title: Comparison of outcomes of operative versus non-operative treatment of acetabular fractures in the elderly and severely comorbid patient.
abstract: BACKGROUND
  Acetabular fractures in the elderly and severely comorbid patient can be associated with high morbidity and mortality; however, differences in outcomes of acute ORIF versus non-operative care of acetabular fractures in a subgroup of elderly (>75 years) and/or severely comorbid younger patients (>65) remain unclear.
  
  
  METHODS
  A retrospective review of 243 patients who sustained an acetabular fracture between April 2005 and November 2014 was performed. Eighty-seven patients met inclusion criteria: age > 75 with or without comorbidities or age > 65 if complicated by two or more medical comorbidities. Outcomes measures evaluated were 1-year mortality, duration of hospital stay, return to pre-injury ambulation status and treatment failure marked by conversion to a total hip arthroplasty (THA) within 1 year of treatment.
  
  
  RESULTS
  Thirty-seven patients with acetabular fractures were treated with surgical fixation, and 49 were treated non-operatively. Operative patients did not demonstrate a statistically significant difference in mortality within 1 year of treatment compared to non-operatively treated patients. Operative patients demonstrated a statistically significant increase in treatment failure marked by a conversion to a THA within 1 year when compared to conservatively treated patients. No differences in age, duration of follow-up, or ability to return to baseline at latest clinical follow-up were found between groups. However, non-operatively treated patients had a higher incidence of Alzheimer's disease/Dementia and Parkinson's compared to operatively treated patients.
  
  
  CONCLUSIONS
  Analysis of our small cohort suggests that there may be a role for the non-operative treatment of acetabular fractures in this debilitated patient population despite a somewhat longer length of hospital stay at the time of injury. Conversion to THA was significantly higher at 1 year in our operated patients. No differences in mortality at 1 year were noted between patient groups. Return to baseline ambulation status was slightly higher in the non-operated group but not significantly so. However, a potential bias to more likely treat complex fractures operatively cannot be ruled out, as non-operative fractures were most often anterior column variants, usually more amenable to non-operative care.
  
  
  METHODS
  Prognostic Level III.
authors.affiliation: Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA, 02215, USA. kwalley@bidmc.harvard.edu.
authors.forename: Kempland C
authors.initials: KC
authors.lastname: Walley
authors.affiliation: Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA, 02215, USA.
authors.forename: P T
authors.initials: PT
authors.lastname: Appleton
authors.affiliation: Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA, 02215, USA.
authors.forename: E K
authors.initials: EK
authors.lastname: Rodriguez
mesh_terms: D000077:Acetabulum / Q000293:injuries*; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data; D015897:Comorbidity; D000072700:Conservative Treatment; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007902:Length of Stay; D000070799:Open Fracture Reduction; D010300:Parkinson Disease / Q000453:epidemiology; D012189:Retrospective Studies; D017211:Treatment Failure; D016138:Walking
keywords: Acetabular fracture; Elective total hip arthroplasty; Geriatric fracture