Management of geriatric acetabular fractures: Contemporary treatment strategies

Abstract

Acetabular fractures in the geriatric population are typically low-energy fractures resulting from a fall from standing height. Compromised bone quality in the elderly, as well as this population’s concomitant medical comorbidities, render the management of such fractures challenging and controversial. Non-operative management remains the mainstay of treatment, although such a choice is associated with numerous and serious complications related to both the hip joint as well as the general condition of the patient. On the other hand, operatively treating acetabular fractures (e.g., with osteosynthesis or total hip arthroplasty) is gaining popularity. Osteosynthesis can be performed with open reduction and internal fixation or with minimally invasive techniques. Total hip arthroplasty could be performed either in the acute phase combined with osteosynthesis or as a delayed procedure after a period of non-operative management or after failed osteosynthesis of the acetabulum. Regardless of the implemented treatment, orthogeriatric co-management is considered extremely crucial, and it is currently one of the pillars of a successful outcome after an acetabular fracture.

Keywords: Acetabular fractures; Geriatric fractures; Fracture fixation; Total hip arthroplasty; Mortality; Morbidity

Core Tip: Treatment of geriatric acetabular fractures is a challenging clinical problem that has recently gained significant attention within the orthopaedic community. Whilst non-operative management is a used treatment strategy, surgery in the form of either osteosynthesis or combination of osteosynthesis and acute total hip arthroplasty is currently extensively performed. The orthogeriatric co-management of the fragile patients who have sustained an acetabular fracture is essential and of paramount importance.