Which treatment in acetabular fractures of the elderly: Osteosynthesis, osteosynthesis-THA or orthopedic treatment? 2-years retrospective outcomes of a therapeutic algorithm.

Autor: Rajillah O; Department of Orthopedic and Traumatological Surgery, Hôpital François Mitterrand, CHU, 21079 Dijon Cedex, France. Electronic address: omar.rajillah@chu-dijon.fr., Piercecchi A; Department of Orthopedic and Traumatological Surgery, Hôpital François Mitterrand, CHU, 21079 Dijon Cedex, France., Girardot G; Department of Orthopedic and Traumatological Surgery, Hôpital François Mitterrand, CHU, 21079 Dijon Cedex, France., Baulot E; Department of Orthopedic and Traumatological Surgery, Hôpital François Mitterrand, CHU, 21079 Dijon Cedex, France; INSERM, UMR1093-CAPS, Univ. Bourgogne Franche-Comté, UB, 21000, Dijon, France., Lebaron M; University Hospital Department of Orthopedics and Traumatology, Hôpital Nord, Chemin des Bourrely, 13015 Marseille, France., Martz P; Department of Orthopedic and Traumatological Surgery, Hôpital François Mitterrand, CHU, 21079 Dijon Cedex, France; INSERM, UMR1093-CAPS, Univ. Bourgogne Franche-Comté, UB, 21000, Dijon, France; INSERM, CIC 1432, Module Plurithématique, Plateforme d'Investigation Technologique, 21000 Dijon, France.
Jazyk: angličtina
Zdroj: Orthopaedics & traumatology, surgery & research : OTSR [Orthop Traumatol Surg Res] 2024 Oct 24, pp. 104031. Date of Electronic Publication: 2024 Oct 24.
DOI: 10.1016/j.otsr.2024.104031
Abstrakt: Introduction: Acetabular fractures account for 7% of osteoporotic fractures, with an epidemiological peak between 75 and 80 years of age. The aim of this study is to evaluate the results of treatment of these fractures in a population aged over 65.
Hypothesis: Surgical treatment would lead to better survival and functional outcomes in the management of acetabular fractures in subjects aged over 65.
Material and Methods: Patients over 65 years of age treated for acetabular fracture between January 2017 and May 2020 were included in this retrospective single-center study and divided into three treatment groups: osteosynthesis, osteosynthesis-THA (Osteosynthesis-THA) and orthopedic treatment. The choice of treatment was made according to an algorithm that considered the patient's co-morbidities, autonomy and bone lesions. The primary endpoint was patient survival at 12 and 24 months' follow-up.
Results: 94 patients (mean age 78.5 +/-8.4 years) were included: 29 patients treated with orthopedic therapy, 46 patients with osteosynthesis and 19 patients with osteosynthesis-THA. Mean follow-up was 32.7+/-14.9 months. Mortality rates were higher in the orthopedic and osteosynthesis-THA groups (20.7% and 21.1% respectively). Patients in the orthopedic and osteosynthesis-THA groups showed excess mortality, with hazard ratios (HR) of 3.4 ([1.02; 11.3], p < 0.05) and 3.3 ([0.9; 12.3], p = 0.08) respectively, compared with those treated with osteosynthesis. Mean PMA at 2 years, mean Harris score at 2 years and Parker score were significantly higher in the operated groups. The rate of conversion to THA (THA) was higher in the orthopedic treatment group (27.6%). The complication rate was 24% (11/46) for the osteosynthesis group, 42% (8/19) for the osteosynthesis-THA group.
Discussion: Applying our decision algorithm, orthopedic treatment is inferior to surgical treatment in terms of survival and functional results, with a higher re-intervention rate for THA than treatment with osteosynthesis. This study confirms the place of osteosynthesis, with higher functional scores, lower complication and revision rates, and a positive effect on mortality.
Level of Evidence: IV; Retrospective cohort study.
Competing Interests: Declaration of competing interest Pierre Martz: consultant for SERF, NEWCLIP and ORTHOFIX, designer for Xnov, member of the advisory board for Depuy Synthes Emmanuel Baulot: consultant and designer for SERF, ASTON, XO and consultant for XNov. The other authors declare that they have no conflicts of interest. The authors have no conflicts of interest to declare in relation to the content of this article.
(Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)
Databáze: MEDLINE
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