Treatment of Pelvic and Acetabular Fractures in Elderly Patients


The combination of a longer human lifespan and an active lifestyle continuing later into life has both increased the extent of pelvic and acetabular fractures in the elderly and made their treatment more significant. The greater number of medical comorbidities in the older population, the osteopenic or osteoporotic condition of bone in much of this age group, and the frequency of concomitant hip arthrosis are all essential considerations.The weakening of bone with aging allows its fracture with forces of lower energy, results in fractures with patterns that differ from those in younger persons, including more frequent impactions of the dome of the femoral head, and makes more challenging the reduction of pelvic and acetabular fractures and maintenance of their repaired state. Although some injuries in the elderly should be treated with principles and methods similar to those used in younger patients, including anatomic restoration with rigid fixation of the acetabular articular surface and pelvic ring, most injuries of the pelvis and acetabular ring in elderly patients are unique in various ways and may require treatment through other options as well as internal fixation. This paper discusses fragility fractures of the pelvis and acetabulum, and reviews the clinical presentation, different treatment options, and surgical techniques for treating these fractures in elderly patients. Although nonsurgical care, external fixation, open reduction and internal fixation (ORIF), percutaneous/limited ORIF, acute total hip arthroplasty with or without ORIF, and delayed total hip arthroplasty have all been advocated as treatment options for such fractures, considerable debate continues to surround the indications for each of them.

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