Acetabular Fractures in the Elderly

Epidemiology and Mechanism of Injury With an aging population, the prevalence and burden of all osteopenic fractures, especially hip fractures, continue to be a concern. Specifically, in patients over the age of sixty, there has been a 2.4-fold increase in the incidence of acetabular fractures over the past quarter of a century, and geriatric patients are the fastest growing subgroup of patients with acetabular fractures. The mechanism of injury in this age cohort differs substantially in comparison with that in younger adults. Ferguson et al. found that while low-energy falls from a standing height accounted for 50% (117) of 235 acetabular fractures in patients over sixty years of age, high-energy mechanisms accounted for 82% (884) of 1072 fractures in young adults. Additionally, only 30% (seventy) of 235 older patients with an acetabular fracture had associated injuries, likely because of decreased involvement in motor vehicle collisions. The anterior column-posterior hemitransverse fracture pattern is the classic osteopenic acetabular fracture as it displays a number of features commonly seen in geriatric acetabular fractures (Figs. 1-A and 1-B). In patients with normal bone quality who are involved in high-energy trauma, fracture patterns are typical of those described by the Letournel classification. However, osteopenic patients who fall on their side experience an impact through the greater trochanter, which results in an anteromedial force fracturing and displacing the anterior column and quadrilateral plate. The femoral head then medializes with the anterior column and impacts the posteromedial portion of the roof . At times, the femoral head can be impacted by the intact acetabulum. This mechanism results