Treatment Of Acetabular Fractures In The Elderly

Objective To investigate and summarize the characteristics and corresponding treatments of the acetabular fractures in the elderly.Methods From February 1998 to June 2007,38cases of acetabular fracture in the elderly were treated in our hospital,with a mean age of 71-year-old(range 60～81).Case files were retrospectively analyzed including characteristics,treatment and clinical effect of the fractures.Results After 0.5 to 3 years(average 1.3 years),36 cases were followed up.The followed-up clinical effects were evaluated by the improved d'Aubigne and Postel hip score standards-excellent in 24 cases,good in 8 cases,fair in 2 cases,poor in 2 cases and a good rate of 89.00%.Conclusions The acetabular fractures in the elderly have the characteristics of complication,serious smashing,serious compression,difficult reduction and hemostasis. For most of the elderly acetabular fractures we proposed to be treated with open reduction and internal fixation.Open reduction and internal fixation of geriatric acetabular fractures is recommended in the majority of cases with displacement and hip subluxation,and it should be performed strictly based on the indications listed as follows:①Good condition.Patients should be tolerant to the impairment of the operation.②Poor stability.Dislocation of the hip is associated with the displacement of anterior wall or column/posterior wall or column.③Poor compatibility,a.Fractures of the top of acetabulumm——displacement of the fracture fragments,T-shape-fracture,fracture of both columns(displacement of posterior column)that causes poor compatibility,b.Residual bone mass.c.Displacement of the femoral head fracture,d.Embedding of soft tissue.④Associated with femoral neck or intertrochanteric fracture.⑤Not associated with serious osteoporosis,adequate bone quality for fixation,and the reconstruction may be performed in a reasonable surgical time(i.e.3 to 4 hours).Indications for acute treatment with open reduction and internal fixation are listed as follows:①Dislocation that cannot be reducted,②Poor stability of the hip joint after reduction.③Severe injury of nerves.④Injury of vascula.⑤Open fracture.Surgery should not be in pursuit of strict anatomical reduction,and joint surface subsidence needs grafting.Patients may do some exercise in the early age after ORIF to prevent osteoporosis.Non-surgical treatment may be considered in the following condition:①Serious osteoporosis.②Good stability and compatibility of the hip joint.A:No displacement.B: Mild displacement.C:Fracture with secondary compatibility(fractures of both columns).③Patients with poor condition can not tolerate surgery.We can treat patients that have mild fracture displacement or smashing or poor condition with closed nailing with the help of 3-D navigation(CAOS)to make them be capable of exercising early.