Challenges in periprosthetic acetabular fracture management of geriatric patients: A clinical case report of a novel treatment method

Case history An 82-year-old female patient (ASA III: hypertension, type 2 diabetes) sustained a non-displaced periprosthetic acetabular fracture during a ground-level fall on the left hip. This injury was Initially treated at a peripheral hospital with full weight-bearing, which led to secondary fracture displacement.

Clinical findings Upon admission, the patient suffered from severe left hip pain, leg shortening, and painful inability to ambulate. Peripheral circulation was integral and there were no new sensomotoric deficits other than a pre-existing left peroneal nerve lesion (post-hip revision 05/2023)

Investigation/Results The initial radiological diagnostics are shown in Fig.1. The postoperative radiological result following operative revision is shown in Fig 2.

Diagnosis Left periprosthetic acetabular fracture following total hip replacement with cup loosening and pelvic discontinuity.

Treatment Given the fracture's complexity and the patient"s medical history, a two-stage revision procedure was planned. The initial stage involved open acetabular reduction and inmternal fixation applying a supra-pectineal plate (PRO Pelvis-Stryker™) via an anterior intrapelvic approach. Four days after, the second stage comprised acetabular reconstruction with a revision cup (MRS-TITAN Maximum – Peter Brehm™) through a modified Hardinge approach was conducted. The further course of in-hospital treatment was unremarkable and the patient was transferred for geriatric rehabilitation 4 days past the second surgery. Upon transfer, wound healing was satisfactory, and the patient was fully weight-bearing on a wheeled walker. Postoperative radiographs confirmed proper alignment and correct implant positioning.

Comments This case report presents a novel treatment approach of periprosthetic acetabular fractures in geriatric patients, enabling promptly full weight-bearing and thus, preventing possible immobility induced complications in this vulnerable geriatric population.

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