Is non-operative management of acetabular fracture a viable option for older patients? A systematic review of the literature for indication, treatments, complications and outcome

Is non-operative management of acetabular fracture a viable option for older patients? A systematic review of the literature for indication, treatments, complications and outcome

Authors

  • Giorgio Cacciola University of Turin, Department of Orthopaedic Surgery, C.T.O., Turin, Italy
  • Alessandro Aprato University of Turin
  • Luigi Branca Vergano Ospedale Santa Chiara, Trento, Italy
  • Adel Sallam University of Turin
  • Alessandro Massé University of Turin

Keywords:

acetabular fracture, elderly patients, nonoperative management, conservative management

Abstract

There is no consensus about the best treatment for acetabular fracture in older patients. The purpose of this study was to review the current literature looking for indication, perioperative information and outcome of nonoperative management for acetabular fractures in elderly.A systematic review of literature was performed on different research database by using various combination of the keywords “acetabular fracture”, “elderly patients”, “60 years”, “nonoperative”, “nonsurgical” and “conservative treatment”.Six articles met our inclusion criteria, 315 patients aged 60 or more treated nonoperatively for acetabular fracture were included in the analysis. The average age was 78.1 years, the average follow-up length was 48.7 months. The main criteria for indication of nonoperative management for acetabular fractures were, old age (75 years or more), two or more important medical comorbidities, and minimally or undisplaced fracture. The most frequent fracture pattern was anterior column in 25.3% of cases. Fall from standard height was the most frequent causative mechanism in 80% of patients. A conversion total hip arthroplasty was performed after 8.3% of cases. A 1-year mortality of 18% was reported, an overall mortality of 33.1% at last follow-up was reported.The management of acetabular fractur in elderly is a challenging problem and there is no consensus about the best treatment. Currently, multiple treatment options have been suggested, depending on fracture pattern and patients’ general conditions. Although operatively treatment allow for an early recovery, there is not an high level of evidence about the superiority in terms or complications and mortality rate compared to nonoperative treatment.

 

References

Agostini P, Lugg ST, Adams K, Vartsaba N, Kalkat MS, Rajesh PB. Postoperative pulmonary complications and rehabilitation requirements following lobectomy: a propensity score matched study of patients undergoing video-assisted thoracoscopic surgery versus thoracotomy. Interact Cardiovasc Thorac Surg 2017; 24: 931–7.

Manson T, Schmidt AH. Acetabular Fractures in the Elderly: A Critical Analysis Review. JBJS Rev. 2016 Oct 4;4(10):01874474-201610000-00002.

Macera CA, Ham SA, Yore MM, Jones DA, Ainsworth BE, Kimsey CD, Kohl HW 3rd. Prevalence of physical activity in the United States: Behavioral Risk Factor Surveillance System, 2001. Prev Chronic Dis. 2005 Apr;2(2):A17. Epub 2005 Mar 15. PMID: 15888228; PMCID: PMC1327711.

Aznar-Lou I, Zabaleta-Del-Olmo E, Casajuana-Closas M, Sánchez-Viñas A, Parody-Rúa E, Bolíbar B, Iracheta-Todó M, Bulilete O, López-Jiménez T, Pombo-Ramos H, Martín Miguel MV, Magallón-Botaya R, Maderuelo-Fernández JÁ, Motrico E, Bellón J, Martí-Lluch R, Rubio-Valera M, Serrano-Blanco A. Cost-effectiveness analysis of a multiple health behaviour change intervention in people aged between 45 and 75 years: a cluster randomized controlled trial in primary care (EIRA study). Int J Behav Nutr Phys Act. 2021 Jul 2;18(1):88. doi: 10.1186/s12966-021-01144-5. PMID: 34215275.

Ferguson TA, Patel R, Bhandari M, Matta JM. Fractures of the acetabulum in patients aged 60 years and older: an epidemiological and radiological study. J Bone Joint Surg Br. 2010 Feb;92(2):250-7. doi: 10.1302/0301-620X.92B2.22488. PMID: 20130318.

Boudissa M, Francony F, Drevet S, Kerschbaumer G, Ruatti S, Milaire M, Merloz P, Tonetti J. Operative versus non-operative treatment of displaced acetabular fractures in elderly patients. Aging Clin Exp Res. 2020 Apr;32(4):571-577. doi: 10.1007/s40520-019-01231-5.

Walley KC, Appleton PT, Rodriguez EK. Comparison of outcomes of operative versus non-operative treatment of acetabular fractures in the elderly and severely comorbid patient. Eur J Orthop Surg Traumatol. 2017 Jul;27(5):689-694.

McCormick BP, Serino J, Orman S, Webb AR, Wang DX, Mohamadi A, Mortensen S, Weaver MJ, Von Keudell A. Treatment modalities and outcomes following acetabular fractures in the elderly: a systematic review. Eur J Orthop Surg Traumatol. 2021

Gautam D, Gupta S, Malhotra R. Total hip arthroplasty in acetabular fractures. J Clin Orthop Trauma. 2020 Nov-Dec;11(6):1090-1098.

Anglen JO, Burd TA, Hendricks KJ, Harrison P. The “Gull Sign”: a harbinger of failure for internal fixation of geriatric acetabular fractures. J Orthop Trauma. 2003 Oct;17(9):625-34.

10 Zha GC, Sun JY, Dong SJ. Predictors of clinical outcomes after surgical treatment of displaced acetabular fractures in the elderly. J Orthop Res. 2013 Apr;31(4):588-95. doi: 10.1002/jor.22279. Epub 2012 Nov 28. PMID: 23192663.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71

Cacciola G, Mancino F, De Meo F, Di Matteo V, Sculco PK, Cavaliere P, Maccauro G, De Martino I. Mid-term survivorship and clinical outcomes of the medial stabilized systems in primary total knee arthroplasty: A systematic review. J Orthop. 2021 Feb 22;24:157-164. doi: 10.1016/j.jor.2021.02.022.

Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003 Sep;73(9):712-6. doi: 10.1046/j.1445-2197.2003.02748.x.

Cacciola G, De Martino I, De Meo F. Does the medial pivot knee improve the clinical and radiographic outcome of total knee arthroplasty? A single centre study on two hundred and ninety seven patients. Int Orthop. 2020 Feb;44(2):291-299. doi: 10.1007/s00264-019-04462-3.

Spencer RF. Acetabular fractures in older patients. J Bone Joint Surg Br. 1989 Nov;71(5):774-6. doi: 10.1302/0301-620X.71B5.2584245.

Firoozabadi R, Cross WW, Krieg JC, Routt MLC. Acetabular Fractures in the Senior Population- Epidemiology, Mortality and Treatments. Arch Bone Jt Surg. 2017 Mar;5(2):96-102. PMID: 28497099;

Ryan SP, Manson TT, Sciadini MF, Nascone JW, LeBrun CT, Castillo RC, Muppavarapu R, Schurko B, OʼToole RV. Functional Outcomes of Elderly Patients With Nonoperatively Treated Acetabular Fractures That Meet Operative Criteria. J Orthop Trauma. 2017 Dec;31(12):644-649.

Wollmerstädt J, Pieroh P, Schneider I, Zeidler S, Höch A, Josten C, Osterhoff G. Mortality, complications and long-term functional outcome in elderly patients with fragility fractures of the acetabulum. BMC Geriatr. 2020 Feb 17;20(1):66. doi: 10.1186/s12877-020-1471-x. PMID: 32066394; PMCID: PMC7027204.

De Martino I, Strigelli V, Cacciola G, Gu A, Bostrom MP, Sculco PK. Survivorship and Clinical Outcomes of Custom Triflange Acetabular Components in Revision Total Hip Arthroplasty: A Systematic Review. J Arthroplasty. 2019 Oct;34(10):2511-2518. doi: 10.1016/j.arth.2019.05.032.

inne PP, Laitinen MK, Huttunen T, Kannus P, Mattila VM. The incidence and trauma mechanisms of acetabular fractures: A nationwide study in Finland between 1997 and 2014. Injury. 2017 Oct;48(10):2157-2161. doi: 10.1016/j.injury.2017.08.003.

Lundin N, Huttunen TT, Berg HE, Marcano A, Felländer-Tsai L, Enocson A. Increasing incidence of pelvic and acetabular fractures. A nationwide study of 87,308 fractures over a 16-year period in Sweden. Injury. 2021 Jun;52(6):1410-1417. doi: 10.1016/j.injury.2021.03.013.

Cacciola G, De Meo F, Cavaliere P. Mechanical and elution properties of G3 Low Viscosity bone cement loaded up to three antibiotics. J Orthop. 2018 Sep 6;15(4):1004-1007. doi: 10.1016/j.jor.2018.08.035.

Waseem S, Lenihan J, Davies BM, Rawal J, Hull P, Carrothers A, Chou D. Low body mass index is associated with increased mortality in patients with pelvic and acetabular fractures. Injury. 2021 May 4:S0020-1383(21)00414-9. doi: 10.1016/j.injury.2021.04.066

R Rinne PP, Laitinen MK, Huttunen T, Kannus P, Mattila VM. The incidence and trauma mechanisms of acetabular fractures: A nationwide study in Finland between 1997 and 2014. Injury. 2017 Oct;48(10):2157-2161. doi: 10.1016/j.injury.2017.08.003

Capone A, Peri M, Mastio M. Surgical treatment of acetabular fractures in the elderly: a systematic review of the results. EFORT Open Rev. 2017 Apr 27;2(4):97-103. doi: 10.1302/2058-5241.2.160036. PMID: 28507782; PMCID: PMC5420821.

Goyal T, Singh G, Kumar Tripathy S, Schuh A, Veerappa LA, Kumar Sen R. Acetabulum fractures in elderly: A systematic review of fracture pattern and treatment. J Clin Orthop Trauma. 2020 Nov-Dec;11(6):989-1001. doi: 10.1016/j.jcot.2020.09.008.

Mohan K, Broderick JM, Raza H, O’Daly B, Leonard M. Acetabular fractures in the elderly: modern challenges and the role of conservative management. Ir J Med Sci. 2021 Jul 19. doi: 10.1007/s11845-021-02711-2

Peterson MD, Casten K, Collins S, Hassan H, García-Hermoso A, Faul J. Muscle weakness is a prognostic indicator of disability and chronic disease multimorbidity. Exp Gerontol. 2021 Sep;152:111462. doi: 10.1016/j.exger.2021.111462.

Klinedinst TC, Terhorst L, Rodakowski J. Multimorbidity groups based on numbers of chronic conditions are associated with daily activity. Chronic Illn. 2021 Jun 23:17423953211023964. doi: 10.1177/17423953211023964.

Borg T, Hernefalk B, Hailer NP. Acute total hip arthroplasty combined with internal fixation for displaced acetabular fractures in the elderly: a short-term comparison with internal fixation alone after a minimum of two years. Bone Joint J. 2019 Apr;101-B(4):478-483. doi: 10.1302/0301-620X.101B4.BJJ-2018-1027.R2.

Weaver MJ, Smith RM, Lhowe DW, Vrahas MS. Does Total Hip Arthroplasty Reduce the Risk of Secondary Surgery Following the Treatment of Displaced Acetabular Fractures in the Elderly Compared to Open Reduction Internal Fixation? A Pilot Study. J Orthop Trauma. 2018 Feb;32 Suppl 1:S40-S45. doi: 10.1097/BOT.0000000000001088.

Gary JL, Paryavi E, Gibbons SD, Weaver MJ, Morgan JH, Ryan SP, Starr AJ, OʼToole RV. Effect of surgical treatment on mortality after acetabular fracture in the elderly: a multicenter study of 454 patients. J Orthop Trauma. 2015 Apr;29(4):202-8. doi: 10.1097/BOT.0000000000000223.

Bruschetta D, Anastasi G, Andronaco V, Cascio F, Rizzo G, Di Mauro D, Bonanno L, Izzo V, Buda D, Vermiglio G, Bertino S, Cacciola G, Bramanti A, Milardi D. Human calf muscles changes after strength training as revealed by diffusion tensor imaging. J Sports Med Phys Fitness. 2019 May;59(5):853-860. doi: 10.23736/S0022-4707.18.08759-5. Epub 2018 Jul 18. PMID: 30024127.

Aprato A, Nardi M, Arduini M, Bove F, Branca Vergano L, Capitani D, Casiraghi A, Cavanna M, Cominetti G, Commessatti M, Favuto M, Ferreli A, Fino A, Gulli S, Lamponi F, Massè A, Mezzadri U, Monesi M, Oransky M, Pannella A, Santolini F, Stella M, Tigani D, Zoccola K, Rocca G. Italian Consensus Conference on Guidelines for preoperative treatment in acetabular fractures. Acta Biomed. 2021 Sep 2;92(4):e2021290. doi: 10.23750/abm.v92i4.9856. PMID: 34487106; PMCID: PMC8477087.

Khoshbin A, Atrey A, Chaudhry H, Nowak L, Melo LT, Stavrakis A, Schemitsch EH, Nauth A. Mortality Rate of Geriatric Acetabular Fractures Is High Compared With Hip Fractures. A Matched Cohort Study. J Orthop Trauma. 2020 Aug;34(8):424-428. doi: 10.1097/BOT.0000000000001758.

Mancino F, Cacciola G, Di Matteo V, Perna A, Proietti L, Greenberg A, Ma M, Sculco PK, Maccauro G, De Martino I. Surgical implications of the hip-spine relationship in total hip arthroplasty. Orthop Rev (Pavia). 2020 Jun 25;12(Suppl 1):8656. doi: 10.4081/or.2020.8656. PMID: 32913592

Masse A, Aprato A, Rollero L, Bersano A, Ganz R. Surgical dislocation technique for the treatment of acetabular fractures. Clin Orthop Relat Res. 2013 Dec;471(12):4056-64. doi: 10.1007/s11999-013-3228-8. Epub 2013 Sep 4. PMID: 2400286

Massè A, Aprato A, Alluto C, Favuto M, Ganz R. Surgical hip dislocation is a reliable approach for treatment of femoral head fractures. Clin Orthop Relat Res. 2015 Dec;473(12):3744-51. doi: 10.1007/s11999-015-4352-4. PMID: 25995178; PMCID: PMC4626487.

Downloads

Published

10-03-2022

How to Cite

1.
Cacciola G, Aprato A, Branca Vergano L, Sallam A, Massé A. Is non-operative management of acetabular fracture a viable option for older patients? A systematic review of the literature for indication, treatments, complications and outcome. Acta Biomed [Internet]. 2022 Mar. 10 [cited 2024 Jul. 14];92(S3):e2021555. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/12544