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Management of Acetabular Fractures in the Elderly Patient

HSS Journal

Image - Photo of Charles N. Cornell, MD
Charles N. Cornell, MD
Clinical Director of Orthopedic Surgery, Hospital for Special Surgery
Attending Orthopedic Surgeon, Hospital for Special Surgery

Operative management of displaced acetabular fractures yields better results than non-operative management. Over the past decade the surgical approaches to the acetabulum and the surgical tactic for repair of the common fracture patterns has been advanced. Excellent outcomes following repair of these injuries can be achieved. In some cases as in the elderly or in those cases where there is significant destruction of the articular cartilage primary total hip arthroplasty may provide the best solution. Removal of the femoral head allows for excellent exposure of the acetabulum making it possible to stabilize most fractures without the need for extensile or intrapelvic approaches. The surgical technique that has been successfully used calls for gaining primary stability of the acetabular columns by ORIF and then using the acetabular component to replace the articular surface. The columns need not be anatomically reduced. Multi-holed acetabular shells can be used as internal fixation devices placing screws into the columns enhancing the stability of the repair. In older individuals with severe osteoporosis a typical fracture pattern results in intra-pelvic dislocation of the femoral head with a blowout fracture of the anterior column and medial wall. Reinforcement rings with cemented acetabular fixation can be used in these cases. The femoral head can be used as bulk bone graft to replace and re-enforce the reconstruction. Techniques common to revision of failed acetabular components are helpful in this setting. The results of reconstruction of severe acetabular fractures with THR have been reported to be similar to those achieved for reconstruction of osteoarthritis.

This article appears in HSS Journal: Volume 1, Number 1.
View the full article at springerlink.com.

About the HSS Journal
HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.


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