JOURNAL ARTICLE

Functional outcomes in elderly patients with acetabular fractures treated with minimally invasive reduction and percutaneous fixation

Joshua L Gary, Michael VanHal, Steven D Gibbons, Charles M Reinert, Adam J Starr
Journal of Orthopaedic Trauma 2012, 26 (5): 278-83
22198651

OBJECTIVES: To present the functional outcomes of elderly patients treated with percutaneous acetabular surgery and compare them with those treated with traditional open reduction and internal fixation in previously published series.

DESIGN: Retrospective.

SETTING: University level I trauma center.

PATIENTS: All patients aged 60 and older treated with percutaneous screw fixation for acetabular fractures from 1994 to 2007 were included. Seventy-nine consecutive patients were identified. Thirty-six patients died before functional outcomes were obtained, leaving 43 patients and fractures in our study group. Functional outcomes were obtained in 35 of 43 (81.3%) patients at an average of 6.8 years after the index surgery.

INTERVENTION: Minimally invasive reduction and percutaneous fixation of acetabular fractures.

MAIN OUTCOME MEASUREMENT: Short musculoskeletal functional assessment and Harris Hip Score.

RESULTS: One-year mortality was 13.9% (11 of 79). Average short musculoskeletal functional assessment dysfunction and bother indices were 23.3 and 21.3, respectively, in 24 patients who maintained their native hip. When compared with Short Musculoskeletal Functional Assessment data from 2 other series of patients treated with formal open reduction and internal fixation, no differences existed in the dysfunction (P = 0.49) or bother (P = 0.55) indices. Conversion to total hip arthroplasty occurred in 11 of 36 patients (30.6%). Average Harris Hip Scores in patients with their native hip was 77 (range, 33-100). In the 11 patients converted to total hip arthroplasty, average Short Musculoskeletal Functional Assessment dysfunction and bother indices were 24.3 and 23.9, respectively. No differences were found in the dysfunction (P = 0.93) or bother (P = 0.16) indices when compared with patients converted from open reduction and internal fixation to total hip arthroplasty. Average Harris Hip Score in patients converted to total hip arthroplasty was 83 (range, 68-92), and this was not significantly different from the best scores reported with acute total hip arthroplasty.

CONCLUSIONS: Functional outcomes and rates of conversion to total hip arthroplasty of acetabular fractures in elderly patients treated with percutaneous reduction and fixation show no significant differences when compared with published series of patients treated with formal open reduction and internal fixation.

LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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