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Fix and replace: Simultaneous fracture fixation and hip replacement for acetabular fractures in older patients

  • Author Footnotes
    1 Equal first authors contribution
    Simon Hislop
    Footnotes
    1 Equal first authors contribution
    Affiliations
    Department of Trauma & Orthopaedic Surgery, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
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  • Author Footnotes
    1 Equal first authors contribution
    Joseph Alsousou
    Footnotes
    1 Equal first authors contribution
    Affiliations
    Department of Trauma & Orthopaedic Surgery, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
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  • Daud Chou
    Affiliations
    Department of Trauma & Orthopaedic Surgery, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
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  • Jaikirty Rawal
    Affiliations
    Department of Trauma & Orthopaedic Surgery, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
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  • Peter Hull
    Affiliations
    Department of Trauma & Orthopaedic Surgery, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
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  • Andrew Carrothers
    Correspondence
    Corresponding author.
    Affiliations
    Department of Trauma & Orthopaedic Surgery, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
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  • Author Footnotes
    1 Equal first authors contribution
Published:September 17, 2022DOI:https://doi.org/10.1016/j.injury.2022.09.024

      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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