Percutaneous Treatment of Acetabular Fractures in Older Patients

Acetabular fracture in older patients presents many challenges to even experienced pelvic surgeons. There remains a lack of clarity regarding many indications for nonoperative or operative management. Chronological age should not be considered in isolation when deciding upon a treatment plan; rather, the surgeon must individualize the plan to the patient’s activity level, physiological age, and risks for blood loss and general anesthesia. When an operative path is chosen, closed or limited open reduction techniques paired with percutaneous screw stabilization are an option for fracture patterns not associated with posterior instability of the hip joint. The goals of treatment should be restoration of the normal relationship of the cranial femoral head with the dome of the acetabulum and to provide fixation that is stable to allow for early mobilization. Fixation with screws alone provides less resistance to loss of reduction than do plates, but allows for implant placement without large open approaches. A secondary benefit of fixation with percutaneous screw is the ability to remove them at a later date with percutaneous incisions rather than open approaches. Common screw pathways used are familiar to pelvic surgeons and include anterior and posterior column screw and the LC-2 (pelvic brim) screw, but screw placement is only performed after an appropriate reduction has been achieved.