Answer
Geriatric Acetabular Fractures — Treatment, ORIF and Acute Total Hip Arthroplasty
DNB Orthopaedics • October 2024 • Paper IV • 10 Marks
Introduction
Acetabular fractures in the elderly differ from those in younger adults because they commonly occur in osteoporotic bone, often after low-energy trauma, and may be associated with marginal impaction, quadrilateral plate involvement, dome impaction and pre-existing hip degeneration.
Treatment aims are:
- Restore a stable, congruent hip joint.
- Allow early mobilization.
- Reduce complications of prolonged recumbency.
- Preserve the native hip when reconstruction is durable.
- Use acute arthroplasty when reliable joint preservation is unlikely.
Key concept
In geriatric acetabular trauma, the decision is not simply “operate or not”; it is often “ORIF versus acute THA ± fixation”.
Typical Features of Geriatric Acetabular Fractures
- Anterior column involvement is common.
- Anterior column with posterior hemitransverse patterns are frequent.
- Quadrilateral plate medial displacement may occur.
- Superomedial or anteromedial dome impaction is common.
- Marginal impaction may compromise articular congruity.
- Femoral head damage may coexist.
- Osteoporosis compromises screw purchase.
Initial Evaluation
- ATLS-based assessment for polytrauma.
- AP pelvis + Judet views when feasible.
- CT scan with 3D reconstruction for fracture morphology.
- Assess:
- Roof/dome involvement
- Posterior wall involvement
- Marginal impaction
- Quadrilateral plate