From the Department of Orthopaedic Surgery, MetroHealth Medical Center affiliated with Case Western Reserve University, Cleveland, OH.
J Am Acad Orthop Surg Glob Res Rev. 2022 Mar 2;6(3):e22.00014. doi: 10.5435/JAAOSGlobal-D-22-00014.
Among elderly patients, anterior column posterior hemitransverse (ACPHT) and associated both column (ABC) are common acetabular fracture patterns after low-energy mechanisms. Given the paucity of outcomes data in this cohort, the goal of this study was to determine the favorability of results with surgical versus nonsurgical management. Secondarily, factors linked with poor functional outcomes were assessed.
Over a 16-year period, 81 patients aged ≥60 years with 82 ACPHT and ABC acetabular fractures were evaluated. Retrospectively, patient demographics, injury details, and early and late complications were collected. Functional outcomes were assessed with the Musculoskeletal Function Assessment (MFA) after a minimum of 12 months of follow-up.
During the study period, 81 patients sustained 82 ACPHT (n = 35, 43%) or ABC (n = 47) fractures, most secondary to low-energy falls (71%). Patients managed surgically were younger, had higher-energy mechanisms, and more often had an associated hip dislocation or marginal impaction (all P < 0.05). Of note, 42.3% and 18.5% of patients had early and late complications, respectively, with no differences between surgical and nonsurgical groups. Posttraumatic arthrosis (PTA) was noted in 27% overall (36% surgical versus 16% nonsurgical, P = 0.10). The mean MFA score was 25.2 after 59 months. Better outcomes were associated with high-energy mechanisms, multiple injuries, and surgical management (all P < 0.05). The worst MFA outcomes were among patients with PTA (40.2) and those requiring a secondary procedure (45.7), both P < 0.05.
Nonsurgical management had a low rate of PTA. Mitigating PTA and decreasing the rate of secondary surgeries seem crucial achieving satisfactory outcomes. Higher-energy injuries benefit from open reduction and internal fixation, as indicated by better MFA scores.
在老年患者中，经低能机制导致的髋臼骨折中，前柱后横半（ACPHT）和联合前后柱（ABC）是常见的骨折模式。鉴于该队列中缺乏结局数据，本研究旨在确定手术与非手术治疗的结果优劣。其次，评估了与不良功能结局相关的因素。
在 16 年的时间里，对 81 名年龄≥60 岁的 ACPHT 和 ABC 髋臼骨折患者进行了评估。回顾性收集患者人口统计学、损伤细节以及早期和晚期并发症等数据。在至少 12 个月的随访后，采用肌肉骨骼功能评估（MFA）评估功能结局。
在研究期间，81 名患者发生 82 例 ACPHT（n=35，43%）或 ABC（n=47）骨折，大多数由低能跌倒引起（71%）。手术治疗的患者更年轻，损伤机制的能量更高，且更常伴有髋关节脱位或边缘嵌压（均 P<0.05）。值得注意的是，分别有 42.3%和 18.5%的患者发生早期和晚期并发症，手术组与非手术组之间无差异。总体而言，27%的患者出现创伤后关节炎（PTA）（手术组为 36%，非手术组为 16%，P=0.10）。59 个月后，MFA 平均评分为 25.2。高能机制、多发损伤和手术治疗与更好的结局相关（均 P<0.05）。PTA（40.2）和需要二次手术的患者（45.7）的 MFA 结局最差，均 P<0.05。
非手术治疗的 PTA 发生率较低。减轻 PTA 并降低二次手术率似乎对于获得满意的结局至关重要。高能损伤受益于切开复位内固定，这可通过更好的 MFA 评分来体现。
