Acetabular fractures in elderly

Comparative study of the 3D morphological differences in associated both-column acetabular fractures between elderly and young adults

INTRODUCTION

The occurrence of associated both-column acetabular fractures (ABC-AFs) is common in the elderly, yet their morphological characteristics compared to younger adults remain unclear.

MATERIALS AND METHODS

This retrospective study analyzed 123 cases of ABC-AFs: elderly patients (≥ 65 years, n = 47, group A) and younger adults (< 65 years, n = 76, group B). Using Mimics and 3-matic, fracture line (FL) distributions in the anterior column (AC), quadrilateral plate (QP), and posterior wall (PW) fragments were examined. Comparisons focused on the articular surface, ilium, QP area, and retro-acetabular surface (RAS). Harris hip scores (HHS) were recorded and compared one-year post-surgery.

RESULTS

The distribution of FLs of the AC fragment on the anteroinferior wall, acetabulum, inner and outer sides of the ilium was similar between groups A and B except that group A had sparser FL distribution on the posterosuperior rim and fewer FLs extending into the sacroiliac joint. A comparable pattern of FLs of the QP fragments on the QP area and the RAS was also confirmed. On the RAS, group A exhibited fewer cranial transverse lines (8.5% vs. 25.0%) and more inverse lines (44.7% vs. 23.7%) than group B (p = 0.011). A higher incidence of PW fragments was identified in group A (72.3% vs. 53.9%, p = 0.042). The number of intra-articular fragments was higher in group A than group B (3.8 vs. 3.4, p = 0.031), but the composition of the articular surface was similar. The average HHS was 77.6 in group A and 83.0 in group B (p = 0.007), with excellent/good ratios of 59.5% and 74.7% (p < 0.001), respectively.

CONCLUSIONS

The similar morphological patterns of ABC-AFs and favorable functional outcomes suggest that surgical principles for younger patients could be applicable to elderly patients, with careful considerations for osteoporosis and co-morbidities.

Predictors of mortality one year after pelvic fractures in an older population: a retrospective cohort study

The goal was to investigate if patient characteristics can be used to predict 1-year post-fracture mortality after pelvic fracture. Multivariate logistic regression identified male gender, comorbidities and presence of in-hospital complications as predictors of 1-year mortality.

PURPOSE

Osteoporotic pelvic fractures have significant mortality and morbidity in the older population. The aim of this study was to investigate the factors predicting one-year mortality of patients sustaining a low-impact pelvic fracture (pelvic ring and acetabulum).

METHODS

A total of 282 patients aged ≥ 65 years presenting with a low-energy pelvic ring (n =254) or acetabular (n =28) fracture to the emergency department at the University Hospitals Leuven were included. Demographic and clinical data were retrospectively collected and predictors for mortality one year after pelvic ring fractures were evaluated.

RESULTS

The one-year mortality after osteoporotic pelvic ring fractures and acetabular fractures was respectively 20.4% (95% CI 15.7-26.0) and 14% (95% CI 4.0-32.7). Multivariate logistic regression adjusted for confounders identified male gender (OR 3.18; 95% CI (1.06-9.49), p =0.038), a higher number of comorbidities (OR 1.5; 95% CI (1.16-1.95), p =0.002) and in-hospital complications (OR 5.00; 95% CI (1.39-17.97), p =0.014) as independent predictors of one-year mortality after pelvic ring fractures.

CONCLUSION

The one-year mortality after low-energy pelvic is high and can be predicted by different patient characteristics. These findings can guide pelvis fracture treatment decisions in the older population.

Finite element analysis of the use of two new types of internal fixation for acetabular fractures

BACKGROUND

Both-column fracture is a common type of acetabular fracture and is sometimes accompanied by a comminuted fracture of the quadrilateral area. Such fractures are difficult to anatomically reduce and securely fix. In this study, the authors compared the application value and mechanical properties of the Bespoke 3D-printed titanium alloy plates and Union Plate in acetabular both-column fractures.

METHODS

A both-column fracture model of the acetabulum was established, and the Bespoke 3D-printed titanium alloy plates, Union Plate and a common reconstruction plate were used for fixation. External loads were applied to the model at different angles, and the effects on the plates and the stress and displacement of the screws were determined.

RESULTS

Under different states of hip joint activity, the maximum stress experienced by the Bespoke 3D-printed titanium alloy plates and Union Plate was significantly smaller than the maximum stress experienced by the common reconstruction plate. The Bespoke 3D-printed titanium alloy plates experienced the lowest maximum stress under different hip joint motions. There was no statistically significant difference between the maximum displacement of the Bespoke 3D-printed titanium alloy plates and Union Plate and that of the common reconstructed plate.

CONCLUSIONS

The design of the Bespoke 3D-printed titanium alloy plates imparts a smaller maximum stress and better mechanical properties when repairing acetabular both-column fractures.

The Association between Hip Joint Morphology and Posterior Wall Fracture: Analysis of Radiologic Parameters in Computed Tomography

Although numerous radiologic parameters of abnormal hip joint morphology are utilized in practice, studies on the relation of these parameters to acetabular fractures are limited. This study hypothesized that certain morphological features of hip joints are associated with acetabular posterior wall (PW) fracture patterns and aimed to identify morphological characteristics predictive of acetabular PW fracture. The records of 107 consecutive patients, who were diagnosed with acetabular fractures in a level I trauma center from August 2017 to April 2021, were initially reviewed. After excluding patients who lacked proper radiographic evaluation and had previous surgery or concomitant injury on the ipsilateral lower limb, a total of 99 patients were analyzed to investigate the morphological characteristics of the hip joint, measured in computed tomography, associated with acetabular posterior wall fracture. We included patient demographics, acetabular index (AI), sharp angle, acetabular depth-to-width ratio (AD/WR), center-edge angle (CEA), head-neck offset ratio (HNOR), acetabular head index (AHI), anterior acetabular sector angle (AASA), posterior acetabular sector angle (PASA), and acetabular version angle (AVA) in the univariate and multivariate analyses. The injury mechanism (p = 0.001) and AD/WR (p = 0.021) were predictors of PW fracture in the univariate analysis. In the multivariable analysis, injury mechanism (p = 0.011), AI (coefficient B = 0.320; Exp (B) = 1.377; p = 0.017), and AD/WR (coefficient B = 33.047; Exp (B) = 2.250 × 1014; p = 0.028) were significant predictors of PW fracture. This study highlights the importance of morphological factors, such as a larger AI and AD/WR, that may influence joint stress distribution, resulting in acetabular PW fracture. Understanding these pathomechanisms may protect the hip joint and prevent future injuries through the early identification and treatment of pathological conditions.