Comparison of open reduction and internal fixation and primary
total hip replacement for osteoporotic acetabular fractures:
a retrospective clinical study
Sebastian P. Boelch
Martin C. Jordan
Rainer H. Meffert
Received: 6 December 2015 /Accepted: 25 July 2016 /Published online: 10 August 2016
SICOT aisbl 2016
Purpose Treating acetabular fractures with open reduction
and internal fixation (ORIF) may lead to poorer outcomes in
older patients. As data for osteoporotic acetabular fractures are
limited, we compared primary total hip replacement (THR)
with ORIF for treating osteoporotic acetabular fractures, in-
cluding those with posterior column instability.
Methods All patients with osteoporotic acetabular fractures,
treated with ORIF or primary THR from 2005 to 2015, were
assessed retrospectively for clinical and radiologic outcomes.
Indication criteria for selecting primary THR were evaluated.
Results Twenty-three patients were treated with ORIF and nine
with primary THR (performed with an anti-protrusion cage). If
the posterior column was unstable, THR was combined with
posterior column bridge plating. Indications for THR were the
presence of a comminuted fracture pattern, approach-related
risk factors for ORIF, and mobilization issues. Biomechanical
reconstruction was acceptable with THR. Acetabular compo-
nent loosening was observed only once. Secondary THR was
indicated in 45 % of the ORIF cases.
Discussion ORIF for acetabular fracture in older patients is
unsatisfactory and may be even worse for osteoporotic frac-
tures. Immobilization for long-term restricted weight bearing
after ORIF is hazardous. Primary THR may enable early post-
operative full weight-bearing. Various techniques, affording
fixation of the unstable acetabular columns, are described. In
THR with an anti-protrusion cage, only dorsal column insta-
bility needs to be addressed.
Conclusion The described technique achieved sufficient ace-
tabular component stability. Primary THR with an anti-
protrusion cage is an advantageous option to ORIF and should
be strongly considered for osteoporotic acetabular fractures.
Keywords Total hip replacement/arthroplasty
reduction and internal fixation
Fractures of the acetabulum were prevalent two and a half
decades ago, particularly in the age group 21–30 years as a
consequence of high-energy trauma, such as car accidents.
Today, however, the older population is increasingly affected
. Acetabular fracture in the elderly originates not only from
high-energy trauma but also low-energy trauma. Low-energy
trauma is not consistently defined, but trauma resulting from a
fall from body height or a chair is commonly considered low-
energy trauma. If there is no other evidence for the presence of
increased bone fragility, osteoporosis must be assumed to be
the causal factor for fractures due to low-energy trauma [2, 3].
Osteoporosis, a diseases of the whole skeleton, leads to re-
duced bone mass and impaired micro-architecture with in-
creased fragility. Because of the aging process, older patients
with osteoporotic acetabular fractures are becoming increas-
ingly more prevalent.
Acetabular fractures in younger patients are treated with
open reduction and internal fixation (ORIF) [4–8]. For
* Sebastian P. Boelch
Department of Orthopaedic Surgery, University of Würzburg,
König-Ludwig-Haus, 11 Brettreichstrasse,
97074 Würzburg, Germany
Department of Trauma, Hand, Plastic and Reconstructive Surgery,
Würzburg University Hospital, Julius-Maximilians University
Würzburg, 6 Oberdürrbacher Strasse, 97080 Würzburg, Germany
International Orthopaedics (SICOT) (2017) 41:1831–1837