Navigation-Assisted Percutaneous Fixation of an Anterior Column and Posterior Hemitransverse Fracture in an Elderly...

Acetabular fractures in elderly patients are often the result of low-energy trauma and are complicated by osteopenia, comorbidities, and limited physiologic reserve. Minimally invasive approaches, such as percutaneous fixation have emerged as viable alternatives to open reduction in selected fracture patterns.

We report the case of a 76-year-old male with a history of coronary artery disease, hypertension, hyperlipidemia, and osteopenia who sustained a comminuted right anterior column and posterior hemitransverse acetabular fracture following a ground-level fall. His hospital course was complicated by rhabdomyolysis and elevated troponin levels, necessitating cardiac evaluation, which demonstrated normal left ventricular function and no evidence of valvular disease. Given the fracture pattern and his polytrauma status, including an ipsilateral proximal humerus fracture and multiple rib fractures, he underwent navigated percutaneous screw fixation of the right acetabulum using O-arm-assisted guidance and iFuse TORQ TNT screws (SI-Bone, Santa Clara, California).

The patient recovered well without perioperative or post-operative complications. Radiographs at 6 months post-operatively demonstrated fracture healing and stable hardware. He achieved independent ambulation with full, pain-free, passive right hip range of motion.

This case highlights the successful application of image-guided percutaneous fixation in an elderly patient with polytrauma and poor bone quality. The use of 3-dimensional navigation and larger-diameter porous screws may offer a biomechanical advantage with improved fixation in osteoporotic acetabulum fractures. Further studies are warranted to evaluate long-term outcomes in this patient population.