Primary total hip arthroplasty after acetabular fracture using intra-acetabular bended plates.

Acetabular fractures in the elderly represent the most rapidly growing segment of acetabular trauma (1,2,3,4,5,6,7). The most common cause of traumatic acetabular fractures in the elderly are falls (low-energy) (1,4,6,8) and the marjority of these fractures are the result of minimal trauma regarding osteoporotic bones (1,6,8). The peak incidence of moderate trauma, resulting from a fall to the ground from an erect position, was in the seventh decade (1,3,6). The factors that influence outcomes are : age, comorbidities, decreased physiological reserve, reduced healing capacity, osteopenic bone and fracture patterns (2,4). Elementary fracture patterns (in elderly 27 – 37 % of all fractures) consist of anterior and posterior wall fractures, anterior and posterior column fractures and transverse fractures. Posterior wall fractures are the most common type of acetabulum fracture in the elderly (8,10). According to epidemiological studies performed by the German pelvic study group 2 fractures of the anterior column combined with posterior hemitransverse fractures resulting in a protrusion of the femoral head (clasification of Letournel ; type 62B3 according to the classification of the AO/ASIF) are prevalent in elderly patients (9). Treatment methods used for acetabulum fractures are : skeletal traction (non-operative), minimal invasive fixation techniques, open reduction and internal fixation with or without total hip arthroplasty (THA), and cable fixation of acetabular fractures with or without THA. According to literature there is no optimal method of acetabulum fracture management (2,4,5). The non-operative management of displaced fractures often results in poor outcomes (2,5,6). The High (Audrius – is the h capitalized in High because it is a name?) rates of acetabular loosening are higher for delayed THA compared with a control group of primary THA. Primary THA combined with ORIF can provide optimal outcomes (2,10). Advantages of acute THA in the elderly are earlier mobilization, faster recovery, avoidance of technical problems that can occur with delayed arthroplasty, and less revisions as compared with delayed arthroplasty (2,6,10). The disadvantages are major technical challenges of simultaneously obtaining both implant and fracture stability, in addition to the prolonged duration of the operations (2).