Related Experiment Video
Updated: Jan 9, 2026
Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
Is the "Fix-and-Replace" Method Associated With Higher Early Perioperative Risk Than Isolated Internal Fixation for
Tyler K Williamson1,2, Luke Verlinsky1, Loc-Uyen Vo1
1Department of Orthopaedic Surgery, University of Texas Health San Antonio, San Antonio, TX.
Objectives:
To examine the impact of frailty on 30-day outcomes of open reduction internal fixation (ORIF) alone or ORIF + total hip arthroplasty (THA) (fix-and-replace) for the treatment of acetabular fractures.
Methods:
.
Design:
Retrospective Cohort.
Setting:
A total of 700 hospitals in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.
Patient Selection Criteria:
Included were patients aged 60 years or older undergoing ORIF ± THA for OTA/AO type 62 A-C fractures from 2015 to 2020.
Outcome Measures And Comparisons:
Preoperative frailty was assessed by the revised Risk Analysis Index (not frail: <21, prefrail: 21-30, frail: 31-40, severely frail: >40) and the 5-Item Modified Frailty Index factor. All outcome measures were in-hospital or within 30 days postoperatively, including the "favorable outcome," defined as no readmission, length of stay (LOS) < cohort median, and no major complication or death.
Results:
There were 585 patients included [ORIF (88%): mean age-70.5 ± 14.2, sex-41.4% female; ORIF + THA (12%): mean age-77.0 ± 13.4; sex-65.7% female]. Frail patients (n = 353, 65.5%) were more likely to experience a complication [OR: 3.31, CI: (1.83-5.96)] and mortality (3.7% vs. 0.0%). ORIF + THA had higher association with postoperative transfusion [OR: 2.70, CI: (1.63-4.48)] but lower association with LOS >3 days [OR: 0.41, CI: (0.24-0.72)] and nonhome discharge [OR: 0.52, CI: (0.27-0.98)] than ORIF. Prefrail and frail patients undergoing ORIF + THA were more likely to achieve favorable outcomes than those nonfrail or severely frail [OR: 9.69, (3.40-27.57)].
Conclusions:
Surgical intervention for acetabular fractures carried a 30-day complication risk of 12%-19% for frail patients. Frailty had similar predictability to age for early morbidity after surgery to treat acetabular fractures. Open reduction and internal fixation with the addition of an acute THA was associated with a higher rate of blood transfusion and shorter hospital LOS in frail patients with acetabular fractures.
Level Of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
More Related Videos
09:51The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
04:19Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
