Treatment of Acetabular Fractures in an Older Population

Objective: To identify factors predicting poor radiographic and functional outcome and delayed total hip arthroplasty in operatively managed acetabular fractures in patients 55 years of age and older. Design: Retrospective chart and radiographic review of a prospectively maintained database. Setting: Tertiary care hospital. Patients: Ninety-three with a mean age of 67 years met all inclusion criteria and had follow up averaging 5 years. Intervention: Open reduction and internal fixation and less commonly acute total hip arthroplasty for displaced acetabular fractures in an older cohort. Main Outcome Measurement: Three validated patient self-assessment measures were used: the Musculoskeletal Functional Assessment, the Short Musculoskeletal Functional Assessment, and the SF-36. Results: The overall rate of hip replacement in our study was 30.95%. Poor fracture reduction (P < 0.02), development of avascular necrosis (P < 0.001), and previous contralateral hip arthroplasty (P = 0.02) were statistically associated with the need for secondary surgeries. Functional outcome scores in the current study compared favorably with functional outcome scores reported for acetabular fractures in younger populations and with age-matched non-injured norms published in recent literature. Conclusions: There was an acceptably low rate of major complications in 93 operatively managed fractures in this population. Nearly 70% of patients achieved functional outcomes similar to age- and injury-matched control subjects without the need for secondary surgeries. Thirty percent of patients required secondary total hip arthroplasty for posttraumatic arthritis. These patients achieved outcomes similar to patients in the other outcome groups and to injury-and age-matched norms.