Complications vary among acetabular fracture treatments in the elderly

The increasing rate of acetabular fractures in the elderly — as well as a rising incidence of complications and 37.8% mortality — warrants further investigation, according to a study presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons, in San Diego.

The findings were shared by Arthur L. Malkani, MD, of Louisville. “Treatment of acetabular fractures in elderly patients consists of closed treatment, operative treatment, and occasionally arthroplasty,” he said. “Treatment is based on several factors, including age of the patient, osteoporosis, quality of lifestyle, comorbidities, and surgeon experience.”

“The purpose of this study was to compare the rates of postoperative complications in patients treated [for] acetabular fractures either closed or operative, and identify risk factors of complications to improve future outcome,” he added.

Differences in complications

Malkani and colleagues searched a 5% national sample of Medicare records from 1998 to 2007 for cases of acetabular fracture treatment, complication codes and reoperation codes for the purpose of assessing complications within 90 days and 1 year afterwards. Overall the team found and reviewed 1,286 fractures that were treated closed and 359 fractures treated with open reduction/internal fixation (ORIF), he reported.

Complication rates and risk factors were ascertained through multivariate Cox regression, according to the abstract.

The results of the study pointed toward a 29% increase in the incidence of acetabular fractures among the Medicare population since 1998. Further analysis revealed a higher complications incidence among the ORIF group, Malkani noted, with ORIF patients demonstrating higher rates of cardiac issues, deep vein thrombosis (DVT), pulmonary embolism (PE), infection, conversion to total hip arthroplasty, and a greater need to redo the fixation.

“There are significant differences in complications between closed versus ORIF,” Malkani said. “From this study, you cannot conclude that closed treatment should be advocated over ORIF — but this is a difficult group of patients with small margin for error.”

A high complication rate

The study abstract noted that lower complication rates were found in closed treatment patients for both time frames — 90 days and 1 year. Advanced age and comorbidities were both listed as risk factors for these complications. Mortality for the entire group at the 1-year mark, Malkani reported, was 37.8%.

“There is a high complication rate with acetabular fractures in the Medicare population,” Malkani concluded. “Closed treatment patients have a lower adjusted risk of complications. We would suggest patients with advanced age and comorbidities perhaps go the path of closed treatment — especially if it is not a significant displacement. We would recommend ORIF for the active, healthier displaced fracture group with attention placed on minimizing complications such as DVT, PE, infection, and loss of fixation.”

Another strategy the investigators suggested was referring these fractures to centers specializing in these fracture patterns.

Reference:

Malkani AL, Roberts CS, Seligson D, et al. Complication risk following treatment of acetabular fractures in the Medicare population. Paper #212. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19. San Diego.

Disclosure: Malkani receives royalties and institutional or research support from and is a paid consultant to Stryker. He has also received research or institutional support from Synthes.

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