Treatment modalities and outcomes following acetabular fractures in the elderly: a systematic review
Purpose The treatment of geriatric acetabular fractures remains controversial. Treatment options include nonoperative management, open reduction and internal fixation (ORIF), total hip arthroplasty (THA) with or without internal fixation, and closed reduction with percutaneous pinning (CRPP). There...
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| Veröffentlicht in: | European journal of orthopaedic surgery & traumatology 2022-05, Vol.32 (4), p.649-659 |
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| container_title | European journal of orthopaedic surgery & traumatology |
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| creator | McCormick, Brian P. Serino, Joseph Orman, Sebastian Webb, Alex R. Wang, David X. Mohamadi, Amin Mortensen, Sharri Weaver, Michael J. Von Keudell, Arvind |
| description | Purpose
The treatment of geriatric acetabular fractures remains controversial. Treatment options include nonoperative management, open reduction and internal fixation (ORIF), total hip arthroplasty (THA) with or without internal fixation, and closed reduction with percutaneous pinning (CRPP). There is currently no consensus on the optimal treatment strategy for geriatric patients with acetabular fractures. The purpose of this study is to compare adverse event rates, functional and radiographic outcomes, and intraoperative results between the various treatment modalities in order to help guide surgical decision making.
Methods
We performed a systematic review (registration number CRD42019124624) of observational and comparative studies including patients aged ≥ 55 with acetabular fractures.
Results
Thirty-eight studies including 3,928 patients with a mean age of 72.6 years (range 55–99 years) and a mean follow-up duration of 29.4 months met our eligibility criteria. The pooled mortality rate of all patients was 21.6% (95% confidence interval [CI] 20.9–22.4%) with a mean time to mortality of 12.6 months, and the pooled non-fatal complication rate was 24.7% (95% CI 23.9–25.5%). Patients treated with ORIF had a significantly higher non-fatal complication rate than those treated with ORIF + THA, THA alone, CRPP, or nonoperative management (odds ratios [ORs] 1.87, 2.24, 2.15, and 4.48, respectively;
p
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| doi_str_mv | 10.1007/s00590-021-03002-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2536483752</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2649213726</sourcerecordid><originalsourceid>FETCH-LOGICAL-c441t-a0173177bdec499497fad2d58cd6d8c572aa2dc2dc180088ab5265264609f6063</originalsourceid><addsrcrecordid>eNp9kU9LHjEQh0Npqdb2C_RQAr142XbyZze7vYloFYRe7DnMm8zalexGk6zyfvvGvtaKh8JAEuaZJyE_xj4K-CIAzNcM0A7QgBQNKADZqFdsX2glGwFd__rZfo-9y_kaQLSDaN-yPaXBdEabfeYvE2GZaSl8jh7DVCbKHBfP41pcnOthjCHE-2m54uio4GYNmPiY0JU11fa08PKLOAVPKWy_ceR5mwvNWCbHE91NdP-evRkxZPrwuB6wn6cnl8dnzcWP7-fHRxeN01qUBkEYJYzZeHJ6GPRgRvTSt73zne9daySi9K6W6AH6Hjet7GrpDoaxg04dsMOd9ybF25VysfOUHYWAC8U1W9mqTvfKtLKin1-g13FNS32drcJBCmXkg1DuKJdizolGe5OmGdPWCrAPGdhdBrZmYP9kYFUd-vSoXjcz-aeRv59eAbUDcm0tV5T-3f0f7W_1w5Ha</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2649213726</pqid></control><display><type>article</type><title>Treatment modalities and outcomes following acetabular fractures in the elderly: a systematic review</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>McCormick, Brian P. ; Serino, Joseph ; Orman, Sebastian ; Webb, Alex R. ; Wang, David X. ; Mohamadi, Amin ; Mortensen, Sharri ; Weaver, Michael J. ; Von Keudell, Arvind</creator><creatorcontrib>McCormick, Brian P. ; Serino, Joseph ; Orman, Sebastian ; Webb, Alex R. ; Wang, David X. ; Mohamadi, Amin ; Mortensen, Sharri ; Weaver, Michael J. ; Von Keudell, Arvind</creatorcontrib><description>Purpose
The treatment of geriatric acetabular fractures remains controversial. Treatment options include nonoperative management, open reduction and internal fixation (ORIF), total hip arthroplasty (THA) with or without internal fixation, and closed reduction with percutaneous pinning (CRPP). There is currently no consensus on the optimal treatment strategy for geriatric patients with acetabular fractures. The purpose of this study is to compare adverse event rates, functional and radiographic outcomes, and intraoperative results between the various treatment modalities in order to help guide surgical decision making.
Methods
We performed a systematic review (registration number CRD42019124624) of observational and comparative studies including patients aged ≥ 55 with acetabular fractures.
Results
Thirty-eight studies including 3,928 patients with a mean age of 72.6 years (range 55–99 years) and a mean follow-up duration of 29.4 months met our eligibility criteria. The pooled mortality rate of all patients was 21.6% (95% confidence interval [CI] 20.9–22.4%) with a mean time to mortality of 12.6 months, and the pooled non-fatal complication rate was 24.7% (95% CI 23.9–25.5%). Patients treated with ORIF had a significantly higher non-fatal complication rate than those treated with ORIF + THA, THA alone, CRPP, or nonoperative management (odds ratios [ORs] 1.87, 2.24, 2.15, and 4.48, respectively;
p
< 0.01). Patients that underwent ORIF were significantly less likely to undergo subsequent THA than these treated with CRPP (OR 0.49, 95% CI 0.32–0.77) but were more likely to require THA than patients treated nonoperatively (OR 6.81, 95% CI 4.63–10.02).
Conclusion
Elderly patients with acetabular fractures tend to have favorable functional outcomes but suffer from high rates of mortality and complications. In patients treated with internal or percutaneous fixation, there was a high rate of conversion to THA. When determining surgical treatment in this population, THA alone or concurrent with ORIF should be considered given the significantly lower rate of non-fatal complications and similar mortality rate. Nonoperative management remains a viable option and was associated with the lowest non-fatal complication rate.
Level of evidence
This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors
www.springer.com/00266
.</description><identifier>ISSN: 1432-1068</identifier><identifier>ISSN: 1633-8065</identifier><identifier>EISSN: 1432-1068</identifier><identifier>DOI: 10.1007/s00590-021-03002-3</identifier><identifier>PMID: 34076747</identifier><language>eng</language><publisher>Paris: Springer Paris</publisher><subject>Acetabulum - injuries ; Acetabulum - surgery ; Aged ; Arthroplasty, Replacement, Hip - adverse effects ; Arthroplasty, Replacement, Hip - methods ; Evidence-based medicine ; Fracture Fixation, Internal - adverse effects ; Fracture Fixation, Internal - methods ; Fractures, Bone - etiology ; Fractures, Bone - surgery ; Geriatrics ; Hip Fractures - surgery ; Humans ; Medicine ; Medicine & Public Health ; Mortality ; Open Fracture Reduction - methods ; Original Article ; Retrospective Studies ; Spinal Fractures - surgery ; Surgical Orthopedics ; Systematic review ; Traumatic Surgery ; Treatment Outcome</subject><ispartof>European journal of orthopaedic surgery & traumatology, 2022-05, Vol.32 (4), p.649-659</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature 2021</rights><rights>2021. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.</rights><rights>The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c441t-a0173177bdec499497fad2d58cd6d8c572aa2dc2dc180088ab5265264609f6063</citedby><cites>FETCH-LOGICAL-c441t-a0173177bdec499497fad2d58cd6d8c572aa2dc2dc180088ab5265264609f6063</cites><orcidid>0000-0002-4883-9927</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00590-021-03002-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00590-021-03002-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,782,786,27931,27932,41495,42564,51326</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34076747$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McCormick, Brian P.</creatorcontrib><creatorcontrib>Serino, Joseph</creatorcontrib><creatorcontrib>Orman, Sebastian</creatorcontrib><creatorcontrib>Webb, Alex R.</creatorcontrib><creatorcontrib>Wang, David X.</creatorcontrib><creatorcontrib>Mohamadi, Amin</creatorcontrib><creatorcontrib>Mortensen, Sharri</creatorcontrib><creatorcontrib>Weaver, Michael J.</creatorcontrib><creatorcontrib>Von Keudell, Arvind</creatorcontrib><title>Treatment modalities and outcomes following acetabular fractures in the elderly: a systematic review</title><title>European journal of orthopaedic surgery & traumatology</title><addtitle>Eur J Orthop Surg Traumatol</addtitle><addtitle>Eur J Orthop Surg Traumatol</addtitle><description>Purpose
The treatment of geriatric acetabular fractures remains controversial. Treatment options include nonoperative management, open reduction and internal fixation (ORIF), total hip arthroplasty (THA) with or without internal fixation, and closed reduction with percutaneous pinning (CRPP). There is currently no consensus on the optimal treatment strategy for geriatric patients with acetabular fractures. The purpose of this study is to compare adverse event rates, functional and radiographic outcomes, and intraoperative results between the various treatment modalities in order to help guide surgical decision making.
Methods
We performed a systematic review (registration number CRD42019124624) of observational and comparative studies including patients aged ≥ 55 with acetabular fractures.
Results
Thirty-eight studies including 3,928 patients with a mean age of 72.6 years (range 55–99 years) and a mean follow-up duration of 29.4 months met our eligibility criteria. The pooled mortality rate of all patients was 21.6% (95% confidence interval [CI] 20.9–22.4%) with a mean time to mortality of 12.6 months, and the pooled non-fatal complication rate was 24.7% (95% CI 23.9–25.5%). Patients treated with ORIF had a significantly higher non-fatal complication rate than those treated with ORIF + THA, THA alone, CRPP, or nonoperative management (odds ratios [ORs] 1.87, 2.24, 2.15, and 4.48, respectively;
p
< 0.01). Patients that underwent ORIF were significantly less likely to undergo subsequent THA than these treated with CRPP (OR 0.49, 95% CI 0.32–0.77) but were more likely to require THA than patients treated nonoperatively (OR 6.81, 95% CI 4.63–10.02).
Conclusion
Elderly patients with acetabular fractures tend to have favorable functional outcomes but suffer from high rates of mortality and complications. In patients treated with internal or percutaneous fixation, there was a high rate of conversion to THA. When determining surgical treatment in this population, THA alone or concurrent with ORIF should be considered given the significantly lower rate of non-fatal complications and similar mortality rate. Nonoperative management remains a viable option and was associated with the lowest non-fatal complication rate.
Level of evidence
This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors
www.springer.com/00266
.</description><subject>Acetabulum - injuries</subject><subject>Acetabulum - surgery</subject><subject>Aged</subject><subject>Arthroplasty, Replacement, Hip - adverse effects</subject><subject>Arthroplasty, Replacement, Hip - methods</subject><subject>Evidence-based medicine</subject><subject>Fracture Fixation, Internal - adverse effects</subject><subject>Fracture Fixation, Internal - methods</subject><subject>Fractures, Bone - etiology</subject><subject>Fractures, Bone - surgery</subject><subject>Geriatrics</subject><subject>Hip Fractures - surgery</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Open Fracture Reduction - methods</subject><subject>Original Article</subject><subject>Retrospective Studies</subject><subject>Spinal Fractures - surgery</subject><subject>Surgical Orthopedics</subject><subject>Systematic review</subject><subject>Traumatic Surgery</subject><subject>Treatment Outcome</subject><issn>1432-1068</issn><issn>1633-8065</issn><issn>1432-1068</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kU9LHjEQh0Npqdb2C_RQAr142XbyZze7vYloFYRe7DnMm8zalexGk6zyfvvGvtaKh8JAEuaZJyE_xj4K-CIAzNcM0A7QgBQNKADZqFdsX2glGwFd__rZfo-9y_kaQLSDaN-yPaXBdEabfeYvE2GZaSl8jh7DVCbKHBfP41pcnOthjCHE-2m54uio4GYNmPiY0JU11fa08PKLOAVPKWy_ceR5mwvNWCbHE91NdP-evRkxZPrwuB6wn6cnl8dnzcWP7-fHRxeN01qUBkEYJYzZeHJ6GPRgRvTSt73zne9daySi9K6W6AH6Hjet7GrpDoaxg04dsMOd9ybF25VysfOUHYWAC8U1W9mqTvfKtLKin1-g13FNS32drcJBCmXkg1DuKJdizolGe5OmGdPWCrAPGdhdBrZmYP9kYFUd-vSoXjcz-aeRv59eAbUDcm0tV5T-3f0f7W_1w5Ha</recordid><startdate>20220501</startdate><enddate>20220501</enddate><creator>McCormick, Brian P.</creator><creator>Serino, Joseph</creator><creator>Orman, Sebastian</creator><creator>Webb, Alex R.</creator><creator>Wang, David X.</creator><creator>Mohamadi, Amin</creator><creator>Mortensen, Sharri</creator><creator>Weaver, Michael J.</creator><creator>Von Keudell, Arvind</creator><general>Springer Paris</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4883-9927</orcidid></search><sort><creationdate>20220501</creationdate><title>Treatment modalities and outcomes following acetabular fractures in the elderly: a systematic review</title><author>McCormick, Brian P. ; Serino, Joseph ; Orman, Sebastian ; Webb, Alex R. ; Wang, David X. ; Mohamadi, Amin ; Mortensen, Sharri ; Weaver, Michael J. ; Von Keudell, Arvind</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c441t-a0173177bdec499497fad2d58cd6d8c572aa2dc2dc180088ab5265264609f6063</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Acetabulum - injuries</topic><topic>Acetabulum - surgery</topic><topic>Aged</topic><topic>Arthroplasty, Replacement, Hip - adverse effects</topic><topic>Arthroplasty, Replacement, Hip - methods</topic><topic>Evidence-based medicine</topic><topic>Fracture Fixation, Internal - adverse effects</topic><topic>Fracture Fixation, Internal - methods</topic><topic>Fractures, Bone - etiology</topic><topic>Fractures, Bone - surgery</topic><topic>Geriatrics</topic><topic>Hip Fractures - surgery</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Open Fracture Reduction - methods</topic><topic>Original Article</topic><topic>Retrospective Studies</topic><topic>Spinal Fractures - surgery</topic><topic>Surgical Orthopedics</topic><topic>Systematic review</topic><topic>Traumatic Surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McCormick, Brian P.</creatorcontrib><creatorcontrib>Serino, Joseph</creatorcontrib><creatorcontrib>Orman, Sebastian</creatorcontrib><creatorcontrib>Webb, Alex R.</creatorcontrib><creatorcontrib>Wang, David X.</creatorcontrib><creatorcontrib>Mohamadi, Amin</creatorcontrib><creatorcontrib>Mortensen, Sharri</creatorcontrib><creatorcontrib>Weaver, Michael J.</creatorcontrib><creatorcontrib>Von Keudell, Arvind</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of orthopaedic surgery & traumatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McCormick, Brian P.</au><au>Serino, Joseph</au><au>Orman, Sebastian</au><au>Webb, Alex R.</au><au>Wang, David X.</au><au>Mohamadi, Amin</au><au>Mortensen, Sharri</au><au>Weaver, Michael J.</au><au>Von Keudell, Arvind</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Treatment modalities and outcomes following acetabular fractures in the elderly: a systematic review</atitle><jtitle>European journal of orthopaedic surgery & traumatology</jtitle><stitle>Eur J Orthop Surg Traumatol</stitle><addtitle>Eur J Orthop Surg Traumatol</addtitle><date>2022-05-01</date><risdate>2022</risdate><volume>32</volume><issue>4</issue><spage>649</spage><epage>659</epage><pages>649-659</pages><issn>1432-1068</issn><issn>1633-8065</issn><eissn>1432-1068</eissn><abstract>Purpose
The treatment of geriatric acetabular fractures remains controversial. Treatment options include nonoperative management, open reduction and internal fixation (ORIF), total hip arthroplasty (THA) with or without internal fixation, and closed reduction with percutaneous pinning (CRPP). There is currently no consensus on the optimal treatment strategy for geriatric patients with acetabular fractures. The purpose of this study is to compare adverse event rates, functional and radiographic outcomes, and intraoperative results between the various treatment modalities in order to help guide surgical decision making.
Methods
We performed a systematic review (registration number CRD42019124624) of observational and comparative studies including patients aged ≥ 55 with acetabular fractures.
Results
Thirty-eight studies including 3,928 patients with a mean age of 72.6 years (range 55–99 years) and a mean follow-up duration of 29.4 months met our eligibility criteria. The pooled mortality rate of all patients was 21.6% (95% confidence interval [CI] 20.9–22.4%) with a mean time to mortality of 12.6 months, and the pooled non-fatal complication rate was 24.7% (95% CI 23.9–25.5%). Patients treated with ORIF had a significantly higher non-fatal complication rate than those treated with ORIF + THA, THA alone, CRPP, or nonoperative management (odds ratios [ORs] 1.87, 2.24, 2.15, and 4.48, respectively;
p
< 0.01). Patients that underwent ORIF were significantly less likely to undergo subsequent THA than these treated with CRPP (OR 0.49, 95% CI 0.32–0.77) but were more likely to require THA than patients treated nonoperatively (OR 6.81, 95% CI 4.63–10.02).
Conclusion
Elderly patients with acetabular fractures tend to have favorable functional outcomes but suffer from high rates of mortality and complications. In patients treated with internal or percutaneous fixation, there was a high rate of conversion to THA. When determining surgical treatment in this population, THA alone or concurrent with ORIF should be considered given the significantly lower rate of non-fatal complications and similar mortality rate. Nonoperative management remains a viable option and was associated with the lowest non-fatal complication rate.
Level of evidence
This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors
www.springer.com/00266
.</abstract><cop>Paris</cop><pub>Springer Paris</pub><pmid>34076747</pmid><doi>10.1007/s00590-021-03002-3</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-4883-9927</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1432-1068 |
| ispartof | European journal of orthopaedic surgery & traumatology, 2022-05, Vol.32 (4), p.649-659 |
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| language | eng |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Acetabulum - injuries Acetabulum - surgery Aged Arthroplasty, Replacement, Hip - adverse effects Arthroplasty, Replacement, Hip - methods Evidence-based medicine Fracture Fixation, Internal - adverse effects Fracture Fixation, Internal - methods Fractures, Bone - etiology Fractures, Bone - surgery Geriatrics Hip Fractures - surgery Humans Medicine Medicine & Public Health Mortality Open Fracture Reduction - methods Original Article Retrospective Studies Spinal Fractures - surgery Surgical Orthopedics Systematic review Traumatic Surgery Treatment Outcome |
| title | Treatment modalities and outcomes following acetabular fractures in the elderly: a systematic review |
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