J Korean Fract Soc.  2018 Jul;31(3):102-113. 10.12671/jkfs.2018.31.3.102.

Pelvis/Acetabular Fractures in the Elderly: When and How to Fix?

• Park KH
• Oh CW
• Kim JW

• KMID: 2417152
• DOI: http://doi.org/10.12671/jkfs.2018.31.3.102

Abstract

Owing to the increase in life expectancy, the incidence of osteoporotic fracture of the pelvis and acetabulum is increasing. Fractures in the elderly population is different from those in younger patients. Pelvic ring and acetabular fractures in geriatric patients are more likely the result of low-energy trauma, but the outcomes are generally poorer than those of the younger population. Multiple management options are available, but no intervention has become the standard of care for these fractures in the elderly. A treatment strategy should be established depending on the state of the individual patient. Regardless of whether nonsurgical or surgical treatment is selected, early ambulation should be considered to avoid the complications associated with prolonged immobilization.

Keyword

Pelvis; Acetabulum; Pelvic ring; Osteoporotic fracture; Complication

MeSH Terms

Acetabulum
Aged*
Early Ambulation
Humans
Immobilization
Incidence
Life Expectancy
Osteoporotic Fractures
Pelvis
Standard of Care

Figure

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  Fig. 1 Radiographs of a 67-year-old male patient. (A) Initial anteroposterior radiograph shows a suspicious symphysis pubis injury. (B) Stress images showing significant widening of interpubic distance. (C, D) Postoperative radiograph of a stabilized symphysis pubis with dual plates.

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  Fig. 2 (A) Initial radiograph of a 70-year-old female with a lateral compression injury. (B) The right side was stabilized with a conventional plate, and the left side was fixed with an intramedullary screw. (C) Follow-up radiograph after 10 days revealed plate pull-out on the right side. (D) Follow-up radiograph of 10 months after revision surgery showed union of the fracture on both sides.

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  Fig. 3 (A) A 70-year-old male sustained a symphysis pubis diastasis with a Denis type I sacral fracture on the right side (arrow). (B) The patient was treated with symphyseal plating and iliosacral screwing. (C) Radiograph after 5 weeks revealed loosening of the iliosacral screw and multiple screws in the plate with a redisplacement of the fracture. (D) Revision surgery with dual plates for the anterior ring and posterior tension band plate as well as a change in the iliosacral screw was performed.

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  Fig. 4 (A) Radiograph of a 72-year-old female shows lateral compression injury with a crescent fracture on the left side. (B) Axial computed tomography (CT) image demonstrates the fracture line entering the middle third of the sacroiliac joint. (C) A 3-dimensional CT image shows the size and extent of the crescent fragment. (D) Interfragmentary screw fixation across an orthogonal fracture line with the addition of contoured reconstruction plates was carried out via the direct posterior approach. (E) Radiograph after 10 months showed healing of the fracture.

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  Fig. 5 (A) A 77-year-old male experienced a lateral compression injury. (B) After stabilization of the anterior ring, the patient was laid in the prone position and tension band plating was performed using a minimally invasive technique. (C) Postoperative surgical wound. (D) Postoperative radiograph.

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  Fig. 6 (A) A 72-year-old male had a lateral compression injury from the left side. (B, C) A 3-dimensional computed tomography scan shows the crescent fragment of the iliac fracture. (D) An anterior ring was stabilized with a pelvic brim plate via the ilioinguinal approach, followed by fixation of the posterior ring with 2 contoured reconstruction plates through same surgical window.

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  Fig. 7 Example of secondary congruence of associated both column fracture. (A, B) Although there was both column fracture in the left acetabulum, surgery could not be performed due to the extreme condition of the patient. (C, D) Follow-up radiograph at 10 months after injury. The left hip shows minimal cartilage space loss and the joint is relatively maintained with union of the fracture.

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  Fig. 8 (A) A 75-year-old female suffered from both column fractures of the right acetabulum after a ground-level fall. The arrow indicates medial protrusion of the disrupted quadrilateral plate with severe comminution. (B, C) A 3-dimensional computed tomography (CT) image revealed the characteristics of the fracture. (D) Medially displaced quadrilateral plate fragments with severe comminution (arrows) were observed after the surgical approach. (E) Direct reduction was performed. (F, G) Direct medial buttress plating inferior to the pectineal line was done (infrapectineal plating), followed by pelvic brim plating. (H-J) Postoperative radiographs. (I) The arrow indicates infrapectineal plate. (K-M) Postoperative 3-dimensional CT images. (M) The arrow indicates the infrapectineal plate.

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  Fig. 9 (A-C) Radiograph and 3-dimensional computed tomography images of a 70-year-old male with both column fractures in left acetabulum. (D) Fracture was stabilized via the ilioinguinal approach. Note that only the lateral and medial windows of the ilioinguinal approach were developed to fix the fracture instead of a whole wide dissection. (E) Postoperative surgical wound. (F) Postoperative radiograph.

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  Fig. 10 (A, B) A 67-year-old male suffered from a posterior wall fracture of the right acetabulum combined with posterior dislocation of the hip joint. (C) A 3-dimensional computed tomography image demonstrates comminution of the fractured posterior wall fragments and severe posterosuperior impaction. (D) Open reduction and internal fixation was performed. (E) Radiograph after 10 months of the index operation demonstrates post-traumatic arthrosis of the right hip joint. (F) Total hip arthroplasty was finally performed.

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