Hanschen Marc, Pesch Sebastian, Huber-Wagner Stefan, Biberthaler Peter
Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Strasse 22, 81675 Munich, Germany.
SICOT J. 2017;3:37. doi: 10.1051/sicotj/2017026. Epub 2017 May 25.
Open reduction and internal fixation (ORIF) is standard care for most acetabular fractures. With increasing numbers of acetabular fractures in the elderly, the risk of revision surgery and conversion to total hip replacement (THR) is increasing. Alarmingly, about 20-25% of acetabular fractures in the elderly following ORIF needed revision and conversion to delayed THR.
Recently, prognostic factors have been identified, which correlate with an increased risk of worse outcomes following ORIF of acetabular fractures in the elderly patient. Patient risk factors include, for example, age, comorbidities, and degree of osteoporosis. Injury risk factors mainly include the fracture pattern.
The concept of primary THR following acetabular fractures is an alternative to ORIF, especially in the elderly patient. Satisfactory outcomes have been reported in different studies for primary THR following acetabular fractures in the elderly. The surgeon should be aware of strict selection criteria in order to achieve these satisfactory outcomes. Therefore, an individualized treatment plan has to be defined for elderly patients following acetabular fractures.
Here, the advantages and disadvantages of ORIF versus THR following acetabular fractures in the elderly are discussed.
切开复位内固定术（ORIF）是大多数髋臼骨折的标准治疗方法。随着老年髋臼骨折患者数量的增加，翻修手术以及转为全髋关节置换术（THR）的风险也在上升。令人担忧的是，老年患者接受ORIF治疗后，约20% - 25%的髋臼骨折需要翻修并转为延期THR。
最近，已确定了一些预后因素，这些因素与老年患者髋臼骨折行ORIF后预后较差风险增加相关。患者风险因素包括年龄、合并症和骨质疏松程度等。损伤风险因素主要包括骨折类型。
髋臼骨折后一期THR的概念是ORIF的一种替代方案，尤其适用于老年患者。不同研究报道了老年患者髋臼骨折后一期THR取得了满意的结果。为了获得这些满意的结果，外科医生应了解严格的选择标准。因此，必须为老年髋臼骨折患者制定个体化的治疗方案。
本文讨论了老年髋臼骨折后ORIF与THR的优缺点。
