energy trauma.