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Lommerse MI, Willems HC, van Dieren S, Bloemers FW, Schuijt HJ, van Embden D. Increasing incidences of acetabular, pelvic, and proximal femur fractures in The Netherlands. Injury 2025; 56:112322. [PMID: 40198969 DOI: 10.1016/j.injury.2025.112322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2025] [Accepted: 03/30/2025] [Indexed: 04/10/2025]
Abstract
PURPOSE This study aims to investigate incidence rates of acetabular, pelvic, and proximal femur fractures in The Netherlands over a 10-year period (2012-2022). With an aging population, understanding trends in these osteoporotic fractures is essential for improving patient outcomes and guiding healthcare strategies. METHODS A retrospective cohort study was conducted using data from two national databases, forming a 'hospitalised' and an 'all patients' cohort. The study population included patients diagnosed with acetabular, pelvic, and proximal femur fractures in The Netherlands during the study period. Incidence rates were calculated per 100,000 person-years and linear regression was used to assess temporal trends. Age-adjustments were performed using Dutch population data from the Central Bureau of Statistics (CBS). Comparative analyses between the two cohorts were conducted to identify discrepancies. RESULTS A total of 283,991 patients were identified (12,020 acetabular, 70,595 pelvic and 201,376 proximal femur fractures). Of these patients, 159,563 were hospitalised (7123 acetabular, 24,192 pelvic, and 128,252 proximal femur fractures). Incidence rates of acetabular fractures increased by 26 % (hospitalised) and 98 % (all patients), while pelvic fractures showed stagnation in hospitalised patients (-0.13 %) but a 44 % rise in all patients. Proximal femur fractures increased by 5 % (hospitalised) and 15 % (all patients). Significant differences between the databases were noted across all fracture types. CONCLUSION The incidence of acetabular, pelvic, and proximal femur fractures has significantly increased in the last decade, most notably in acetabular and pelvic fractures. Furthermore, a shift toward out-patient treatment of acetabular and pelvic fractures was found. These findings highlight the need for improved fracture prevention and out-patient management strategies, while also underscoring the need for a nationwide registration for these injuries.
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Affiliation(s)
- M I Lommerse
- Department of Trauma Surgery, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands; Geriatrics Section, Department of Internal Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Amsterdam University Medical Center research institute, The Netherlands.
| | - H C Willems
- Geriatrics Section, Department of Internal Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands; Amsterdam Bone Center, Amsterdam University Medical Center research center, The Netherlands
| | - S van Dieren
- Epidemiology Section, Department of Surgery, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
| | - F W Bloemers
- Department of Trauma Surgery, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands; Amsterdam Bone Center, Amsterdam University Medical Center research center, The Netherlands
| | - H J Schuijt
- Geriatrics Section, Department of Internal Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands; Department of Trauma Surgery, St. Antonius Ziekenhuis, Utrecht, The Netherlands
| | - D van Embden
- Department of Trauma Surgery, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands; Amsterdam Bone Center, Amsterdam University Medical Center research center, The Netherlands
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Albrektsson M, Möller M, Sundfeldt M, Wennergren D, Wolf O. Secondary surgery and mortality following primary treatment for acetabular fractures - an observational study from Swedish national quality registers. J Orthop Surg Res 2025; 20:465. [PMID: 40380330 PMCID: PMC12083103 DOI: 10.1186/s13018-025-05796-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Accepted: 04/07/2025] [Indexed: 05/19/2025] Open
Abstract
BACKGROUND The treatment of acetabular fractures ranges from non-operative with no restrictions in mobilisation to some of the more complex operative treatments in orthopaedics. Treatment strategies are developing, and outcomes need to be studied continuously. The study's primary aim was to assess the rate of secondary treatment in patients with acetabular fractures treated non-operatively or operatively. A secondary aim was to study mortality. METHODS Data were retrieved from the Swedish Fracture Register and cross-referenced with the Swedish Arthroplasty Register for all patients aged ≥ 18 years with an acetabular fracture between 2014 and 2023. Patients were divided into three primary treatment groups: non-operative treatment, open reduction and internal fixation (ORIF), and total hip arthroplasty (THA) with/without combined ORIF (THA/combined hip procedure, CHP). The study examined mortality rates within each treatment group. RESULTS Of the 3318 patients included in the study, 74% were treated non-operatively, 18% with ORIF, and 8% with THA/CHP. 4% of non-operatively treated patients and 17% of patients treated with ORIF had been converted to THA at 5 years, 12% of patients with THA as primary treatment had been revised. Patients who underwent THA as their initial treatment were more likely to undergo secondary treatment early. However, in those initially treated with ORIF the prevalence of secondary treatment increased after the first year. The non-operatively treated group had the highest mortality rate (19% at 1 year), followed by the THA group (14% at 1 year). CONCLUSIONS This observational nationwide register study on acetabular fractures shows that surgically treated patients have a relatively high reoperation rate. Younger patients are predominately treated with ORIF and display low mortality rates. Older patients with complex fracture patterns may benefit from primary treatment with THA/CHP being more frequently performed compared to prevailing practice.
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Affiliation(s)
- Madelene Albrektsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Mölndal, Sweden.
| | - Michael Möller
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Mölndal, Sweden
| | - Mikael Sundfeldt
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Mölndal, Sweden
| | - David Wennergren
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Mölndal, Sweden
| | - Olof Wolf
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Orthopaedics and Hand Surgery, Uppsala University Hospital, Uppsala, Sweden
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Walters S, Hague M, Coveney E, Smith S, Gillespie P, Day A, Coomber R. Fix and replace for acetabular fractures: a decade of outcomes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2025; 35:160. [PMID: 40237859 DOI: 10.1007/s00590-025-04281-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Accepted: 03/30/2025] [Indexed: 04/18/2025]
Abstract
BACKGROUND Fix and replace is the combination of fixation and hip arthroplasty for the treatment of acetabular fractures. This technique is typically performed for elderly patients with complex fracture patterns, whereby fixation alone may not achieve a satisfactory result or allow early unrestricted weightbearing. METHODS This was a retrospective observational study of patients with acetabular fractures treated with fix and replace, identified from a locally maintained, prospectively collected database. Imaging and case notes were reviewed for patient and injury characteristics and outcomes. RESULTS Between 2014 and 2024, 92 consecutive cases (91 patients) were identified with a median age of 78 years. Operations performed with a single approach had a significantly lower mean anaesthetic time and intra-operative blood loss than dual approach (4.4 h vs 5.0 h, p = 0.043; 500 ml vs 800 ml, p = 0.036). There were 3 revisions for infection (3.3%) and 5 dislocations (5.4%), one of which was revised, with the other four treated successfully with manipulation only. Mortality rates were 12.5%, 30.9%, and 50% at 1, 3, and 5 years, respectively. Increasing age, dependent pre-operative mobility status, and increasing Charlson Comorbidity Index were all associated with all-time mortality risk (p < 0.001, p < 0.001, and p = 0.002, respectively). CONCLUSION This is the largest series of its kind to date, providing additional information about typical patient and injury characteristics and expected outcomes. Due to the benefits of single rather than dual approach, this should be considered where possible using percutaneous techniques and acetabular component augmentation where required, to minimise operative time and blood loss.
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MESH Headings
- Humans
- Acetabulum/injuries
- Acetabulum/surgery
- Aged
- Male
- Female
- Retrospective Studies
- Aged, 80 and over
- Fractures, Bone/surgery
- Fractures, Bone/mortality
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Hip/adverse effects
- Middle Aged
- Fracture Fixation, Internal/methods
- Fracture Fixation, Internal/adverse effects
- Operative Time
- Treatment Outcome
- Blood Loss, Surgical/statistics & numerical data
- Reoperation/statistics & numerical data
- Adult
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Affiliation(s)
- Samuel Walters
- St George's University Hospitals NHS Foundation Trust, London, UK.
| | - Matthew Hague
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Eamonn Coveney
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Simon Smith
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Paul Gillespie
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Adrian Day
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Ross Coomber
- St George's University Hospitals NHS Foundation Trust, London, UK
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Walus P, Ohla J, Wójcicki R, Pielak T, Bulski J, Wesołowski M, Huri G, Zabrzyński J. Prevalence of Depressive Disorders in Operatively Treated Pelvic Trauma Patients. Diseases 2025; 13:105. [PMID: 40277816 PMCID: PMC12026098 DOI: 10.3390/diseases13040105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2025] [Revised: 03/24/2025] [Accepted: 03/29/2025] [Indexed: 04/26/2025] Open
Abstract
AIM The aim of this study is to assess the prevalence of depressive disorders in patients with pelvic fractures treated surgically at our center in the years 2017-2022. MATERIALS AND METHODS The study included 75 patients, 57 men and 18 women, operated on in our center in the years 2017-2022 due to acetabular fracture and pelvic ring injury. Factors such as age, gender, chronic pain measured with the VAS scale, and the incidence of suicidal thoughts were also analyzed. The participants completed the Beck Depression Inventory (BDI). RESULTS Thirty-five out of the seventy-five patients showed symptoms of depression (BDI score > 11), which is 47%, with an average score of 29 (p < 0.0001). Women obtained an average BDI score of 23, which corresponds to moderate depression on Beck's scale (p < 0.008). The correlation between BDI score and chronic pain in pelvic trauma patients has been found to be positive (p < 0.0003; r = 0.4094). Furthermore, women in our studied population reported suicidal thoughts more often than men (44% vs. 14%; p < 0.01). No statistically significant correlation was found between the occurrence of depression and the length of hospital stay and the patient's age (p < 0.5 and p < 0.06, respectively). CONCLUSIONS The prevalence of depression in the pelvic trauma patients of the studied population has been determined to be 47%.
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Affiliation(s)
- Piotr Walus
- Department of Orthopaedics and Traumatology, Jan Kochanowski University, 25736 Kielce, Poland (J.Z.)
| | - Jakub Ohla
- Department of Orthopaedics and Traumatology, Nicolaus Copernicus University, 87100 Toruń, Poland
| | - Rafał Wójcicki
- Department of Orthopaedics and Traumatology, Jan Kochanowski University, 25736 Kielce, Poland (J.Z.)
| | - Tomasz Pielak
- Department of Orthopaedics and Traumatology, Jan Kochanowski University, 25736 Kielce, Poland (J.Z.)
| | - Jakub Bulski
- Department of Orthopaedics and Traumatology, Jan Kochanowski University, 25736 Kielce, Poland (J.Z.)
| | - Michał Wesołowski
- Department of Orthopaedics and Traumatology, Jan Kochanowski University, 25736 Kielce, Poland (J.Z.)
- Department of Pathophysiology, Wroclaw Medical University, 50368 Wrocław, Poland
| | - Gazi Huri
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Hacettepe University, 06800 Ankara, Türkiye
| | - Jan Zabrzyński
- Department of Orthopaedics and Traumatology, Jan Kochanowski University, 25736 Kielce, Poland (J.Z.)
- Department of Orthopaedics and Traumatology, Nicolaus Copernicus University, 87100 Toruń, Poland
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Trouwborst NM, Oldhoff MGE, Ten Duis K, van Helden SH, Hermans E, Jaarsma RL, van Lieshout EMM, Reininga IHF, Tromp TN, Verhofstad MHJ, de Vries JPPM, Wijffels MME, Meesters AML, IJpma FFA. 3D fracture assessment could be predictive of native hip survival after nonoperative treatment of acetabular fractures. Bone Joint J 2025; 107-B:204-212. [PMID: 39889745 DOI: 10.1302/0301-620x.107b2.bjj-2024-0390.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2025]
Abstract
Aims The aim of the study was to apply 3D measurements for fracture displacement in minimally to moderately displaced acetabular fractures treated nonoperatively, and to evaluate whether this measurement can be used to estimate the likelihood of conversion to total hip arthroplasty (THA) at follow-up. Methods A multicentre, cross-sectional study was performed on 144 patients who were treated nonoperatively for an acetabular fracture in four level 1 trauma centres between January 2000 and December 2020. For each patient, fracture displacement was measured on CT-based 3D models. The 3D gap area represents fracture displacement (mm2) between all fracture fragments. A receiver operating characteristic curve was generated to determine a 3D gap area threshold representing the optimal sensitivity and specificity to predict conversion to THA. Native hip survival was reported using Kaplan-Meier curves. Predictors of conversion to THA were determined using Cox regression analysis. Results Of 144 patients, 18 (12%) received a THA. The median 3D gap area of the complete study cohort was 692 mm2 (IQR 216 to 1,400). Native hip survival in patients with a gap area threshold ≤ 1,171 or > 1,171 mm2 differed at one-year (98% vs 85%), two-year (96% vs 77%), and five-year follow-up (92% vs 73%). 3D gap area > 1,171 mm2 (hazard ratio (HR) 4.3; 95% CI 1.7 to 11.0) and the presence of osteoarthritis grade 2 or higher (HR 3.1; 95% CI 1.2 to 7.8) independently predicted the likelihood of conversion to THA during follow-up. Conclusion For nonoperatively treated acetabular fractures, introducing 3D gap area assessment to measure fracture displacement offers a promising approach for assessing the risk of conversion to THA. With the introduction of (semi-)automatic segmentation and measurement techniques, or their implementation into commercially available software, this 3D gap area measurement can serve as an addition to the Letournel classification and an alternative to traditional 2D gap and step-off measurements, improving accuracy, reproducibility, and applicability in clinical decision-making.
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Affiliation(s)
- Neeltje M Trouwborst
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Orthopaedic & Trauma Surgery, Flinders University, Flinders Medical Centre, Adelaide, Australia
| | - Miriam G E Oldhoff
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- 3D Lab/Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Kaj Ten Duis
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | | | - Erik Hermans
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ruurd L Jaarsma
- Department of Orthopaedic & Trauma Surgery, Flinders University, Flinders Medical Centre, Adelaide, Australia
| | - Esther M M van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Inge H F Reininga
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Emergency Care Network Northern Netherlands (AZNN), Northern Netherlands Trauma Registry, Groningen, Netherlands
| | - Tjarda N Tromp
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Mathieu M E Wijffels
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Anne M L Meesters
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- 3D Lab/Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Frank F A IJpma
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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6
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Ljungdahl J, Hernefalk B, Pallin A, Brüggemann A, Hailer NP, Wolf O. Mortality and reoperations following treatment of acetabular fractures in patients ≥ 70 years: a retrospective cohort study of 247 patients. Acta Orthop 2025; 96:94-101. [PMID: 39832287 PMCID: PMC11747840 DOI: 10.2340/17453674.2024.42704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 12/06/2024] [Indexed: 01/22/2025] Open
Abstract
BACKGROUND AND PURPOSE Evidence for long-term outcomes following acetabular fractures in older adults is limited. We aimed to evaluate mortality, complications, and need for subsequent surgical procedures in operatively and nonoperatively treated older patients with acetabular fractures. METHODS Patients aged ≥ 70 years with acetabular fractures treated at Uppsala University Hospital between 2010 and 2020 were included. Fractures were classified according to Letournel. Local medical records were analyzed and cross-referenced with the Swedish Arthroplasty Register to identify reoperations and delayed arthroplasty procedures. Follow-up time ranged from 2-12 years. Primary outcome was mortality 1 year after injury. Descriptive statistics, survival analysis using the Kaplan-Meier method, and logistic regression models were used. RESULTS 247 patients (67% men) with a median age of 80 years (range 70-102) were included. Most patients were ASA class 3 (67%). 148 (60%) patients were treated operatively. The 1-year mortality was 15% (95% confidence interval [CI] 9-21) in the operatively and 29% (CI 19-37) in the nonoperatively treated group. Difference in adjusted mortality rates between treatments did not reach statistical significance. 20% of patients treated with open reduction internal fixation (ORIF) underwent some form of reoperation. In the nonoperatively treated group, 1% had a delayed THA. CONCLUSION The 1-year mortality following acetabular fractures in older people was 21% (CI 15-26), underscoring the frailty of this patient group. ORIF alone was associated with a 20% reoperation rate while the rate of delayed surgical treatment in patients selected for nonoperative treatment was 1%.
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Affiliation(s)
- Johan Ljungdahl
- Department of Surgical Sciences, Section for Orthopaedics, Uppsala University, Uppsala, Sweden.
| | - Björn Hernefalk
- Department of Surgical Sciences, Section for Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Anna Pallin
- Department of Surgical Sciences, Section for Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Anders Brüggemann
- Department of Surgical Sciences, Section for Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Nils P Hailer
- Department of Surgical Sciences, Section for Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Olof Wolf
- Department of Surgical Sciences, Section for Orthopaedics, Uppsala University, Uppsala, Sweden
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Perumal R, Ahmed O, Imran A, Zackariya M, Jayaramaraju D, Shanmuganathan R. Integrative surgical approach for complex transverse-posterior wall fractures of the acetabulum: A case series of 21 patients evaluating mid-term outcomes. J Clin Orthop Trauma 2025; 60:102851. [PMID: 39759469 PMCID: PMC11699480 DOI: 10.1016/j.jcot.2024.102851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Accepted: 11/27/2024] [Indexed: 01/07/2025] Open
Affiliation(s)
- Ramesh Perumal
- Department of Orthopaedics and Trauma, Ganga Medical Center & Hospital, Coimbatore, India
| | - Owais Ahmed
- Department of Orthopaedics and Trauma, Ganga Medical Center & Hospital, Coimbatore, India
| | - Asif Imran
- Department of Orthopaedics and Trauma, Ganga Medical Center & Hospital, Coimbatore, India
| | - Mohamed Zackariya
- Department of Orthopaedics and Trauma, Ganga Medical Center & Hospital, Coimbatore, India
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Touet A, Schmiedt Y, Köller J, Prangenberg C, Cucchi D, Welle K, Endler C, Scheidt S. Impact of Patient-Specific Hip Joint Geometry on the Morphology of Acetabular Fractures. J Clin Med 2024; 13:7332. [PMID: 39685789 DOI: 10.3390/jcm13237332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 11/24/2024] [Accepted: 11/27/2024] [Indexed: 12/18/2024] Open
Abstract
Background: Acetabular fractures continue to pose a major challenge in clinical practice, not least because of the growing geriatric population. While the influence of the force vectors on fracture formation is well established, the impact of anatomical factors on fracture morphology remains poorly understood. The aim of this study was to investigate patient-specific hip joint geometry, identify structural risk factors and correlate these with the resulting fracture patterns. Methods: This retrospective cohort analysis included 226 patients (Mdn age = 58 yrs.) with acetabular fracture categorized by Judet/Letournel and the AO/OTA classification. Computed tomography (CT) datasets of the injured and contralateral sides were analyzed using multiplanar reconstruction. Parameters included modified center-edge (CE) angle (Wiberg), rotation angles (Ullmann and Anda), acetabular sector angle (Anda), true caput-collum-diaphyseal (CCD) angle, femoral head diameter and volume, as well as femoral neck length, circumference, and diameter. In addition, intrarater reliability within a subcohort was assessed for the metric measurements and inter-rater analysis for the classification of the entire sample. Results: The primary analysis showed direct effects of femoral head diameter, femoral neck length and femoral head size on the fracture type according to AO/OTA (type A/B/C), whereby this effect was particularly seen between type A and type C fractures (p = 0.001). Ordinal regression identified femoral head diameter as the only significant predictor (p = 0.02), with a 25% increased likelihood of complex fractures per unit of change. Low-energy trauma doubled the risk of severe fractures. Specific findings include a higher acetabular anteversion in anterior column fractures. Age correlated positively with the cause of injury and fracture type. The inter-rater reliability for fracture classification was excellent, as was the intrarater reliability of the measurements. Conclusions: This study suggests that anatomical factors, particularly proximal femoral geometry, have an impact on acetabular fracture morphology-in addition to factors such as trauma type and patient demographics.
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Affiliation(s)
- Amadeo Touet
- Clinic for Orthopedics and Trauma Surgery, University Hospital of Bonn, 53127 Bonn, Germany
| | - Yannick Schmiedt
- Clinic for Orthopedics and Trauma Surgery, University Hospital of Bonn, 53127 Bonn, Germany
| | - Jessica Köller
- Clinic for Orthopedics and Trauma Surgery, University Hospital of Bonn, 53127 Bonn, Germany
| | - Christian Prangenberg
- Clinic for Orthopedics and Trauma Surgery, University Hospital of Bonn, 53127 Bonn, Germany
| | - Davide Cucchi
- Clinic for Orthopedics and Trauma Surgery, University Hospital of Bonn, 53127 Bonn, Germany
| | - Kristian Welle
- Clinic for Orthopedics and Trauma Surgery, University Hospital of Bonn, 53127 Bonn, Germany
| | - Christoph Endler
- Clinic for Diagnostic and Interventional Radiology, University Hospital of Bonn, 53127 Bonn, Germany
| | - Sebastian Scheidt
- Clinic for Orthopedics and Trauma Surgery, University Hospital of Bonn, 53127 Bonn, Germany
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Albrektsson M, Möller M, Sundfeldt M, Wennergren D, Wolf O, Bergdahl C. Patient-reported outcome following an acetabular fracture: an observational study of 385 patients from the Swedish Fracture Register. Acta Orthop 2024; 95:695-700. [PMID: 39607367 PMCID: PMC11603666 DOI: 10.2340/17453674.2024.42414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 11/01/2024] [Indexed: 11/29/2024] Open
Abstract
BACKGROUND AND PURPOSE The primary aim of this study was to assess the patient's self-reported change in health 1 year after sustaining an acetabular fracture. The secondary objective was to examine differences in patient-reported outcomes (PROMs) based on sex, age groups, injury mechanisms, type of fracture, and treatment. METHODS Data was collected from the Swedish Fracture Register (SFR) for patients with acetabular fractures sustained between 2014 and 2021. Patients with additional fractures at the time of injury or during the following 18 months, periprosthetic fractures, or pediatric fractures were excluded. The PROM used was the Short Musculoskeletal Function Assessment (SMFA) wherein the subindices of bother, dysfunction, and mobility were analyzed with a higher score indicating worse outcome. The differences in SMFA and in subindices between the score 1 year after fracture and preinjury (recall) were analyzed. RESULTS Of the 385 included patients with complete PROMs, there was no significant difference in changes in SMFA score between the sexes. Surgically treated patients had significantly higher scores 1 year post-injury compared with non-surgically treated patients with bother index 18.3 (95% confidence [CI] 14.0-22.6) vs 7.2 (CI 4.7-9.8), dysfunction index 15.8 (CI 12.7-18.9) vs 7.0 (CI 5.0-9.0), and mobility index 21.6 (CI 17.9-25.2) vs 9.2 (CI 6.9-11.5). CONCLUSION Most patients sustaining an acetabular fracture experience a decline in their functional abilities 1 year after the injury compared with before the injury. Younger patients with high-energy injuries and complex fracture types, which typically require surgical intervention, experience the most unfavorable outcomes. The large group of non-surgically treated patients reported minimal functional changes, likely attributable to selection bias.
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Affiliation(s)
- Madelene Albrektsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden.
| | - Michael Möller
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
| | - Mikael Sundfeldt
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
| | - David Wennergren
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
| | - Olof Wolf
- Department of Orthopaedics and Hand Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Carl Bergdahl
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
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Dwight KD, Maceroli M. Posttraumatic Arthritis After Acetabular Fractures. Orthop Clin North Am 2024; 55:453-459. [PMID: 39216950 DOI: 10.1016/j.ocl.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
This article highlights patient, radiographic, and surgical risk factors for the development of posttraumatic arthritis after acetabular fractures. Surgical treatment options including acute and staged total hip arthroplasty as well as outcomes after arthroplasty for fracture management are addressed.
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Affiliation(s)
- Kathryn D Dwight
- Department of Orthopaedics, University of California at San Diego, San Diego, CA, USA
| | - Michael Maceroli
- Department of Orthopaedics, Orthopaedic Trauma, Emory University, Atlanta, GA, USA.
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Sen RK, Trikha V, Meena U, Perumal R, Tripathy SK, Mahesh M, Vashisht S, Khan S. Acetabular fracture in India: An epidemiological study. J Clin Orthop Trauma 2024; 56:102540. [PMID: 39328296 PMCID: PMC11422141 DOI: 10.1016/j.jcot.2024.102540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Revised: 08/31/2024] [Accepted: 09/12/2024] [Indexed: 09/28/2024] Open
Abstract
INTRODUCTION Acetabular fractures, resulting from high-energy trauma, present significant orthopaedic challenges. Despite their rarity, the incidence of these fractures is rising, necessitating a comprehensive understanding of their epidemiological characteristics, especially in diverse populations like India. METHODS This retrospective study analyzed data from 3643 patients across four level-1 trauma centers in India (North 1, North 2, West, and South) from January 2001 to December 2019. Prior ethical approval was obtained from the respective institutions. Data were collected using the computerized patient record system (CPRS) and included patients with complete clinical and radiological records. Only patients with full radiological data were included, comprising standard anteroposterior radiograph, Judet views on radiographs, and computed tomography scan of the pelvis. The study evaluated the demographic characteristics, fracture patterns and surgical approaches. RESULTS The majority of patients were males (84.05 %) and the fractures were mostly seen in young individuals between 19 and 40 years' age group (44.9 %), followed by 41-60 years (42.3 %). Associated bony or other system injuries were seen in 53.42 % of patients, with pelvic injuries being the most common (9.8 %). Posterior wall fractures were the most frequent (20.7 %), while anterior wall fractures were the least common (0.8 %). Operative management was employed in 82 % of cases, with the Kocher-Langenbeck approach being the most commonly employed (42.5 %). CONCLUSION High-velocity trauma remains the commonest cause of acetabular trauma in India, primarily affecting young male individuals. Pelvic fractures are the most commonly associated injuries. Posterior wall fractures are the commonest type of acetabular fracture, and the Kocher-Langenbeck approach is the commonly adopted surgical approach.
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Affiliation(s)
| | | | | | | | - Sujit Kumar Tripathy
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, India
| | - M. Mahesh
- Department of Orthopaedics Max Hospital, Mohali, India
| | | | - Shahnawaz Khan
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, India
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Tosounidis T, Chalidis B. Management of geriatric acetabular fractures: Contemporary treatment strategies. World J Clin Cases 2024; 12:2151-2156. [PMID: 38808354 PMCID: PMC11129118 DOI: 10.12998/wjcc.v12.i13.2151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/15/2024] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
Acetabular fractures in the geriatric population are typically low-energy fractures resulting from a fall from standing height. Compromised bone quality in the elderly, as well as this population's concomitant medical comorbidities, render the management of such fractures challenging and controversial. Non-operative management remains the mainstay of treatment, although such a choice is associated with numerous and serious complications related to both the hip joint as well as the general condition of the patient. On the other hand, operatively treating acetabular fractures (e.g., with osteosynthesis or total hip arthroplasty) is gaining popularity. Osteosynthesis can be performed with open reduction and internal fixation or with minimally invasive techniques. Total hip arthroplasty could be performed either in the acute phase combined with osteosynthesis or as a delayed procedure after a period of non-operative management or after failed osteosynthesis of the acetabulum. Regardless of the implemented treatment, orthogeriatric co-management is considered extremely crucial, and it is currently one of the pillars of a successful outcome after an acetabular fracture.
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Affiliation(s)
- Theodoros Tosounidis
- Academic Department of Orthopaedic Surgery, Heraklion University Hospital, University of Crete, Greece, Heraklion 71500, Greece
| | - Byron Chalidis
- 1st Department of Orthopaedic, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
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Carrothers A, O'Leary R, Hull P, Chou D, Alsousou J, Queally J, Bond SJ, Costa ML. Acetabular Fractures in older patients Intervention Trial (AceFIT): a feasibility triple-arm randomized controlled study. Bone Joint J 2024; 106-B:401-411. [PMID: 38555939 DOI: 10.1302/0301-620x.106b4.bjj-2023-1080.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Aims To assess the feasibility of a randomized controlled trial (RCT) that compares three treatments for acetabular fractures in older patients: surgical fixation, surgical fixation and hip arthroplasty (fix-and-replace), and non-surgical treatment. Methods Patients were recruited from seven UK NHS centres and randomized to a three-arm pilot trial if aged older than 60 years and had a displaced acetabular fracture. Feasibility outcomes included patients' willingness to participate, clinicians' capability to recruit, and dropout rates. The primary clinical outcome measure was the EuroQol five-dimension questionnaire (EQ-5D) at six months. Secondary outcomes were Oxford Hip Score, Disability Rating Index, blood loss, and radiological and mobility assessments. Results Between December 2017 and December 2019, 60 patients were recruited (median age 77.4 years, range 63.3 to 88.5) (39/21 M/F ratio). At final nine-month follow-up, 4/60 (7%) had withdrawn, 4/60 (7%) had died, and one had been lost to follow-up; a 98% response rate (50/51) was achieved for the EQ-5D questionnaire. Four deaths were recorded during the three-year trial period: three in the non-surgical treatment group and one in the fix-and-replace group. Conclusion This study has shown a full-scale RCT to be feasible, but will need international recruitment. The Acetabular Fractures in older patients Intervention Trial (AceFIT) has informed the design of a multinational RCT sample size of 1,474 or 1,974 patients for a minimal clinically important difference of 0.06 on EQ-5D, with a power of 0.8 or 0.9, and loss to follow-up of 20%. This observed patient cohort comprises a medically complex group requiring multidisciplinary care; surgeon, anaesthetist, and ortho-geriatrician input is needed to optimize recovery and rehabilitation.
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Affiliation(s)
| | | | - Peter Hull
- Orthopaedic Trauma Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Daud Chou
- Orthopaedic Trauma Unit, Addenbrookes Hospital, Cambridge, UK
| | - Joseph Alsousou
- Manchester Royal Infirmary, Manchester, UK
- Musculoskeletal Group, University of Liverpool, Liverpool, UK
| | | | - Simon J Bond
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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