title: How often does open reduction and internal fixation of geriatric acetabular fractures lead to hip arthroplasty?
abstract: OBJECTIVE
  We hypothesized that open reduction and internal fixation (ORIF) of displaced acetabular fractures in geriatric patients result in a low rate of conversion to hip arthroplasty and satisfactory hip-specific validated outcome scores at medium-term follow-up.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  One hundred forty-seven consecutive patients who were 60 years or older who had acetabular fractures were treated at our center from 2001 through 2006. During this time period, fractures meeting operative criteria were treated with ORIF unless medical conditions warranted nonoperative treatment. Twenty-nine patients were lost to follow-up, 46 were deceased, and 11 declined to participate, leaving 61 potential patients for inclusion, 46 of whom were treated with ORIF (average follow-up, 4.4 years; range, 1.1-8.0 years).
  
  
  METHODS
  Standardized telephone interviews included hip-specific questions and validated outcome measures.
  
  
  METHODS
  Rates of conversion to hip arthroplasty and hip-specific validated outcome scores.
  
  
  RESULTS
  Among 46 patients treated with ORIF (15 others were treated nonoperatively or with percutaneous screw fixation), 28% underwent hip arthroplasty an average 2.5 years after injury (range, 0.4-5.5 years) and had an average Western Ontario and McMaster Universities Index of Osteoarthritis score of 17 (range, 0-56; n = 38). This score is similar to or better than the typical scores after elective arthroplasty for arthritis and much better than the scores for patients with established arthritis (P < 0.05). The average SF-8 Health Survey physical component score was 46.1 (range, 31-62), similar to US population norms for the geriatric age group (P > 0.20).
  
  
  CONCLUSIONS
  Few data exist regarding the treatment outcomes for geriatric acetabular fractures. It is difficult for clinicians to decide among ORIF, percutaneous fixation, acute arthroplasty, and nonoperative treatment. Our protocol of mostly ORIF showed a high 1-year mortality rate of 25% and a rate of conversion to arthroplasty after ORIF of 28%.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Robert V
authors.initials: RV
authors.lastname: O'Toole
authors.forename: Emily
authors.initials: E
authors.lastname: Hui
authors.forename: Amit
authors.initials: A
authors.lastname: Chandra
authors.forename: Jason W
authors.initials: JW
authors.lastname: Nascone
mesh_terms: D000077:Acetabulum / Q000293:injuries* / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome