Toro Giuseppe, Braile Adriano, De Cicco Annalisa, Pezzella Raffaele, Ascione Francesco, Cecere Antonio Benedetto, Schiavone Panni Alfredo
Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy.
Indian J Orthop. 2022 May 26;56(7):1139-1149. doi: 10.1007/s43465-022-00653-0. eCollection 2022 Jul.
The incidence of fragility fractures of the acetabulum (FFA) is constantly increasing. Generally, these fractures are related to a fall on the greater trochanter involving the anterior column. The management of FFA is extremely difficult considering both patients' comorbidities and poor bone quality. Both non-operative and several operative treatment protocols are available, and the choice among them is still ambiguous. The proposed surgical techniques for FFA [namely open reduction and internal fixation (ORIF), percutaneous fixation and total hip arthroplasty (THA)] are associated with a high complication rate. The treatment with the higher early mortality is the ORIF + THA, while the one with the lowest is the non-operative. However, at longer follow-up, this difference dreadfully change is becoming the opposite. Frequently ORIF, percutaneous fixation, and non-operative treatment need a subsequent re-operation through a THA. This latter could be extremely difficult, because of poor bone quality, acetabular mal union/non-union, bone gaps and hardware retention. However, the outcomes of each of the proposed treatment are mostly poor and controverted; therefore, a comprehensive patient evaluation and an accurate fracture description are required to appropriately manage acetabular fracture in the elderly.
髋臼脆性骨折（FFA）的发病率在持续上升。一般来说，这些骨折与大转子着地且累及前柱的跌倒有关。考虑到患者的合并症和骨质不佳，FFA的治疗极其困难。非手术和多种手术治疗方案都有，而在它们之间做出选择仍不明确。针对FFA提出的手术技术[即切开复位内固定术（ORIF）、经皮固定术和全髋关节置换术（THA）]都伴有较高的并发症发生率。早期死亡率较高的治疗方法是ORIF + THA，而最低的是非手术治疗。然而，在更长时间的随访中，这种差异正可怕地发生逆转。ORIF、经皮固定术和非手术治疗常常需要随后通过THA进行再次手术。由于骨质不佳、髋臼畸形愈合/不愈合、骨间隙和内固定物存留，后者可能极其困难。然而，所提出的每种治疗方法的结果大多不佳且存在争议；因此，需要对患者进行全面评估并准确描述骨折情况，以便妥善处理老年患者的髋臼骨折。
