title: Variation in Treatment of Displaced Geriatric Acetabular Fractures Among 15 Level-I Trauma Centers.
abstract: OBJECTIVE
  To document the initial treatment of displaced acetabular fractures among older adults across multiple trauma centers and to investigate the factors that influence the decision to operate and the choice of operative procedure [open reduction internal fixation (ORIF) vs. total hip arthroplasty (THA)].
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Fifteen US level-I trauma centers participating in the Major Extremity Trauma Research Consortium.
  
  
  METHODS
  Overall, 269 patients aged 60 years or older admitted for the treatment of a displaced acetabular fracture.
  
  
  METHODS
  None.
  
  
  METHODS
  Treatment.
  
  
  RESULTS
  Sixty percent of fractures (n = 162) were treated operatively. Younger age (<80 years), injury from high-energy mechanism, fractures with femoral head impaction, and fractures without hip congruency were significantly associated with receiving operative treatment (P < 0.05). Significant site variation in operative versus nonoperative treatment occurred even after accounting for these factors (P = 0.0044). Among operatively treated patients, 88% (n = 142) received ORIF and 12% (n = 20) received THA as the initial treatment. Women were more likely to be treated with initial THA compared with men; of the known risk factors for poor outcomes with ORIF (ie, dome or roof impaction, femoral head impaction, or posterior wall involvement), only dome impaction was significantly associated with receiving initial THA (P < 0.05).
  
  
  CONCLUSIONS
  Currently, no treatment guidelines exist for acetabular fractures in older adults, which likely explains the significant site variation in operative versus nonoperative treatment. This study identifies patient and injury factors that drive treatment decisions, which will be important in planning and designing future trials needed to determine the best treatment for these fractures.
authors.affiliation: *Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD; †Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; ‡Boston University Medical Center; and §Department of Orthopaedic Surgery, University of Texas Medical School at Houston, Houston, TX.
authors.forename: Theodore T
authors.initials: TT
authors.lastname: Manson
authors.forename: Lisa
authors.initials: L
authors.lastname: Reider
authors.forename: Robert V
authors.initials: RV
authors.lastname: OʼToole
authors.forename: Daniel O
authors.initials: DO
authors.lastname: Scharfstein
authors.forename: Paul
authors.initials: P
authors.lastname: Tornetta
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Gary
mesh_terms: D000077:Acetabulum / Q000293:injuries* / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D005260:Female; D017102:Fracture Healing; D050723:Fractures, Bone / Q000453:epidemiology* / Q000601:surgery*; D017759:Fractures, Malunited; D006801:Humans; D008297:Male; D008875:Middle Aged; D000070799:Open Fracture Reduction / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology