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Management of Acetabular Fractures in the Elderly

Antell, Nicholas, B., MD; Switzer, Julie, A., MD; Schmidt, Andrew, H., MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: August 2017 - Volume 25 - Issue 8 - p 577–585
doi: 10.5435/JAAOS-D-15-00510
Review Article

The incidence of acetabular fractures in the elderly population is increasing. Fractures in this population differ from those in younger patients, with more frequent involvement of the anterior column, more comminution, and more severe articular impaction in elderly patients. Although acetabular fractures in geriatric patients are more likely the result of low-energy trauma, outcomes are generally poorer than those in young patients. Multiple management options have been proposed, but no intervention has become the standard of care for these fractures in the elderly. Patient characteristics (eg, prior ambulation status, functional capacity, bone quality), the nature of the fracture, and the experience of the treating orthopaedic surgeon all must be considered when choosing among nonsurgical treatment, percutaneous fixation, open reduction and internal fixation, and immediate or delayed arthroplasty. Each treatment option has the potential for satisfactory results in properly selected patients.

From the Orthopaedic Trauma Institute, Department of Orthopaedics, University of California, San Francisco, CA (Dr. Antell) and the Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN (Dr. Switzer and Dr. Schmidt).

Dr. Switzer or an immediate family member has received research or institutional support from Stryker. Dr. Schmidt or an immediate family member serves as a paid consultant to Acumed, Bone Support AB, and St. Jude Medical; serves as an unpaid consultant to Conventus Orthopaedics and Twin Star Medical; has stock or stock options held in Conventus Orthopaedics, EPIEN Medical, EPIX Orthopaedics, International Spine and Orthopaedic Institute, and Twin Star Medical; and serves as a board member, owner, officer, or committee member of the Orthopaedic Trauma Association. Neither Dr. Antell nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.

Received September 22, 2015

Accepted June 11, 2016

© 2017 by American Academy of Orthopaedic Surgeons
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