Samuel R Ajay Nickson, Prashanth K Tarun, Thirunthaiyan M R, Kumar R Dorai, Sundararaja B
Department of Orthopedic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
J Orthop Case Rep. 2025 Aug;15(8):260-264. doi: 10.13107/jocr.2025.v15.i08.5962.
Geriatric acetabular fractures resulting from low-energy trauma represent an emerging challenge in orthopedic trauma care. This case highlights the successful management of a complex osteoporotic acetabular fracture with medial dome impaction ("Gull sign") and quadrilateral plate involvement using a modified Stoppa approach with suprapectineal plating, followed by an accelerated rehabilitation protocol. While not the first report of its kind, this case provides critical insights into achieving early weight-bearing in elderly patients, addressing a key gap in current management strategies for these challenging fractures.
A 63-year-old male presented with right hip pain and inability to bear weight after a standing-height fall. Imaging revealed a comminuted right acetabular fracture with superomedial dome impaction, quadrilateral plate involvement, and central subluxation. The patient underwent open reduction and internal fixation through a modified Stoppa approach using a suprapectineal plate. Postoperatively, an accelerated rehabilitation protocol was implemented, progressing to full weight-bearing by 6 weeks with radiographic evidence of union.
This case demonstrates that anatomical reduction and stable fixation of complex geriatric acetabular fractures can be achieved through the modified Stoppa approach with suprapectineal plating. More importantly, it establishes the feasibility and safety of an accelerated rehabilitation protocol enabling full weight-bearing by 6 weeks postoperatively. These findings significantly advance the management of osteoporotic acetabular fractures by providing orthopedic surgeons with a replicable treatment strategy that prioritizes early mobilization - a critical factor in reducing complications and improving functional outcomes in elderly patients. The protocol presented here has broad clinical implications for geriatric trauma care and post-operative rehabilitation.
低能量创伤导致的老年髋臼骨折是骨科创伤治疗中一个新出现的挑战。本病例突出展示了采用改良的Stoppa入路联合耻骨上钢板固定术成功治疗一例合并内侧穹窿嵌插（“海鸥征”）和四边形板受累的复杂骨质疏松性髋臼骨折，随后采用加速康复方案。虽然这并非首例此类报告，但该病例为老年患者实现早期负重提供了关键见解，填补了当前这些具有挑战性骨折治疗策略中的一个关键空白。
一名63岁男性在站立高度跌倒后出现右髋疼痛且无法负重。影像学检查显示右侧髋臼粉碎性骨折，伴有上内侧穹窿嵌插、四边形板受累及中心半脱位。患者通过改良的Stoppa入路使用耻骨上钢板进行切开复位内固定。术后实施加速康复方案，至6周时实现完全负重，影像学显示骨折愈合。
本病例表明，通过改良的Stoppa入路联合耻骨上钢板固定术可实现复杂老年髋臼骨折的解剖复位和稳定固定。更重要的是，它确立了加速康复方案的可行性和安全性，该方案可使患者在术后6周实现完全负重。这些发现通过为骨科医生提供一种可复制的治疗策略，显著推进了骨质疏松性髋臼骨折的治疗，该策略优先考虑早期活动——这是减少老年患者并发症和改善功能结局的关键因素。本文提出的方案对老年创伤护理和术后康复具有广泛的临床意义。
