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Variation in Treatment of Displaced Geriatric Acetabular Fractures Among 15 Level-I Trauma Centers

Manson, Theodore T. MD; Reider, Lisa PhD; O'Toole, Robert V. MD; Scharfstein, Daniel O. ScD; Tornetta, Paul III MD; Gary, Joshua L. MDthe Major Extremity Trauma Research Consortium (METRC)

doi: 10.1097/BOT.0000000000000632
Original Article

Objectives: To document the initial treatment of displaced acetabular fractures among older adults across multiple trauma centers and to investigate the factors that influence the decision to operate and the choice of operative procedure [open reduction internal fixation (ORIF) vs. total hip arthroplasty (THA)].

Design: Retrospective observational study.

Setting: Fifteen US level-I trauma centers participating in the Major Extremity Trauma Research Consortium.

Patients/Participants: Overall, 269 patients aged 60 years or older admitted for the treatment of a displaced acetabular fracture.

Intervention: None.

Main Outcome Measurements: Treatment.

Results: Sixty percent of fractures (n = 162) were treated operatively. Younger age (<80 years), injury from high-energy mechanism, fractures with femoral head impaction, and fractures without hip congruency were significantly associated with receiving operative treatment (P < 0.05). Significant site variation in operative versus nonoperative treatment occurred even after accounting for these factors (P = 0.0044). Among operatively treated patients, 88% (n = 142) received ORIF and 12% (n = 20) received THA as the initial treatment. Women were more likely to be treated with initial THA compared with men; of the known risk factors for poor outcomes with ORIF (ie, dome or roof impaction, femoral head impaction, or posterior wall involvement), only dome impaction was significantly associated with receiving initial THA (P < 0.05).

Conclusions: Currently, no treatment guidelines exist for acetabular fractures in older adults, which likely explains the significant site variation in operative versus nonoperative treatment. This study identifies patient and injury factors that drive treatment decisions, which will be important in planning and designing future trials needed to determine the best treatment for these fractures.

*Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD;

Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;

Boston University Medical Center; and

§Department of Orthopaedic Surgery, University of Texas Medical School at Houston, Houston, TX.

Reprints: Lisa Reider, PhD, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington St, Room 351, Baltimore, MD 21231 (e-mail: lsemani1@jhu.edu).

Presented in part at the Annual Meeting of the Orthopaedic Trauma Association, October 15–18, 2014, Tampa, FL.

Supported by the Department of Defense through an award from the Peer Reviewed Orthopaedic Research Program (PRORP) of the Congressionally Directed Medical Research Program (CDMRP): W81XWH0920108. H. C. Sagi is on the editorial board with the Journal of Orthopaedic Trauma and is a paid consultant with Stryker for pelvic and acetabular product development. P. Lafferty is a paid Synthes consultant. R. V. O'Toole is a paid consultant for Smith & Nephew and iMDS, has been involved with research supported by Stryker and Synthes, and sits on the Orthopaedic Trauma Association Board of Directors. T. Manson is a paid consultant for Stryker and has received research support from Depuy-Synthes. P. Tornetta holds intellectual property with Smith & Nephew orthopedics and receives publishing royalties from Wolters-Kluwer.

The authors report no conflict of interest.

*A list of contributors can be found in an Acknowledgment at the end of the article.

Accepted May 11, 2016

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.