Abstract
Aims
To describe the epidemiology of acetabular fractures including patient characteristics, injury mechanisms, fracture patterns, treatment, and mortality.
Methods
We retrieved information from the Swedish Fracture Register (SFR) on all patients with acetabular fractures, of the native hip joint in the adult skeleton, sustained between 2014 and 2020. Study variables included patient age, sex, injury date, injury mechanism, fracture classification, treatment, and mortality.
Results
In total, 2,132 patients with acetabular fractures from the SFR were included in the study. The majority of the patients were male (62%) and aged over 70 years old (62%). For patients aged > 70 years, the 30-day mortality was 8% and one-year mortality 24%. For patients aged ≤ 70 years, the 30-day mortality was 0.2% and one-year mortality 2%. Low-energy injuries (63%) and anterior wall fractures (20%) were most common. Treatment was most often non-surgical (75%).
Conclusion
The majority of patients who sustain an acetabular fracture are elderly (> 70 years), of male sex, and the fracture most commonly occurs after a simple, low-energy fall. Non-surgical treatment is chosen in the majority of acetabular fracture patients. The one-year mortality for elderly patients with acetabular fracture is similar to the mortality after hip fracture, and a similar multidisciplinary approach to care for these patients should be considered.
Cite this article: Bone Jt Open 2023;4(9):652–658.
Take home message
Elderly patients who sustain an acetabular fracture have similar one-year mortality as hip fracture patients.
The majority of acetabular fracture patients are male and aged over 70 years.
Introduction
Fractures of the acetabulum, especially in the elderly population, are an increasing orthopaedic concern.1-4 Larger epidemiological studies are scarce, and available studies have mainly focused on surgically treated patients who sustain acetabular fractures after high-energy trauma mechanisms.4-8 However, in recent years, some epidemiological studies have included non-surgically treated patients.1,3,9,10 In our experience, most acetabular fracture patients are elderly patients sustaining low-energy fractures that are treated non-surgically. The literature describing this large group of patients is still rather limited. However, the Swedish Fracture Register (SFR) enables us to conduct a nationwide study of all patients sustaining acetabular fractures regardless of fracture pattern and treatment.11-13 The current study aimed to provide further information on patients who sustain an acetabular fracture, how the different fracture patterns are distributed, and what treatment the patients receive, and describe the mortality after an acetabular fracture.
Methods
Study design and setting
Information on all acetabular fractures (ICD-10 S32.4) reported to the SFR between 01 January 2014 and 23 October 2020 occurring in patients over the age of 16 years, with closed growth plates and a preserved native hip joint, were collected from the register. Patients with bilateral injuries (n = 18) and patients sustaining a contralateral injury at a later occasion during the study period (n = 3) were excluded. The SFR includes all types of fractures in all patient groups. Registrations and fracture classifications are done by the treating orthopaedic surgeon. Data on mortality are transferred daily to the SFR from the Swedish Tax Agency. During the study period, the SFR went from 50% coverage in 2014 to 100% coverage in 2020, meaning that all orthopaedic departments treating acute fractures in Sweden are now affiliated with the SFR and register fractures on a daily basis.12
The following variables were retrieved from the SFR: age at time of injury, sex, injury date, injury mechanism including energy level, fracture classification, treatment, and mortality. Injury mechanisms were divided into six categories as defined by Bergdahl et al14 and Wennergren et al:15 simple fall, fall from height, unspecified fall, traffic-/transportation-related trauma, miscellaneous injuries, and non-traumatic injuries. Energy level is, in the SFR, defined by the treating orthopaedic surgeon as low or high. Acetabular fractures are classified according to the AO/OTA classification, which is based on the Judet and Letournel classification.5,16,17 Treatment is registered as non-surgical and surgical. Surgical treatment was further divided into osteosynthesis, primary arthroplasty, or a combination thereof.
A total of 2,132 patients with acetabular fractures were included in the study. In the mortality analyses, one patient was excluded because of obvious false data (negative survival time value). A majority of the fractures occurred in males (n = 1,327; 62%). Basic demographic information for the study population are shown in Table I. The median age for the entire cohort was 76 years(interquartile range (IQR) 62 to 86), and for male and female patients 73 and 82 years, respectively. A majority of the patients (n = 1,319; 62%) were over 70 years of age. Age and sex distribution is shown in Figure 1.
Fig. 1
Distribution of age, sex, and injury mechanism in 2,132 patients.
Table I.
Demographic characteristics of the study population (n = 2,132).
| Variable | Value |
|---|---|
| Sex, n (%) | |
| Male | 1,327 (62) |
| Female | 805 (38) |
| Age, n (%) | |
| ≤ 70 yrs | 813 (38) |
| > 70 yrs | 1,319 (62) |
| Median age, yrs (IQR) | |
| All | 76 (62 to 86) |
| Male | 73 (59 to 83) |
| Female | 82 (68.5 to 89.0) |
| Side, n (%) | |
| Left | 1,168 (55) |
| Right | 964 (45) |
| Type of energy, n (%) | |
| High-energy | 456 (21) |
| Male | 367 (80) |
| Female | 89 (20) |
| Low-energy | 1,347 (63) |
| Male | 770 (57) |
| Female | 577 (43) |
| Unknown | 289 (14) |
| Not applicable | 40 (2) |
-
IQR, interquartile range.
Statistical analysis
Nominal variables are presented as numbers, proportions of all registered acetabular fractures in the SFR and median (range), excluding any missing values. Statistical analyses were conducted using SPSS Statistics v. 25 (IBM, USA).
Results
Mortality
The 30-day mortality was 8% in patients aged > 70 years and 0.2% in patients aged ≤ 70 years. The one-year mortality was 24% and 2% for the respective groups. Male patients aged > 70 years had a 30-day mortality of 10% and female patients aged > 70 years had a 30-day mortality of 5% (Table II).
Table II.
30-day and one-year mortality in patients aged ≤ 70 and > 70 years in total and by sex of patients in each group (total n = 2,131). One patient was excluded because of obvious false data (negative survival value).
| Age group, yrs | 30 days, n (%) | One year, n (%) |
|---|---|---|
| ≤ 70 (n = 813) | 2 (0.2) | 17 (2) |
| > 70 (n = 1,318) | 100 (8) | 317 (24) |
| Male ≤ 70 (n = 596) | 2 (0.3) | 11 (2) |
| Male > 70 (n = 730) | 70 (10) | 184 (25) |
| Female ≤ 70 (n = 217) | 0 (0) | 6 (3) |
| Female > 70 (n = 588) | 30 (5) | 133 (23) |
Injury mechanisms
The most common injury mechanisms were a simple fall (56%, n = 1,186), transport accidents (18%, n = 377), and fall from a height (12%, n = 251). Male patients were more frequently injured due to transport accidents or fall from a height compared to female patients (Table III). Simple and unspecified falls accounted for 74% (n = 592) of the injuries in females, compared to 55% (n = 735) in males.
Table III.
Injury mechanism in 2,132 patients.
| Mechanism of injury | Patients, n (%) | Male, n (%) | Female, n (%) |
|---|---|---|---|
| Simple fall | 1,186 (56) | 665 (50) | 521 (65) |
| Fall from height | 251 (12) | 208 (16) | 43 (5) |
| Unspecified fall | 141 (7) | 70 (5) | 71 (9) |
| Transport accident | 377 (18) | 281 (21) | 96 (12) |
| Miscellaneous* | 53 (3) | 36 (3) | 17 (2) |
| Non-traumatic | 40 (2) | 17 (1) | 23 (3) |
| Unknown | 84 (4) | 50 (4) | 34 (4) |
-
*
Includes self-inflicted injuries, abuse, and unspecified accidents.
Overall, 63% (n = 1,347) of the injuries were classified as low-energy and 21% (n = 456) as high-energy trauma (Table I). In patients ≤ 70 years old, 47% (n = 381) of fractures were caused by high-energy trauma compared to 6% (n = 75) in patients > 70 years. High-energy trauma was more common among male patients and in the younger patient groups (Table I and Figure 1).
Fracture classification
The most common fracture type was the anterior wall fracture (20%, n = 437) followed by the posterior wall fracture (14%, n = 292). Anterior column, pure transverse, posterior column, associated both columns, and T-shaped fractures each occurred in 7% to 9% (n = 154 to 191) of the cases. Associated anterior and posterior hemitransverse, associated posterior column and posterior wall, and associated transverse and posterior wall fractures were less common, each accounting for 4% to 6% (n = 92 to 125) of the fractures. In 205 of the 2,132 fractures (10%), the registrant was unable to classify the fracture (Figure 2).
Fig. 2
Distribution of fracture classifications and injury mechanism in 2,132 patients.
Among high-energy injuries, posterior wall fractures were most common (24%, n = 108) compared to anterior wall fractures in the low-energy injuries (23%, n = 309) (Figure 2).
Treatment
Of 1,995 fractures 75% (n = 1,505) were initially treated non-surgically. In less than 1% of these cases (n = 13), the treatment strategy changed early on to surgical treatment. In surgically treated patients (n = 503), open reduction and internal fixation (ORIF) was performed in 73% (n = 369) of the cases, and ORIF in combination with primary arthroplasty (combined hip procedure (CHP)) in 15% (n = 77) of the cases; 7% (n = 36) of the patients received a primary hip arthroplasty without supplemental fixation (Figure 3).
Fig. 3
Flowchart of primary treatment in 1,995 fractures with registered treatment. ORIF, open reduction and internal fixation.
The rate of primary surgical treatment was higher in patients aged ≤ 70 years (316/755; 42%) than in patients aged > 70 years (187/1,240; 15%).
The distribution of surgical and non-surgical treatment also differed between the fracture types. Associated anterior and posterior hemitransverse and associated both column fractures were most commonly treated surgically (60% and 53%, respectively). Anterior wall and posterior column fractures were most commonly treated non-surgically (7% and 8%, respectively) (Table IV).
Table IV.
Distribution of fracture types, and the proportion of primary surgical treatment for each fracture type, for 1,995 fractures with registered treatment information.
| Fracture type | Total fractures, n (%) | Early surgically treated fractures, n | Primary surgical treatment, % |
|---|---|---|---|
| Posterior wall | 271 (14) | 96 | 35 |
| Posterior column | 166 (8) | 14 | 8 |
| Associated posterior column and posterior wall | 111 (6) | 37 | 33 |
| Anterior wall | 418 (21) | 31 | 7 |
| Anterior column | 181 (9) | 60 | 33 |
| Pure transverse | 170 (9) | 23 | 14 |
| Associated transverse and posterior wall | 89 (4) | 37 | 42 |
| T-shaped | 138 (7) | 45 | 33 |
| Associated anterior and posterior hemitransverse | 117 (6) | 70 | 60 |
| Associated both column | 148 (7) | 78 | 53 |
| Unclassifiable | 186 (9) | 12 | 6 |
Discussion
One key finding of the current study was that the mortality after an acetabular fracture in the elderly population was comparable to the mortality after hip fracture. The present study also found that acetabular fractures in Sweden are more common among males and most often due to low-energy injury mechanisms. The distribution of fracture type differed between high- and low-energy injures. There are clear differences in primary treatment modality between different fracture types.
Consistent with previous studies, the current study shows a male predominance (62%) among patients sustaining acetabular fractures. The German Pelvic Registry reports that patients with acetabular fractures were male in 69% of the cases.9 Similar male/female ratios have also been shown by others.1,3,4,18 The reason for this is unclear. A decrease in proximal femur fractures due to enhanced osteoporotic treatment may instead have resulted in an increased load to the pelvis.10 However, such reasoning should result in an increased number of acetabular or pelvic fractures, mainly among the female population, as was the case in the study performed by Boufous et al.19 Part of the explanation for why acetabular fractures mainly occur in the male population may be due to the anatomical differences of the pelvis between the sexes. Wang et al20 described that the more stable hip joint during anteroposterior loading among females is less likely to fracture or dislocate. The reported differences in anteversion and inclination of the acetabulum may also influence the likelihood to fracture under force.21 Another explanation could be that injury mechanisms differs between the sexes, as shown in the current study: male patients are more often the subjects of high-energy trauma mechanisms resulting in an acetabular fracture.
The previously shown increasing incidence of acetabular fractures among the elderly population is also in accordance with our results where more than 60% were aged > 70 years.1-3,7,9
The injury mechanism is classified as high- or low-energy trauma by the individual orthopaedic surgeon in the SFR. It is up to the surgeon to decide what type of trauma the patient was exposed to, as there is no general definition of high- versus low-energy trauma in orthopaedics.
Despite a similar pre-injury function level, geriatric patients (≥ 60 years) with acetabular fractures have been reported to have a higher 30-day mortality risk compared to hip fracture patients in the same age group;22 Bergh et al23,24 reported similar mortality rates for both femoral and acetabular fractures among the elderly (> 80 years) in Sweden. The 30-day and one-year mortality in the elderly population in the current study is comparable to hip fracture patients.22-24
Many hospitals have developed a standardized and multidisciplinary way to improve care for hip fracture patients.25-28 Given the similar mortality rates, a similar multidisciplinary approach in geriatric patients who sustain acetabular fractures should be considered.
The current study also indicates that male patients aged > 70 years have a higher 30-day mortality than female patients. Male sex, adjusted for differences in comorbidities, has been associated with higher mortality, especially in the first weeks, following proximal femur fractures.29 This was found despite males being younger at the time of injury. The reasons for the high mortality among males with either a hip fracture or acetabular fracture are still to be explained, but the causality can probably be expected to be similar in these two patient groups.
An anterior wall fracture was the most common fracture type in the current study, especially in low-energy injuries. In patients with high-energy trauma, a posterior wall fracture was more common. Compared to the cases reported by Letournel5 and Matta,6 this indicates a change in fracture pattern. However, the cohort described by both authors mainly reported on surgically treated, younger patients, while the SFR includes patients of all ages regardless of treatment. Among high-energy injuries, the posterior wall fracture was most common (24%) in the SFR, which is comparable to the results from Letournel (24%). Yet, the fracture distribution in the current study differs from more recent studies where a lower proportion of anterior wall fractures are reported than in the current study.4,7,18,30,31 However, the frequency of posterior wall fractures is similar. Gary et al30 and Ferguson et al4 reported a higher degree of both column fractures than we found. Ferguson et al4 studied displaced acetabular fractures over a 27-year period, noting an increase in elderly patients and describing a difference in fracture class distribution between younger and older patients. The differences in fracture class distribution are probably, at least in part, related to a selection of surgically treated patients in these studies.
Ochs et al7 reported data where the distribution of fracture types was more similar to our study except for anterior wall fractures. However, the number of anterior wall fractures in the SFR needs to be interpreted with some caution. When validating the classification in the SFR, only one out of 11 fractures classified as an anterior wall fracture in the SFR was an actual anterior wall fracture according to the established gold standard in that study.13 According to Letournel et al’s32 description of the fracture classes, a combination of anterior wall and anterior column fractures should be classified as an anterior wall fracture. This may not be known to the inexperienced registrant. Therefore, perhaps the accurate number of anterior wall fractures ought to be higher than previously described. It can also be theorized that lateral fractures of the superior ramus with an insignificant fracture line through the anterior wall are registered as anterior wall fractures. Another part of the explanation might be that, in contrast to most previous studies, the current study includes both surgically and non-surgically treated fractures. Non-surgically treated fractures in the SFR account for 75% of acetabular fractures, and anterior wall fractures were shown to be the fracture type least operated on. Thus, anterior wall fractures may have been under-reported previously.
In the current study, 10% (n = 205) of the fractures are labelled as unclassifiable. The Letournel classification is difficult to fully understand, and it takes experience to classify these fractures correctly. Despite this, it has stood the test of time and its reproducibility has previously been studied.13,33 As the classification is complex, it is surprising to find that only 10% of the acetabular fractures in the SFR are deemed unclassifiable, and that the Kappa value describing the accuracy of classification in the SFR is still acceptable.13
Age, comorbidities, fracture pattern, and the level of energy causing the fracture are considered in the treatment decision and may favour non-surgical treatment to a greater extent in the elderly than in a younger population. This may explain the large proportion of non-surgical treatment in the > 70 years group in the current study. The Letournel classification does not consider the level of displacement in a fracture, and therefore it is a blunt instrument when it comes to indications for surgery.
As expected, associated anterior and posterior hemitransverse fractures, and the both-column fractures, most frequently underwent primary surgical treatment. More surprisingly, the posterior wall fractures were only operated on in 35% of the cases. In other studies, three out of four patients with a posterior wall fracture were treated surgically.7,30 This difference may be due to patient recruitment from level one trauma centres in these studies, in contrast to the current study where all Swedish hospitals, regardless of level, were included.
Most surgically treated fractures were treated with ORIF, which is the first choice of treatment for most displaced acetabular fractures.6,32 One in five surgically treated patients received an arthroplasty alone, or in combination with fixation. This technique is now the preferred option for many acetabular fractures in the elderly patients with osteopenic bone, marginal impaction, and a displaced quadrilateral plate where joint reconstruction is deemed impossible.34-39 Early reports have shown favourable results regarding joint survival compared to ORIF alone.40 The population in high-income countries is ageing, and consequently this group of patients with osteopenic fractures around the hip joint, where reconstruction is precarious, is increasing.1-4
The major strengths of this study are the large number of patients, of all ages and all treatments, and the national coverage of the SFR. The SFR coverage increased during the study period from 50% in 2014 to 100% in 2020.12 The inclusion of patients from all orthopaedic units provides information on the full spectrum of injuries, and not only those selected for surgery or collected only from larger trauma centres.
One limitation is the completeness of the SFR. Although the aim is to register all fractures in the SFR, it can be speculated that the ones missing are more often non-surgically treated fractures, seen only once at the emergency department and not subject to surgery or follow-up.
In summary, acetabular fractures in Sweden are most common in patients aged > 70 years, the majority of whom are male. The fracture pattern is dependent on energy level, anterior wall fractures being most common in low-energy injuries and posterior wall fractures in high-energy injuries. Three out of four patients with acetabular fractures are treated non-surgically. The one-year mortality for patients aged > 70 is similar to the mortality after a hip fracture.
References
1. Lundin N , Huttunen TT , Berg HE , Marcano A , Felländer-Tsai L , Enocson A . Increasing incidence of pelvic and acetabular fractures. A nationwide study of 87,308 fractures over a 16-year period in Sweden . Injury . 2021 ; 52 ( 6 ): 1410 – 1417 . Crossref PubMed Google Scholar
2. Rinne PP , Laitinen MK , Huttunen T , Kannus P , Mattila VM . The incidence and trauma mechanisms of acetabular fractures: A nationwide study in Finland between 1997 and 2014 . Injury . 2017 ; 48 ( 10 ): 2157 – 2161 . Crossref PubMed Google Scholar
3. Melhem E , Riouallon G , Habboubi K , Gabbas M , Jouffroy P . Epidemiology of pelvic and acetabular fractures in France . OTSR . 2020 ; 106 ( 5 ): 831 – 839 . Crossref PubMed Google Scholar
4. Ferguson TA , Patel R , Bhandari M , Matta JM . Fractures of the acetabulum in patients aged 60 years and older: an epidemiological and radiological study . J Bone Joint Surg Br . 2010 ; 92-B ( 2 ): 250 – 257 . Crossref PubMed Google Scholar
5. Letournel E . Acetabulum fractures: classification and management . Clin Orthop Relat Res . 1980 ; 151 : 81 – 106 . PubMed Crossref Google Scholar
6. Matta JM . Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury . J Bone Joint Surg Am . 1996 ; 78-A ( 11 ): 1632 – 1645 . PubMed Google Scholar
7. Ochs BG , Marintschev I , Hoyer H , et al. Changes in the treatment of acetabular fractures over 15 years: Analysis of 1266 cases treated by the German Pelvic Multicentre Study Group (DAO/DGU) . Injury . 2010 ; 41 ( 8 ): 839 – 851 . Crossref PubMed Google Scholar
8. Mears DC . Surgical treatment of acetabular fractures in elderly patients with osteoporotic bone . J Am Acad Orthop Surg . 1999 ; 7 ( 2 ): 128 – 141 . Crossref PubMed Google Scholar
9. Herath SC , Pott H , Rollmann MFR , et al. Geriatric acetabular surgery: Letournel’s contraindications then and now - data from the German Pelvic Registry . J Orthop Trauma . 2019 ; 33 Suppl 2 : S8 – S13 . Crossref PubMed Google Scholar
10. Herteleer M , Dejaeger M , Nijs S , Hoekstra H , Laurent MR . Epidemiology and secular trends of pelvic fractures in Belgium: A retrospective, population-based, nationwide observational study . Bone . 2021 ; 153 : 116141 . Crossref PubMed Google Scholar
11. Wennergren D , Möller M . Implementation of the Swedish Fracture Register . Unfallchirurg . 2018 ; 121 ( 12 ): 949 – 955 . Crossref PubMed Google Scholar
12. Möller M , Wolf O , Bergdahl C , et al. The Swedish Fracture Register - ten years of experience and 600,000 fractures collected in a National Quality Register . BMC Musculoskelet Disord . 2022 ; 23 ( 1 ): 141 . Crossref PubMed Google Scholar
13. Albrektsson M , Wolf O , Enocson A , Sundfeldt M . Validation of the classification of surgically treated acetabular fractures in the Swedish Fracture Register . Injury . 2022 ; 53 ( 6 ): 2145 – 2149 . Crossref PubMed Google Scholar
14. Bergdahl C , Ekholm C , Wennergren D , Nilsson F , Möller M . Epidemiology and patho-anatomical pattern of 2,011 humeral fractures: data from the Swedish Fracture Register . BMC Musculoskelet Disord . 2016 ; 17 : 159 . Crossref PubMed Google Scholar
15. Wennergren D , Bergdahl C , Ekelund J , Juto H , Sundfeldt M , Möller M . Epidemiology and incidence of tibia fractures in the Swedish Fracture Register . Injury . 2018 ; 49 ( 11 ): 2068 – 2074 . Crossref PubMed Google Scholar
16. No authors listed . Fracture and dislocation compendium. Orthopaedic Trauma Association Committee for Coding and Classification . J Orthop Trauma . 1996 ; 10 ( 1 ): v – ix . PubMed Google Scholar
17. Judet R , Judet J , Letournel E . Fractures of the acetabulum: Classification and surgical approaches for open reduction. Preliminary report . J Bone Joint Surg Am . 1964 ; 46-A : 1615 – 1646 . PubMed Google Scholar
18. Laird A , Keating JF . Acetabular fractures: a 16-year prospective epidemiological study . J Bone Joint Surg Br . 2005 ; 87-B ( 7 ): 969 – 973 . Crossref PubMed Google Scholar
19. Boufous S , Finch C , Lord S , Close J . The increasing burden of pelvic fractures in older people, New South Wales, Australia . Injury . 2005 ; 36 ( 11 ): 1323 – 1329 . Crossref PubMed Google Scholar
20. Wang SC , Brede C , Lange D , et al. Gender differences in hip anatomy: possible implications for injury tolerance in frontal collisions . Annu Proc Assoc Adv Automot Med . 2004 ; 48 : 287 – 301 . PubMed Google Scholar
21. Miyasaka D , Sakai Y , Ibuchi S , Suzuki H , Imai N , Endo N . Sex- and age-specific differences in femoral head coverage and acetabular morphology among healthy subjects-derivation of normal ranges and thresholds for abnormality . Skeletal Radiol . 2017 ; 46 ( 4 ): 523 – 531 . Crossref PubMed Google Scholar
22. Khoshbin A , Atrey A , Chaudhry H , et al. Mortality rate of geriatric acetabular fractures is high compared with hip fractures. A matched cohort study . J Orthop Trauma . 2020 ; 34 ( 8 ): 424 – 428 . Crossref PubMed Google Scholar
23. Bergh C , Möller M , Ekelund J , Brisby H . 30-day and 1-year mortality after skeletal fractures: a register study of 295,713 fractures at different locations . Acta Orthop . 2021 ; 92 ( 6 ): 739 – 745 . Crossref PubMed Google Scholar
24. Bergh C , Möller M , Ekelund J , Brisby H . Mortality after sustaining skeletal fractures in relation to age . J Clin Med . 2022 ; 11 ( 9 ): 2313 . Crossref PubMed Google Scholar
25. Kanis JA , Oden A , Johnell O , De Laet C , Jonsson B , Oglesby AK . The components of excess mortality after hip fracture . Bone . 2003 ; 32 ( 5 ): 468 – 473 . Crossref PubMed Google Scholar
26. Vestergaard P , Rejnmark L , Mosekilde L . Increased mortality in patients with a hip fracture-effect of pre-morbid conditions and post-fracture complications . Osteoporos Int . 2007 ; 18 ( 12 ): 1583 – 1593 . Crossref PubMed Google Scholar
27. Katsoulis M , Benetou V , Karapetyan T , et al. Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project . J Intern Med . 2017 ; 281 ( 3 ): 300 – 310 . Crossref PubMed Google Scholar
28. von Friesendorff M , McGuigan FE , Wizert A , et al. Hip fracture, mortality risk, and cause of death over two decades . Osteoporos Int . 2016 ; 27 ( 10 ): 2945 – 2953 . Crossref PubMed Google Scholar
29. Kannegaard PN , van der Mark S , Eiken P , Abrahamsen B . Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival . Age Ageing . 2010 ; 39 ( 2 ): 203 – 209 . Crossref PubMed Google Scholar
30. Gary JL , Paryavi E , Gibbons SD , et al. Effect of surgical treatment on mortality after acetabular fracture in the elderly: a multicenter study of 454 patients . J Orthop Trauma . 2015 ; 29 ( 4 ): 202 – 208 . Crossref PubMed Google Scholar
31. Hutt JRB , Ortega-Briones A , Daurka JS , Bircher MD , Rickman MS . The ongoing relevance of acetabular fracture classification . Bone Joint J . 2015 ; 97-B ( 8 ): 1139 – 1143 . Crossref PubMed Google Scholar
32. Letournel E , Judet R , Elson RA . Fractures of the Acetabulum . In : Fractures of the Acetabulum . 2nd ed . Berlin, Heidelberg : Springer-Verlag , 1993 . Crossref Google Scholar
33. Beaulé PE , Dorey FJ , Matta JM . Letournel classification for acetabular fractures. Assessment of interobserver and intraobserver reliability . J Bone Joint Surg Am . 2003 ; 85-A ( 9 ): 1704 – 1709 . PubMed Google Scholar
34. Weaver MJ , Smith RM , Lhowe DW , Vrahas MS . Does total hip arthroplasty reduce the risk of secondary surgery following the treatment of displaced acetabular fractures in the elderly compared to open reduction internal fixation? A pilot study . J Orthop Trauma . 2018 ; 32 ( 1 ): S40 – S45 . Crossref PubMed Google Scholar
35. Ortega-Briones A , Smith S , Rickman M . Acetabular fractures in the elderly: Midterm outcomes of column stabilisation and primary arthroplasty . Biomed Res Int . 2017 ; 2017 : 4651518 . Crossref PubMed Google Scholar
36. Herscovici D , Lindvall E , Bolhofner B , Scaduto JM . The combined hip procedure: open reduction internal fixation combined with total hip arthroplasty for the management of acetabular fractures in the elderly . J Orthop Trauma . 2010 ; 24 ( 5 ): 291 – 296 . Crossref PubMed Google Scholar
37. Boraiah S , Ragsdale M , Achor T , Zelicof S , Asprinio DE . Open reduction internal fixation and primary total hip arthroplasty of selected acetabular fractures . J Orthop Trauma . 2009 ; 23 ( 4 ): 243 – 248 . Crossref PubMed Google Scholar
38. Anglen JO , Burd TA , Hendricks KJ , Harrison P . The “Gull Sign”: a harbinger of failure for internal fixation of geriatric acetabular fractures . J Orthop Trauma . 2003 ; 17 ( 9 ): 625 – 634 . Crossref PubMed Google Scholar
39. Mears DC , Velyvis JH . Acute total hip arthroplasty for selected displaced acetabular fractures: two to twelve-year results . J Bone Joint Surg Am . 2002 ; 84-A ( 1 ): 1 – 9 . Crossref PubMed Google Scholar
40. Borg T , Hernefalk B , Hailer NP . Acute total hip arthroplasty combined with internal fixation for displaced acetabular fractures in the elderly: a short-term comparison with internal fixation alone after a minimum of two years . Bone Joint J . 2019 ; 101-B ( 4 ): 478 – 483 . Crossref PubMed Google Scholar
Author contributions
M. Albrektsson: Data curation, Formal analysis, Methodology, Visualization, Writing – original draft.
M. Möller: Conceptualization, Funding acquisition, Project administration, Methodology, Supervision, Writing – review & editing.
O. Wolf: Methodology, Supervision, Writing – review & editing.
D. Wennergren: Methodology, Supervision, Writing – review & editing.
M. Sundfeldt: Conceptualization, Methodology, Supervision, Writing – review & editing.
Funding statement
The authors received no financial or material support for the research, authorship, and/or publication of this article.
Data sharing
The datasets generated and analyzed in the current study are not publicly available due to data protection regulations. Access to data is limited to the researchers who have obtained permission for data processing. Further inquiries can be made to the corresponding author.
Acknowledgements
The authors thank Karin Svensson Malchau for language editing.
Ethical review statement
Ethical approval was obtained from the Swedish Ethical Review Authority (ID 2020-03775).
Open access funding
The open access fee for this study was funded by Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
© 2023 Author(s) et al. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/
