Highlights
- •Early mobilisation after acetabular fractures in the elderly is critically important.
- •A fix and replace strategy provides opportunity for early mobilisation.
- •Patient selection is key due to the high morbidity and mortality associated with these injuries.
- •High levels of support in the pre- peri‑ and postoperative period are essential.
Abstract
Introduction
Displaced acetabular fractures in the elderly present significant treatment challenges.
The ‘fix and replace’ concept involves open reduction and internal fixation of the
acetabulum, providing bony stability to accept the press-fit of an acetabular cup,
with a cemented femoral stem. This allows early mobilisation and the advantages this
confers. This study of 57 patients treated with fix and replace describes our technique,
outcomes, and survival analysis.
Methods
A retrospective review of 57 ‘fix and replace’ procedures in patients aged over 60
was performed. Data was collected on mechanism, fracture type, demographics, time
to surgery, comorbidity index, complications, EQ-5D and Oxford hip scores (OHS). Radiographs
were reviewed for fracture healing, implant loosening, cup migration, and heterotopic
ossification.
Results
57 patients aged 60 to 95 had fix and replace surgery. The median ASA score was 3.
The mean Charlson Index was 4.8. 45 patients had a low-energy fall, 6 had a road traffic
accident, 3 fell off a bicycle, and 1 mechanism was unclear. The fracture patterns
were anterior column posterior hemitransverse (67%), associated both columns (9%),
posterior column (9%), posterior column and posterior wall (9%), and transverse (2%).
The mean time to surgery was 8.4 days (0–14). 26 out of 57 (46%) received a blood
transfusion. Mean length of stay was 17.6 days (7–86). The mean follow-up was 35.5
months. 4 dislocations were treated with closed reduction, whilst 1 required excision
arthroplasty. 2 infections resolved with debridement, antibiotics, and implant retention
(DAIR), whilst 1 required a two-stage revision. 1 acetabular component had migrated
requiring revision. The median pre-injury OHS was 44 (26–48) compared to 37.3 (28–48)
at 1 year. There were no deaths at 30-days, whilst at 1 year 7 patients had died.
Kaplan Meier survival analysis showed mean survival was 1984.5 days. Implant survival
was 90% at 1 year.
Conclusion
While fix and replace is conceptually attractive, this medically complex patient group
requires considerable support peri‑ and post-operatively. Further studies are required
to provide clinicians with more information to decide on how best to provide a holistic
management strategy for such injuries in this frail patient cohort.
Keywords
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Article Info
Publication History
Published online: September 17, 2022
Accepted:
September 16,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
