Acetabular Fractures in an Advanced Age - Current Knowledge and Treatment Options

CURRENT CONCEPTS REVIEW SOUBORNÝ REFERÁTthe dislocation of the quadrilateral surface.This mechanism leads to further damage to the articular surface of the hip joint (22,38) and to a superomedial roof impaction that is represented by the so-called gull sign commonly seen on plain pelvic radiographs (Figure 1a) (5).A complicating factor is the constantly seen comminution of the fracture zone in this age group (32).Gary et al. postulated in their study, that many patients who meet operative criteria can be mobilized without surgery and may achieve similar results compared to surgical treatments (11).However, anatomic reduction resulting in articular displacement of less than 2 mm prevents the early onset of posttraumatic osteoarthritis (OA) of the hip and is the main predictor for a good clinical outcome, known from the pioneering work of Matta and Judet (17,30,31).Thus, gold standard is the open reduction followed by a stable fixation in younger patients in an attempt to minimize a secondary need for arthroplasty (11).Up to now, there is no sufficient evidence that elderly patients should be treated under the same criteria than the above mentioned.A 60-yearold active male merits different treatment considerations than a 90-year-old male with a comparable injury (11).As mentioned, decision making process in the treatment of acetabular fractures is fairly more complex for geriatric patients and must be adapted to individual circumstances.Therefore, this review aimed to summarize the current knowledge in the management of acetabular fractures of geriatric patients regarding the conservative or specific surgical treatment options and their clinical outcome. Diagnostic Workup and ClassificationThe basic radiographic evaluation is the anteroposterior pelvic film.However, some authors still recommend the obturator and iliac oblique Judet view (5).In our centre,