Treatment of Protrusio Fractures of the Acetabulum in Patients 70 Years and Older

Objective: To present clinical, radiographic, and functional outcomes in patients 70 years and older with a protrusio-type acetabulum fracture. Design: Retrospective case series. Setting: Two level 1 trauma centers. Patients: Between November 2000 and December 2009, 39 consecutive patients older than 70 years with protrusio acetabulum fractures were enrolled. Intervention: Open reduction internal fixation using a combination of pelvic brim and infrapectineal plates. Main Outcome Measurements: Clinical, radiographic, and functional outcomes as assessed with the modified Merle d'Aubigne score. Results: Twelve patients were lost to follow-up (<12 months), and one patient was excluded from analysis because he was treated with a percutaneous technique. The remaining 26 (67%) had a mean follow-up of 34 months (12-127 months). At the final follow-up, radiographic grades were excellent in 15, good in 3, poor in 3, and 5 patients had a total hip arthroplasty (19%) at an average of 18 months after the index procedure. The average modified Merle d'Aubigne score was 16 (9-18); categorized as excellent in 10, very good in 4, good in 7, fair in 2, and poor in 3. Conclusion: In the senior patient with a protrusio acetabulum fracture, a treatment strategy that optimizes preoperative conditions, minimizes operative time and blood loss, achieves a stable concentric hip joint, and encourages immediate postoperative ambulation can result in reasonable clinical, radiographic, and functional outcomes with acceptable morbidity. This appears to remain true even in the face of a less than anatomic reduction.