The Osteoporotic Acetabular Fracture

Fractures of the acetabulum are some of the most challenging fractures that face orthopedic surgeons. In geriatric patients, these challenges are enhanced by the complexity of fracture patterns, the poor biomechanical characteristics of osteoporotic bone, and the comorbidities present in this population. Nonsurgical management is preferable when the fracture is stable enough to allow mobilization, and healing in a functional position can be expected. When significant displacement and/or hip instability are present, operative management is preferred in most patients, which may include open reduction and internal fixation with or without total hip arthroplasty.

Key points

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Twenty-four percent of acetabular fractures occur in patients older than 60 years, and this proportion is increasing.
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Prolonged traction or bed rest is never indicated for these injuries, especially in the medically ill patient.
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Treatment options include:
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  Nonoperative management with early mobilization
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  Open reduction and internal fixation with standard or minimally invasive techniques
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  With or without planned delayed total hip arthroplasty
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  Acute total hip arthroplasty in selected patients
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Treatment choices need to be individualized based on fracture characteristics, patients’ physiologic age, and functional demands.