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One-year mortality after acetabular fractures in elderly patients presenting to a level-1 trauma center
Jesse E Bible1, Adam Wegner, D Jake McClure
1Division of Orthopaedic Trauma, Vanderbilt Orthopaedic Institute, Nashville, TN.
Objectives:
To evaluate the 1-year mortality of elderly patients after isolated acetabular fractures treated both operatively and nonoperatively, and compared with nonisolated fractures.
Design:
Retrospective review.
Setting:
Single level 1 trauma center.
Patients/Participants:
All consecutive patients who were 60 years of age and older were treated for acetabular fractures over a 12-year period (n = 176).
Intervention:
Operative and nonoperative management.
Main Outcome Measurements:
1-year mortality.
Methods:
Exclusion criteria for the isolated group included associated injuries to other body systems (Abbreviated Injury Score >2), long bone fractures, and concurrent sacral fractures. Mortality data were obtained from the Social Security Death Index.
Results:
The isolated group (n = 86) had an average age of 71.1 ± 7.1 years with 64.0% fractures treated operatively. Mortality rates for the isolated group at 30 days, 3 months, 6 months, and 1 year were 2.3%, 5.8%, 8.1%, and 8.1%, respectively. No significant differences in mortality rates were seen between operative and nonoperative patients across all time points for the isolated group (P = 0.093-0.346). Mortality rates were lower at all time points for the isolated group than for the nonisolated group (n = 90; P = 0.0002-0.02). However, the 1-year postdischarge mortality rates for patients who were discharged from the hospital were similar for the nonisolated and isolated groups (6.8% vs. 7.1%; P = 0.76).
Conclusions:
The mortality rates for elderly patients with isolated acetabular fractures were found to be significantly lower than those for acetabular fractures with concurrent injuries. Age was identified as the only significant variable differing between patients treated operatively versus nonoperatively, as opposed to medical comorbidities in the isolated acetabular fracture group.
Level Of Evidence:
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
