Single-surgeon prospective database study of 1,309 displaced acetabular fractures over 27 years (1980–2007), comparing fracture epidemiology, injury mechanism, fracture classification, and radiological features between patients ≥60 years old (n=235) and those <60 years old (n=1,074).
When an elderly patient presents after a ground-level fall with an anterior column or associated both-column acetabular fracture, expect a high probability of quadrilateral plate separation, roof impaction, and femoral head injury — the combination that makes anatomical ORIF technically difficult and predicts poor fixation outcomes.
These findings should prompt early discussion of acute total hip arthroplasty as an alternative or adjunct to ORIF, with the caveat that displaced anterior fragments must still be stabilized to allow solid cup fixation.
Single-surgeon prospective database study of 1,309 displaced acetabular fractures over 27 years (1980–2007), comparing fracture epidemiology, injury mechanism, fracture classification, and radiological features between patients ≥60 years old (n=235) and those <60 years old (n=1,074).
When an elderly patient presents after a ground-level fall with an anterior column or associated both-column acetabular fracture, expect a high probability of quadrilateral plate separation, roof impaction, and femoral head injury — the combination that makes anatomical ORIF technically difficult and predicts poor fixation outcomes.
These findings should prompt early discussion of acute total hip arthroplasty as an alternative or adjunct to ORIF, with the caveat that displaced anterior fragments must still be stabilized to allow solid cup fixation.