Operative treatment modalities and outcomes following acetabular fractures in the elderly: A scoping review with remarks on clinical and translational anatomy

Background Geriatric acetabular fractures represent an increasingly prevalent and clinically challenging entity. The optimal operative treatment strategy in this fragile population remains a subject of ongoing debate, with multiple modalities available including open reduction and internal fixation (ORIF), acute total hip arthroplasty (THA) combined with fixation (fix-and-replace), and minimally invasive percutaneous osteosynthesis. The primary goal of treatment is to enable early or immediate full weight bearing to reduce the complications of prolonged immobilisation. Objectives This scoping review aims to map the current evidence on operative treatment modalities and outcomes following acetabular fractures in elderly patients, with particular emphasis on identifying the optimal strategy according to fracture pattern and construct stability sufficient to permit early weight bearing. Methods A systematic search of electronic databases (PubMed/MEDLINE, Embase, Cochrane Library, Web of Science) was conducted following the PRISMA-ScR framework. Studies reporting operative treatment and outcomes for acetabular fractures in patients aged 60 years or older were included. Data were extracted on treatment modality, fracture classification, functional outcomes, complication rates, mortality, and conversion to THA. Results The literature demonstrates a significant increase in the incidence of geriatric acetabular fractures over the past decades. ORIF alone carries high rates of hardware failure and subsequent conversion to THA. Acute combined fixation with THA (fix-and-replace) shows promising outcomes in terms of early mobilisation and lower revision rates. Minimally invasive percutaneous techniques offer short-term benefits including reduced blood loss and infection risk, but conversion rates to THA in the long term remain comparable or higher than after ORIF. Fracture pattern — particularly dome impaction and medial wall comminution — critically determines the optimal treatment strategy. Conclusion No single operative modality is universally superior for geriatric acetabular fractures. Patient frailty, fracture pattern, bone quality, and the primary goal of early weight bearing must guide individualized treatment decisions. Acute fix-and-replace appears most promising for complex fractures with poor bone stock, while percutaneous stabilization may be reserved for simple patterns in high-risk patients. Prospective comparative studies are urgently needed.