Outcomes of acetabular fractures treated with acute fix and replace versus open reduction and internal fixation in...

The optimal operative treatment for displaced acetabular fractures in elderly population is still object of debate. Acute fix and replace procedure, the so called "combined hip procedure" (CHP), was introduced because of the poor results of the open reduction and internal fixation (ORIF) alone. The aim of the study is to compare clinical outcomes of CHP and ORIF alone for the treatment of acetabular fractures in elderly patients.

This is the largest multicentric retrospective analytical study, with a case-control design on the issue. Hospital records and clinical notes were reviewed to collect demographic, peri-operative, and clinical data.

A total of 45 patients met the inclusion criteria: 24 patients entered the CHP group whereas 21 entered the ORIF control group. The mean age was 69.5 +  - 1.12 years in the ORIF group and 73.4 +  - 1.84 in the control group. The most frequent traumatic mechanism was the fall from same level in both groups (37.5% CHP; 42.9% ORIF). Operating time was significantly lower in the CHP group compared to the ORIF group (207 +  - 11.0 ORIF; 175 +  - 9.16 CHP; p < 0.05). Moreover, full weight-bearing was allowed significantly earlier in the CHP group compared to ORIF alone (37.3 +  - 1.59 ORIF; 32.5 +  - 1.69 CHP; p < 0.05). Among the clinician-completed scores, the HHS at three months was higher in the CHP group (66.3 +  - 1.83 ORIF;73.6 +  - 2.09 CHP; p < 0.05). All the other clinical outcomes were similar in both study groups.

CHP is desirable treatment option in elderly patients with acetabular fracture when there are poor expected outcomes in terms of joint survival with ORIF alone.