ORIF + THA Not Common for Acetabular Fractures in Elderly

Researchers across 15 level-1 trauma centers banded together to get some clarity on treatment guidelines for acetabular fractures in older adults. In this retrospective observational study, all participating centers were members of the Major Extremity Trauma Research Consortium. A total of 269 patients over the age of 60 who were admitted for a displaced acetabular fracture; of these 60% underwent surgery.

Theodore Manson, M.D. was a co-author on the study. Dr. Manson told OTW, “What really drove us to investigate this topic was the substantial variation in treatment algorithms proposed by speakers at national meetings. Our perception was that patients with comparable injuries would receive a wide spectrum of treatments from non-operative treatment to open reduction and internal fixation (ORIF), to open reduction and internal fixation with concomitant hip replacement (ORIF + THA).

“We found that those more likely to undergo surgery were less than 80 years old, had experienced a high-energy injury, had a fracture with femoral head impaction, and without hip congruency.

“The one take home message is that in our study group, acute hip replacement (ORIF + THA) was not commonly used for treatment of acetabular fractures in older adults; even in patients with risk factors for high failure rates with open reduction and internal fixation.

“What remains to be seen is whether acute hip replacement (ORIF + THA) for patients with this injury really results in better outcomes for older patients with acetabular fractures as opposed to ORIF alone. What is needed now are comparative trials between ORIF versus ORIF + THA for older adults with acetabular fractures so that we can establish guidelines to help surgeons care for these patients.”