Acetabular fractures in the elderly - Essay Example

According to some studies, fractures of acetabulum account for more than 24% of operative fractures n the elderly population (5). Apart from the increase in the elderly population, the rate of acetabular fractures in this segment of population has also increased (5). Historically, acetabular fractures were treated on conservative lines. The management involved prolonged immobilization, casting, traction and pelvic slings. Advances in surgical technique, imaging modalities and our over all understanding of pelvic anatomy have opened ways for better operative management of acetabular fractures.

Increased numbers of patients are now candidates to operative treatment owing to reduction in peri- operative morbidity and mortality, along with advances in anesthesia and medical management of multiple co-morbidities. As opposed to historical conservative management that involved prolonged immobilization, operative management provides the platform for early patient mobilization. Despite these advances, treatment of acetabular fractures continues to pose significant challenge to the orthopedic surgeons.

This article will review various methods of managing and treating these fractures and their respective outcomes. Fractures of the acetabulum can result from various mechanisms. Majority of fractures involve low to moderate energy injuries and are due to fall from a standing position or short ladder (5 18 23). As the result of a fall, when greater trochanter strikes the ground, the pressure due to the hit drives the femoral head in an antero-medial direction into the anterior column and quadrilateral plate.

The displacement of these structures results in medial subluxation of the femoral head which goes beneath the intact weight bearing dome of acetabulum. The weight bearing dome is defined as the superior 10 mm of the acetabulum on axial CT imaging, or the 45 degree roof arc as described by