The combined hip procedure: open reduction internal fixation combined with total hip arthroplasty for the management of acetabular fractures in the elderly

Dolfi Herscovici, Eric Lindvall, Brett Bolhofner, Julia M Scaduto
Journal of Orthopaedic Trauma 2010, 24 (5): 291-6

OBJECTIVE: The objective of this study was to evaluate acetabular fractures in elderly patients treated with open reduction internal fixation combined with acute total hip arthroplasty during the same anesthetic.

DESIGN: The authors conducted a retrospective analysis of a treatment.

SETTING: Level I and Level II trauma centers.

PATIENTS: Between September 1995 through January 2005, 22 elderly patients were treated using the combined hip procedure. There were nine transverse/posterior wall patterns, seven anterior column/posterior hemitransverse patterns, and six presented as a both column injury. Six patients had hip dislocations and 14 patients demonstrated some impaction. Patients underwent medical evaluations and clearance before surgical intervention.

INTERVENTION: Standard open reduction internal fixation techniques followed by immediate total hip arthroplasty during the same anesthesia. Ilioinguinal patients were repositioned and redraped for total hip placement.

MAIN OUTCOME MEASUREMENTS: Complications, physical examinations, and Harris hip scores assessed outcomes. Radiographs evaluated union and stability of the femoral and acetabular components, osteolysis, or the development of any heterotopic bone.

RESULTS: Follow up averaged 29.4 months. Surgeries averaged 232 minutes with 1163 mL average blood loss. Hospital stays approximated 8 days with full weightbearing occurring at 3 months. Hip motion averaged 102 degrees of flexion, 32 degrees of abduction, and 16 degrees of adduction. Harris hip scores averaged 74. Four patients developed heterotopic ossification, and five underwent revisions as result of osteolysis or multiple hip dislocations.

CONCLUSIONS: The combined hip procedure is an option for acetabular fractures in elderly patients. Complications, surgical times, and hospitalizations are consistent with open reductions or belated total hip arthroplasties. Aggressive medical workups may be needed, but a single posterior surgical procedure will avoid the "wait-and-see" approach often used for these patients.

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