The potentially inferior outcomes in acetabular fractures in the elderly have led to the need for specific treatment pathways to best approach these patients.
A 1-year mortality rate of 8.1% following isolated acetabular fracture is described in those over 60 years of age across all treatment strategies, with the rate up to 25% in those presenting with concomitant injuries. Advanced age has been described as a predictor for inferior outcomes following acetabular fractures. While management strategies of acetabular fractures in younger populations are well described, management of these fractures in the elderly requires a unique approach, owing to the additional complexities conferred by both coexisting medical comorbidities and compromised bone quality typically encountered in this elderly patient group. The objective of management of acetabular fractures is to optimise hip function in a method that allows for return to pre-injury levels of activity, minimising both the length of disability and overall complications. This proliferation has resulted in acetabular fractures in the elderly representing the fastest-growing aspect of pelvic trauma, with further increases in incidence expected in the coming years, with an incidence of acetabular fractures of up to 32 per 100,000 predicted in over 75-year-olds. An analogous increase in the incidence of these fractures in the elderly has also been described, with a 2.4-fold increase in the proportion of acetabular fractures detected amongst the elderly population over a 27-year period. Acetabular fractures represent up to 20% of all osteoporotic pelvic fractures and are associated with significant patient morbidity. A corresponding rise in the incidence of acetabular fractures in the elderly of up to 23% per annum has been detected, frequently attributed to increasing levels of both longevity as well as activity within this subgroup. With advances in modern healthcare, the worldwide population is becoming increasingly elderly. If it is to be pursued, we advise a multidisciplinary approach focused on early mobility, minimisation of risk and regular follow-up to optimise patient outcomes. Our recommendation is that conservative management of acetabular fractures in the elderly can be considered as a treatment option on a case-by-case basis accounting for patient, injury, and surgical factors. This review assessing the current literature was undertaken with the purpose of summarising the challenges of management in this at-risk cohort as well as quantifying the role and outcomes following conservative management in the elderly. Conservative management of acetabular fractures in the elderly continues to play an important role in treatment of both stable fracture patterns and those medically unfit for surgery. A variety of treatment strategies including operative and non-operative approaches exists to manage this vulnerable patient group. While management of acetabular fractures in young patients following high-energy trauma is well described, treatment of the elderly patient subgroup is complex and requires a unique, individualized approach. In the longer term, patients who have fractured their acetabulum face an increased risk of arthritis in the joint.The incidence of acetabular fractures in the elderly population is ever increasing. Since acetabular fractures are often caused by auto accidents, such fractures are usually accompanied by other injuries that can complicate treatment of the fracture.
Rehabilitation is required after surgery or after nonsurgical treatment. If a patient walks on the affected leg too soon, it risks displacing the joint again. For older patients, even if the alignment of the joint is not perfect, fractures may be allowed to heal on their own, especially if the ball of the joint is still in the socket and relatively stable.Īfter injury or surgery, patients must not put weight on the affected leg for up to three months. Surgery is most often performed in younger patients. Surgery is used to remove bone debris from the joint, restore stability to the hip and align the surface of the cartilage so the ball is held tightly within the socket of the joint. Depending on the extent of damage to the cartilage in the joint and the degree of instability in the hip, surgery may be required.
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