ORIF linked to higher reoperation risk than acute THA/CHP in older patients with acetabular fractures
Photo by Towfiqu barbhuiya / Unsplash
Key Takeaway
Consider acute THA/CHP over ORIF in older patients with acetabular fractures to reduce reoperation risk, but watch for dislocation.
This systematic review and meta-analysis compared outcomes of open reduction internal fixation (ORIF) versus acute total hip arthroplasty or hemiarthroplasty (THA/CHP) in 949 patients aged 60 years and older with acetabular fractures. The primary outcome was not reported; secondary outcomes included reoperation, post traumatic osteoarthritis, dislocation, and Harris Hip Scores.
Reoperation was significantly more common after ORIF (RR 2.60; 95% CI 1.42 to 4.75; P = 0.002). Post traumatic osteoarthritis occurred in 34% of ORIF patients. Dislocation occurred in 8% of THA/CHP patients. Harris Hip Scores were higher in the arthroplasty group (mean difference -6.11; 95% CI -9.90 to -2.31; P = 0.002). Notably, ORIF patients were younger (mean difference -4.14 years; P < 0.01) and had lower American Society of Anesthesiologists scores (P = 0.02), suggesting potential selection bias.
The authors did not report specific limitations, but the observational nature of included studies and baseline differences between groups limit causal inference. For older patients with acetabular fractures, acute arthroplasty may reduce reoperation risk and improve functional outcomes, though dislocation risk is higher. Individualized surgical decision-making remains essential.
View Original Abstract ↓
BACKGROUND: Acetabular fractures in the elderly are increasingly common and associated with high morbidity and mortality. Although open reduction and internal fixation (ORIF) has been the mainstay of treatment, elderly outcomes have been less consistent. Acute total hip arthroplasty (THA), with or without fixation (combined hip procedure, CHP), is an alternative approach that may facilitate earlier mobilization and reduce early reoperation. This systematic review and meta-analysis compared outcomes of ORIF versus acute THA/CHP for acetabular fractures in patients aged 60 years and older.
METHODS: A systematic review was performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Databases were searched from 2000 to the present. Comparative studies reporting outcomes for ORIF and THA/CHP in patients aged ≥ 60 years were included. Reviewers independently screened and extracted data on demographics, interventions, complications, functional outcomes, and patient-reported outcome measures. Pooled incidence rates, risk ratios (RRs), and mean differences (MDs) were calculated using random-effects models. There were 13 studies and 949 patients (ORIF: 620; THA/CHP: 329) included. The pooled mean age was 74 years (range, 60 to 93). The ORIF patients were younger (MD: -4.14 years; P < 0.01) and had lower American Society of Anesthesiologists scores (P = 0.02).
RESULTS: Reoperation was more common after ORIF (RR: 2.60; 95% confidence interval [CI]: 1.42 to 4.75; P = 0.002), with 84% of conversions due to posttraumatic osteoarthritis. The median time to conversion THA was 14.7 months. The post traumatic osteoarthritis incidence was 34% following ORIF; dislocation occurred in 8% of THA/CHP patients. Harris Hip Scores at one to 2 years postoperatively were higher in the arthroplasty group (MD -6.11; 95% CI: -9.90 to -2.31; P = 0.002).
CONCLUSIONS: Acute THA/CHP may offer a viable treatment option in the elderly, demonstrating lower reoperation rates and improved function compared to ORIF.
VBQ and Hounsfield Units Predict Subsequent Fractures After Vertebral Augmentation
Vertebral Bone Quality Scores Predict Fracture Risk After Vertebral Augmentation
Related in Orthopedics & Sports Medicine
Early functional treatment increases wound complication risk 14% versus cast immobilization in ankle fracture patients
Early functional treatment for ankle fractures carries higher wound risk than casting
This systematic review and meta-analysis evaluated early functional treatment versus cast immobilization for skeletally mature patients with…
A meta-analysis found early functional treatment after ankle fractures increases the risk of wound complications compared to cast immobiliza…
Intercostal nerve cryoablation reduces opioid use and ICU stay compared to surgical stabilization alone in rib fracture patients
Freezing rib nerves may lower pain medicine needs and shorten hospital stays for broken ribs
This systematic review and meta-analysis evaluated intercostal nerve cryoablation versus surgical stabilization alone in adult patients with…
A new analysis suggests freezing rib nerves could reduce pain medicine use and shorten hospital time for adults with broken ribs, though mor…
Discogenic Low Back Pain Management Shifts Toward Mechanism Informed Precision Care Strategies
Discogenic Low Back Pain May Need Precision Care Instead of Generalized Algorithms
Current management of discogenic low back pain requires a shift from generalized algorithms to mechanism-informed precision care. Integratin…
A narrative review suggests moving from generalized algorithms toward mechanism-informed precision care for discogenic low back pain patient…
Tubeless thoracic surgery may reduce pain and hospital stay in pulmonary nodule resection, though long-term safety remains unconfirmed
Tubeless lung surgery may reduce pain and hospital stays for some patients
This narrative synthesis reviews 59 articles on tubeless thoracic surgery for patients with pulmonary nodules. The authors note reductions i…
A review of 59 articles suggests tubeless lung surgery might lower pain and hospital stays, though long-term safety needs more proof.
From Other Specialties
Initial intraosseous access shows no survival benefit over intravenous access in out-of-hospital cardiac arrest
New trial shows bone and vein access methods give similar survival rates for heart stop patients
This randomized clinical trial enrolled 1479 adults with non-traumatic out-of-hospital cardiac arrest to compare initial intraosseous vascul…
Doctors compared putting medicine in a bone versus a vein for adults whose hearts stopped outside a hospital. The study found no important d…
Neurostimulation therapies improve swallowing function in acutely ill patients with a standardized mean difference of -0.74
Neurostimulation Therapies Improve Swallowing in Critically Ill Patients
This systematic review and network meta-analysis evaluated neurostimulation therapies for dysphagia in 2198 acutely and critically ill patie…
A review of 20 studies found that neurostimulation therapies can significantly improve swallowing function in critically ill patients with d…
Interleukin-7 therapy improves lymphocyte counts in sepsis and COVID-19 patients
Recombinant human interleukin-7 boosts white blood cells but does not save lives in sepsis or COVID-19
A meta-analysis shows recombinant IL-7 boosts lymphocytes in sepsis and COVID-19, but only reduces secondary infections in COVID-19.
A new analysis shows this drug raises low white blood cell counts in sepsis and COVID-19 but does not lower death risk or improve survival.
Irinotecan plus cisplatin shows no RFS benefit over etoposide plus cisplatin in resected lung HGNEC
Five-year follow-up shows irinotecan plus cisplatin matches etoposide plus cisplatin for lung cancer survival
This randomized, open-label, phase III study compared irinotecan plus cisplatin to etoposide plus cisplatin in 221 patients with resected hi…
A five-year look at lung cancer patients found that irinotecan plus cisplatin worked just as well as etoposide plus cisplatin for keeping th…