Acetabular Fractures in the Senior Population– Epidemiology, Mortality and Treatments

Abstract

Background:<br />Management of acetabular fractures in the senior population can be one of the most challenging injuries to<br />manage. Furthermore, treating surgeons have a paucity of information to guide the treatment in this patient population.<br />The purpose of this study was to determine: (1) demographic and epidemiologic data, (2) mortality rates for nonoperative<br />compared to operative management at different time points, (3) common fracture configurations, and (4) fracture fixation<br />strategies in senior patients treated with acetabular fractures.<br />Methods:<br />Retrospective review of prospectively gathered data at a Level I trauma center over a five-year period. 1123<br />acetabular fractures were identified. 156 of them were for patients over the age of 65 (average age of 78).<br />Results:<br />Falls and motor vehicle accidents accounted for the two most common mechanisms of injury. 82% of patients<br />had significant medical comorbidities. 51 patients (33%) died within one year, in which 75% of them died within 90 days<br />of their acetabular fracture. 84% of the deceased patients, i.e. from the group of 51 patients, had non-operative treatment.<br />For patients treated with traction alone, there was a 79% one-year mortality and 50% mortality rate within 90 days. Within<br />the entire cohort, 70% had either an associated both-column (ABC) or anterior column/posterior hemitransverse (AC/PHT)<br />fracture pattern. Fifty-seven patients (36.5%) underwent open reduction and internal fixation using standard reduction<br />techniques and surgical implants via two main surgical exposures of ilioinguinal (69%) and Kocher-Langenbeck (29%).<br />Conclusion:<br />Geriatric patients with acetabular fractures are uncommon accounting for only 14% of all acetabular<br />fractures. Patients who undergo surgery show lower mortality rates. ABC and AC/PHT fracture patterns are the two most<br />common fracture patterns. Routine fixation constructs and implants can be used to manage these challenging fractures.<br />Most patients are unable to return to their homes and instead require skilled nursing facility during their convalescence.