Clinical and radiological outcomes of surgically treated geriatric acetabular fractures: The feasible option of primary endoprosthetic fracture treatment

Introduction
The aim of the study was to examine clinical and radiological outcomes following surgical treatment of displaced geriatric acetabular fractures.

Material & Methods
This retrospective single-center cohort-study included geriatric patients ( ≥ 70 years) with operatively treated displaced isolated acetabular fractures between 2016 and 2022 at an academic level one trauma center.. Two cohorts were extracted based on the method of operative treatment: open reduction and internal fixation (ORIF) vs. total hip replacement with or without additional osteosynthesis (THR). Main outcome measures were quality of radiological fracture reduction for the ORIF cohort, and short-term clinical outcomes as indicated by mortality, in-hospital complications and adequacy of re-mobilization.

Results
43 patients with a median age of 81 years and a median Charlson Comorbidity Index score of 5 were included in this study. The most common fracture type, according to the Judet and Letournel classification, was anterior column/posterior hemitransverse fracture (60,5%).
35 patients (81,4%) received ORIF, while 8 patients (18,6%) received THR. 2 patients (4,7%), one from each cohort, died during the hospital stay. The median postoperative fracture step-off and gap were 1mm in the ORIF cohort (Interquartile Range (IQR)=2).
THR was associated with faster remobilization into gait with full weight-bearing (Median postoperative time interval 2 days vs 6 days) and less pain upon discharge (Median VAS 1-3 vs 4-6). There were no significant differences in length of stay and general/implant-related complication between cohorts.

Conclusions
Total hip replacement of geriatric acetabular fractures with or without additional osteosynthesis seems to be associated with faster return to full weight-bearing and less postoperative pain, while it is non-inferior to open reduction and internal fixation in terms of mortality and complications.

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