Treatment modalities and outcomes following acetabular fractures in the elderly: a systematic review

Purpose The treatment of geriatric acetabular fractures remains controversial. Treatment options include nonoperative management, open reduction and internal fixation (ORIF), total hip arthroplasty (THA) with or without internal fixation, and closed reduction with percutaneous pinning (CRPP). There is currently no consensus on the optimal treatment strategy for geriatric patients with acetabular fractures. The purpose of this study is to compare adverse event rates, functional and radiographic outcomes, and intraoperative results between the various treatment modalities in order to help guide surgical decision making. Methods We performed a systematic review (registration number CRD42019124624) of observational and comparative studies including patients aged ≥ 55 with acetabular fractures. Results Thirty-eight studies including 3,928 patients with a mean age of 72.6 years (range 55–99 years) and a mean follow-up duration of 29.4 months met our eligibility criteria. The pooled mortality rate of all patients was 21.6% (95% confidence interval [CI] 20.9–22.4%) with a mean time to mortality of 12.6 months, and the pooled non-fatal complication rate was 24.7% (95% CI 23.9–25.5%). Patients treated with ORIF had a significantly higher non-fatal complication rate than those treated with ORIF + THA, THA alone, CRPP, or nonoperative management (odds ratios [ORs] 1.87, 2.24, 2.15, and 4.48, respectively; p < 0.01). Patients that underwent ORIF were significantly less likely to undergo subsequent THA than these treated with CRPP (OR 0.49, 95% CI 0.32–0.77) but were more likely to require THA than patients treated nonoperatively (OR 6.81, 95% CI 4.63–10.02). Conclusion Elderly patients with acetabular fractures tend to have favorable functional outcomes but suffer from high rates of mortality and complications. In patients treated with internal or percutaneous fixation, there was a high rate of conversion to THA. When determining surgical treatment in this population, THA alone or concurrent with ORIF should be considered given the significantly lower rate of non-fatal complications and similar mortality rate. Nonoperative management remains a viable option and was associated with the lowest non-fatal complication rate. Level of evidence This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266..

Medienart:

E-Artikel

Erscheinungsjahr:

2021

Erschienen:

2021

Enthalten in:

Zur Gesamtaufnahme - volume:32

Enthalten in:

European journal of orthopaedic surgery & traumatology - 32(2021), 4 vom: 02. Juni, Seite 649-659

Sprache:

Englisch

Beteiligte Personen:

McCormick, Brian P. [VerfasserIn]
Serino, Joseph [VerfasserIn]
Orman, Sebastian [VerfasserIn]
Webb, Alex R. [VerfasserIn]
Wang, David X. [VerfasserIn]
Mohamadi, Amin [VerfasserIn]
Mortensen, Sharri [VerfasserIn]
Weaver, Michael J. [VerfasserIn]
Von Keudell, Arvind [VerfasserIn]

Links:

Volltext [lizenzpflichtig]

BKL:

44.65$jChirurgie

44.83$jRheumatologie$jOrthopädie

Themen:

Acetabular fractures
Closed reduction percutaneous pinning
Geriatric
Nonoperative management
Open reduction internal fixation
Total hip arthroplasty

RVK:

RVK Klassifikation

Anmerkungen:

© The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature 2021

doi:

10.1007/s00590-021-03002-3

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

OLC2130113508

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