The aim of the present study is to aid the orthopaedic surgeon in the treatment decision making for fragility acetabular fractures through a comprehensive literature review, focusing on the technical tips that may aid to improve patient’s outcomes.įFA presents some differences from acetabular fractures observed in the young. Moreover, regardless of the treatment choice, final outcomes are mostly poor both in terms of function and mortality (Table (Table1). Particularly, indications for non-operative versus operative treatment, the reliability of surgical fixation in an osteoporotic bone and the safety of complex joint reconstructive procedures (i.e., revision arthroplasties) are some of the unmet needs. The management of FAA is still a matter of debate. The resulting anteromedial force commonly leads to a fracture of the anterior column and/or the quadrilateral plate with a medialization of the femoral head and a supero-medial roof impaction. As a definition, FFA are due to a fall from a standing height, with a subsequent impact on the greater trochanter. Particularly, a 2.4-fold increase in the incidence of acetabular fractures in patients over 60 years of age during the last 3 decades was observed, making this population one of the most commonly affected (about 24% of all acetabular fractures). Recently, a constant increase of fragility fractures of the acetabulum (FFA) has been observed. The constant increase in life expectancy led to a growing incidence of fragility fractures. However, the outcomes of each of the proposed treatment are mostly poor and controverted therefore, a comprehensive patient evaluation and an accurate fracture description are required to appropriately manage acetabular fracture in the elderly. This latter could be extremely difficult, because of poor bone quality, acetabular mal union/non-union, bone gaps and hardware retention. Frequently ORIF, percutaneous fixation, and non-operative treatment need a subsequent re-operation through a THA. However, at longer follow-up, this difference dreadfully change is becoming the opposite. The treatment with the higher early mortality is the ORIF + THA, while the one with the lowest is the non-operative. The proposed surgical techniques for FFA are associated with a high complication rate. Both non-operative and several operative treatment protocols are available, and the choice among them is still ambiguous. The management of FFA is extremely difficult considering both patients’ comorbidities and poor bone quality. Generally, these fractures are related to a fall on the greater trochanter involving the anterior column. The incidence of fragility fractures of the acetabulum (FFA) is constantly increasing.
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