Over a five-year period, adult patients with marginal impaction of acetabular fractures were identified from a registry of patients who underwent acetabular reconstruction in two tertiary referral centres. Fractures were classified according to the system of Judet and Letournel. A topographic classification to describe the extent of articular impaction was used, dividing the joint surface into superior, middle and inferior thirds. Demographic information, hospitalisation and surgery-related complications, functional (EuroQol 5-D) and radiological outcome according to Matta’s criteria were recorded and analysed. In all, 60 patients (57 men, three women) with a mean age of 41 years (18 to 72) were available at a mean follow-up of 48 months (24 to 206). The quality of the reduction was ‘anatomical’ in 44 hips (73.3%) and ‘imperfect’ in 16 (26.7%). The originally achieved anatomical reduction was lost in12 patients (25.8%). Radiologically, 33 hips (55%) were graded as ‘excellent’, 11 (18.3%) as ‘good’, one (1.7%) as ‘fair’ and 15 (25%) as ‘poor’. A total of 11 further operations were required in 11 cases, of which six were total hip replacements.

Univariate linear regression analysis of the functional outcome showed that factors associated with worse pain were increasing age and an inferior location of the impaction. Elevation of the articular impaction leads to joint preservation with satisfactory overall medium-term functional results, but secondary collapse is likely to occur in some patients.

Cite this article: Bone Joint J 2013;95-B:230–8.

Different factors associated with an adverse functional outcome of acetabular fractures involving the posterior wall have been well documented. Among these is marginal impaction. From 1998 until mid-2006, 105 cases were prospectively reviewed to assess the functional and radiological results of simple and complex acetabular fractures associated with a posterior wall component, with special reference to the marginal impaction. Associated posterior wall components associated with marginal impaction were compared to the pattern of fractures without marginal impaction. The exclusion criteria were non-anatomic reductions i.e. > 2 mm displacement, avascular necrosis, deep infection, heterotropic ossification grade III, IV, chondrolysis and nerve injuries. All marginal impaction fractures were identified on the pre-operative CT scan. They were openly reduced, elevated and autografted from the greater trochanter, followed by rigid internal fixation for early post-operative mobilisation i.e. CPM use. Results were assessed clinically by the modified Merle d'Aubigné and Postel score and radiologically by Kellgren and Laurence method of grading of osteoarthritis. 40 cases were excluded for the reasons above. This left 27 cases of marginal impaction and 38 cases of control. The average period of follow-up was 35.7 months. The functional results of the marginal impaction grafting group revealed 13 (48.1%) excellent, 7 (25.9%) very good, 6 (22.2%) good and one (3.8%) fair, while the control group showed 18 (47.4%) excellent, 10 (26.3) very good, 8 (21%) good, one (2.6%) fair and one (2.6%) poor result. The functional and radiological outcome of the posterior wall component fractures associated with marginal impaction showed very satisfactory results in comparison with a control group in the short and mid-term period. An integral part of this is careful recognition of this injury pattern and its management as part of the open reduction and fixation

We have evaluated the functional, clinical and radiological outcome of patients with simple and complex acetabular fractures involving the posterior wall, and identified factors associated with an adverse outcome. We reviewed 128 patients treated operatively for a fracture involving the posterior wall of the acetabulum between 1982 and 1999. The Musculoskeletal Functional Assessment and Short-Form 36 scores, the presence of radiological arthritis and complications were assessed as a function of injury, treatment and clinical variables. The patients had profound functional deficits compared with the normal population. Anatomical reduction alone was not sufficient to restore function. The fracture pattern, marginal impaction and residual displacement of > 2 mm were associated with the development of arthritis, which related to poor function and the need for hip replacement. It may be appropriate to consider immediate total hip replacement for patients aged > 50 years with marginal impaction and comminution of the wall, since 7 of 13 (54%) of these required early hip replacement

Purpose. The purpose of this study is to compare radiographic outcomes of patients treated with dorsal spanning plates with previously reported normal values of radiographic distal radius anatomy and compare the results to prior publications for both external fixation and internal fixation with volar locked plates. Methods. Patients with complex distal radius fractures including dorsal marginal impaction pattern necessitating dorsal distraction plating at the discretion of the senior authors (MAT and MAI) from 5/30/2013 to 12/29/2015 were identified and included in the study. Retrospective chart and radiograph review was performed on nineteen patients, eleven male and eight female, with mean age of 47.83 years (22–82). No patients were excluded from the study. Results. All fractures united prior to plate removal. The average time the plate was in place was 80.5 days (49–129). Follow up radiographs showed average radial inclination of 20.5° (13.2°–25.5°), radial height of 10.7mm (7.5mm–14mm), ulnar variance of −0.3mm (−2.1mm–3.1mm), and volar tilt of 7.9° (−3°–15°). One patient had intra-articular step off >2mm. Conclusion. Dorsal distraction plating of complex distal radius fractures yields good radiographic results with minimal complications. In cases of complex distal radius fractures including dorsal marginal impaction where volar plating is not considered adequate, a dorsal distraction plate should be considered as an alternative to external fixation due to reduced risk for infection and better control of volar tilt. Type of Study/Level of Evidence. Therapeutic Retrospective Level IV

The April 2013 Trauma Roundup. 360 . looks at: ankle sprains; paediatric knee haemarthroses; evidence to support a belief; ‘Moonboot’ saves the day; pamphlets and outcomes; poor gait in pilons; lactate and surgical timing; and marginal results with marginal impaction

Aims. The aims of this study were to determine the cumulative ten-year survivorship of hips treated for acetabular fractures using surgical hip dislocation and to identify factors predictive of an unfavourable outcome. Patients and Methods. We followed up 60 consecutive patients (61 hips; mean age 36.3 years, standard deviation (. sd. ) 15) who underwent open reduction and internal fixation for a displaced fracture of the acetabulum (24 posterior wall, 18 transverse and posterior wall, ten transverse, and nine others) with a mean follow-up of 12.4 years (. sd. 3). . Results. Clinical grading was assessed using the modified Merle d’Aubigné score. Radiographic osteoarthritis was graded according to Matta. Kaplan-Meier survivorship and a univariate Cox-regression analysis were carried out using the following endpoints: total hip arthroplasty, a Merle d’Aubigné score of < 15 and/or progression of osteoarthritis. . Conclusion. The ten-year cumulative survivorship was 82% (95% confidence interval 71 to 92). Predictors for the defined endpoints were femoral chondral lesions, marginal impaction, duration of surgery, and age of patient. Cite this article: Bone Joint J 2017;99-B:508–15

Management of acetabular fractures in the elderly population remains somewhat controversial in regards to when to consider is open reduction internal fixation (ORIF) versus acute primary total hip. study aims to (1) describe outcome of this complex problem and investigate predictors of successful outcome. This retrospective study analyzes all acetabular fractures in patients over the age of 60, managed by ORIF at a tertiary trauma care centre between 2007 and 2018 with a minimum follow up of one year. Of the 117 patients reviewed, 85 patients undergoing ORIF for treatment of their acetabular fracture were included in the analysis. The remainder were excluded based management option including acute ORIF with THA (n=10), two-stage ORIF (n=2), external fixator only (n=1), acute THA (n=1), and conservative management (n=1). The remainder were excluded based on inaccessible medical records (n=6), mislabelled diagnosis (n=6), associated femoral injuries (n=4), acetabular fracture following hemiarthroplasty (n=1). The mean age of the cohort is 70±7 years old with 74% (n=62) of patients being male. Data collected included: demographics, mechanism of injury, Charlson Comorbidity Index (CCI), ASA Grade, smoking status and reoperations. Pre-Operative Radiographs were analyzed to determine the Judet and Letournel fracture pattern, presence of comminution and posterior wall marginal impaction. Postoperative radiographs were used to determine Matta Grade of Reduction. Outcome measures included morbidity-, mortality- rates, joint survival, radiographic evidence of osteoarthritis and patient reported outcome measures (PROMs) using the Oxford Hip Score (OHS) at follow-up. A poor outcome in ORIF was defined as one of the following: 1) conversion to THA or 2) the presence of radiographic OA, combined with an OHS less than 34 (findings consistent with a hip that would benefit from a hip replacement). The data was analyzed step-wise to create a regression model predictive of outcome following ORIF. Following ORIF, 31% (n=26) of the cohort had anatomic reduction, while 64% (n=54) had imperfect or poor reduction. 4 patients did not have adequate postoperative radiographs to assess the reduction. 31 of 84 patients undergoing ORIF had a complication of which 22.6% (n=19) required reoperation. The most common reason being conversion to THA (n=14), which occurred an average of 1.6±1.9 years post-ORIF. The remainder required reoperation for infection (n=5). Including those converted to THA, 43% (n=36) developed radiographic OA following acetabular fracture management. The mean OHS in patients undergoing ORIF was 36 ± 10; 13(16%) had an OHS less than 34. The results of the logistic regression demonstrate that Matta grade of reduction (p=0.017), to be predictive of a poor outcome in acetabular fracture management. With non-anatomic alignment following fixation, patients had a 3 times greater risk of a poor outcome. No other variables were found to be predictive of ORIF outcome. The ability to achieve anatomic reduction of fracture fragments as determined by the Matta grade, is predictive of the ability to retain the native hip with acceptable outcome following acetabular fracture in the elderly. Further research must be conducted to determine predictors of adequate reduction in order to identify candidates for ORIF

The purpose of this study was to investigate the outcome of acetabular fractures treated in our institution with marginal impaction. Over a 5 year period consecutive acetabular cases treated in our institution with marginal impaction were eligible for inclusion in this study. Exclusion criteria were patients lost to follow up and pathological fractures. A retrospective analysis of prospectively documented data was performed. Demographics, fracture types according to the Judet-Letournel classification, radiological criteria of intra-operative reduction (Matta) and secondary collapse, complication rates, and the EuroQol-5D questionnaire were documented over a median period of follow-up of 40 months (12–206). Out of 400 cases, eighty-eight acetabular fractures met the inclusion criteria. The majority (93.2%) involved males with a median age of 40.5 years (16–80). Half of them were posterior-wall fractures, 21.6% bicolumn, 14.7 %posterior-wall and column, 6.8% transverse, 5.7% anterior-column, 1.1% anterior-column posterior hemi-transverse. In 75% of the cases anatomical intra-operative reduction was achieved. Structural-bone-graft was used in 73.9%, and two-level reconstruction in 61%. At the last follow-up, the originally achieved anatomical reduction was lost in 17/66 (25.8%), (10 PW, 4 PC+PW, 1 PC, 1 Transverse, 1 Bicolumn fracture). Avascular necrosis developed in 9.1% and heterotopic ossification in 19.3%. Full return to previous activities was documented in 48.9% of cases, the EuroQol general heath state score had a median of 80% (30–95%), full recovery was recorded as to the patients’ mobility in 51.1%, as to pain in 47.7%, as to self-care in 70.5%, as to work-related activities in 55.7%, and as to emotional parameters in 65.9%. Reoperation (heterotopic-ossification excision, total-hip-arthroplasty, removal of metalwork) was necessary in 19.2% of cases. Utilising different techniques of elevation of the articular joint impaction leads to joint preservation with satisfactory overall functional results. Secondary collapse was noted in 25.8% of the patients predisposing to a poorer outcome

Purpose: The purpose of this study was to investigate the outcome of acetabular fractures treated in our institution with marginal impaction. Patients & Methods: Over a 5 year period consecutive acetabular cases treated in our institution with marginal impaction were eligible for inclusion in this study. Exclusion criteria were patients lost to follow up and pathological fractures. A retrospective analysis of prospectively documented data was performed. Demographics, fracture types according to the Judet-Letournel classification, radiological criteria of intra-operative reduction (Matta) and secondary collapse, complication rates, and the Euro-Qol-5D questionnaire were documented over a median period of follow-up of 40months (12–206). Results: Out of 400 cases, eighty-eight acetabular fractures met the inclusion criteria. The majority (93.2%) involved males with a median age of 40.5years (16–80). Half of them were posterior-wall fractures, 21.6% both column, 14.7% posterior-wall and posterior-column, 6.8% transverse, 5.7% anterior-column, 1.1% anterior-column posterior hemi-transverse. In 75% of the cases anatomical intraoperative reduction was achieved. Structural-bone-graft was used in 73.9%, and two-level reconstruction in 61%. At final follow-up, the originally achieved anatomical reduction was lost in 17/66 (25.8%), (10 PW, 4 PC+PW, 1 PC, 1 Transverse, 1 Bicolumn fracture). Avascular necrosis developed in 9.1% and heterotopic ossification in 19.3%. Full return to previous activities was documented in 48.9% of cases, the EuroQol general heath state score had a median of 80% (30–95%), full recovery was recorded as to the patients’ mobility in 51.1%, as to pain in 47.7%, as to self-care in 70.5%, as to work-related activities in 55.7%, and as to emotional parameters in 65.9%. Reoperation (heterotopic-ossification excision, total-hip-arthroplasty, removal of metalwork) was necessary in 19.2% of cases. Discussion/Conclusion: Utilising different techniques of elevation of the articular joint impaction leads to joint preservation with satisfactory overall functional results. Secondary collapse was noted in 25.8% of the patients predisposing to a poorer outcome

Purpose: The purpose of this study was to investigate the outcome of acetabular fractures treated in our institution with marginal impaction. Patients and Methods: Over a 5 year period consecutive acetabular cases treated in our institution with marginal impaction were eligible for inclusion in this study. Exclusion criteria were patients lost to follow up and pathological fractures. A retrospective analysis of prospectively documented data was performed. Demographics, fracture types according to the Judet-Letournel classification, radiological criteria of intra-operative reduction (Matta) and secondary collapse, complication rates, and the Euro-Qol-5D questionnaire were documented over a median period of follow-up of 40months (12–206). Results: Out of 400 cases, eighty-eight acetabular fractures met the inclusion criteria. The majority (93.2%) involved males with a median age of 40.5years (16–80). Half of them were posterior-wall fractures, 21.6%bicolumn, 14.7%posterior-wall and column, 6.8%transverse, 5.7%anterior-column, 1.1%anterior-column posterior hemi-transverse. In 75% of the cases anatomical intra-operative reduction was achieved. Structural-bone-graft was used in 73.9%, and two-level reconstruction in 61%. At the last follow-up, the originally achieved anatomical reduction was lost in 17/66 (25.8%), (10 PW, 4 PC+PW, 1 PC, 1 Transverse, 1 Bicolumn fracture). Avascular necrosis developed in 9.1% and heterotopic ossification in 19.3%. Full return to previous activities was documented in 48.9% of cases, the EuroQol general heath state score had a median of 80% (30–95%), full recovery was recorded as to the patients’ mobility in 51.1%, as to pain in 47.7%, as to self-care in 70.5%, as to work-related activities in 55.7%, and as to emotional parameters in 65.9%. Reoperation (heterotopic-ossification excision, total-hip-arthroplasty, removal of metalwork) was necessary in 19.2% of cases. Conclusion: Utilising different techniques of elevation of the articular joint impaction leads to joint preservation with satisfactory overall functional results. Secondary collapse was noted in 25.8% of the patients predisposing to a poorer outcome

Purpose: Lower extremity articular fracture treatment requires acccurate diagnosis and anatomic reduction and fixation. As articular injuries, posterior malleolus (PM) fractures are still poorly defined: for example the incidence of associated PM marginal impaction and of free articular fragments is unknown. The purposes of this study were:. to define the articular injuries of PM fractures into clincially relevant groups, as complex articular injuries could require specific surgical steps;. to identify clinical and radiographic parameters which would alert the surgeon to the presence of complex injuries. Method: Our prospectively-collected orthopaedic trauma database (OTDB) query identified 796 ankle fractures treated operatively between 2003–2007. Of these 147 cases involved the posterior malleolus. Four were misclassified leaving 143 cases. We obtained demographic and injury data from the OTDB, and validated the OTDB coded mechanisms of injury by an individual chart review. We reviewed all radiographs to describe the PM injuries (fracture patterns and dimensions) and to identify the associated injuries. Results: Of the 143 cases: Mean age was 50 years (sd=19), 68.5% were female, 51% were right sided injuries, and the median ISS=4 (in fact, 97.5% had ISS=4, most therefore being isolated trauma). The mean post malleolus AP size=11mm (sd=5). We identified recurrent patterns and classified the PM fracture as SIMPLE or COMPLEX (to include marginal impaction or free comminuted fragment, which should be anatomically reduced), 42% of cases (60/143) were COMPLEX (18 were impaction, 42 were free fragment). To help clinicians identify which cases could be COMPLEX we correlated (Chi-sq) the presence of a COMPLEX PM fracture to common clinical and radiographic variables. COMPLEX PM were statistically significantly associated with (p values). an axial loading injury mechanism (.000),. a radiographically captured dislocation (.006),. posteromedial comminution [as defined Tor-netta] (.005). the size of the fragment (.000). For example, axial loading would result in a complex fracture in > 85% of cases. In contrast, there was a statistically significant association between a Weber C fracture and older age and the presence of a SIMPLE PM fracture. These factors being potentially “protective” from joint comminution. Conclusion: We have defined and quantified the PM articular lesions which require anatomic reduction and fixation, beyond what has been published. We have defined clinical and radiographic criteria which, because higly associated with COMPLEX lesions, could. prompt surgeons to order further imaging (CT) to better delineate the lesion, and. draw his/her attention to potentially malaligned fragments at the time surgery

Using a prospective database of 1309 displaced acetabular fractures gathered between 1980 and 2007, we calculated the annual mean age and annual incidence of elderly patients > 60 years of age presenting with these injuries. We compared the clinical details and patterns of fracture between patients > 60 years of age (study group) with those < 60 years (control group). We performed a detailed evaluation of the radiographs of the older group to determine the incidence of radiological characteristics which have been previously described as being associated with a poor patient outcome. In all, 235 patients were > 60 years of age and the remaining 1074 were < 60 years. The incidence of elderly patients with acetabular fractures increased by 2.4-fold between the first half of the study period and the second half (10% (62) vs 24% (174), p < 0.001). Fractures characterised by displacement of the anterior column were significantly more common in the elderly compared with the younger patients (64% (150) vs 43% (462), respectively, p < 0.001). Common radiological features of the fractures in the study group included a separate quadrilateral-plate component (50.8% (58)) and roof impaction (40% (46)) in the anterior fractures, and comminution (44% (30)) and marginal impaction (38% (26)) in posterior-wall fractures. The proportion of elderly patients presenting with acetabular fractures increased during the 27-year period. The older patients had a different distribution of fracture pattern than the younger patients, and often had radiological features which have been shown in other studies to be predictive of a poor outcome

Specific radiological features identified by Brandser and Marsh were selected for the analysis of acetabular fractures according to the classification of Letournel and Judet. The method employs a binary approach that requires the observer to allocate each radiological feature to one of two groups. The inter- and intra-observer variances were assessed. The presence of articular displacement, marginal impaction, incongruity, intra-articular fragments and osteochondral injuries to the femoral head were analysed by a similar method. These factors were termed ‘modifiers’ and are generally considered when planning operative intervention and, critically, they may influence prognosis. Six observers independently assessed 30 sets of plain radiographs and CT scans on two separate occasions, 12 weeks apart. They were asked to determine the presence or absence of specific radiological features. This simple binary approach to classification yields an inter- and intra-observer agreement which ranges from moderate to near-perfect (κ = 0.49 to 0.88 and κ = 0.57 to 0.88, respectively). A similar approach to the modifiers yields only slight to fair inter-observer agreement (κ = 0.20 to 0.34) and slight to moderate intra-observer agreement (κ = 0 to 0.55)

Aims

Acetabular fractures are associated with long-term morbidity. Our prospective cohort study sought to understand the recovery trajectory of this injury over five years.

We investigated the results of complex acetabular fractures that were treated through the extended triradiate approach between January 1996 and September 2002 in our clinic. Sixty acetabular fractures were treated surgically during this period in total. Twenty-nine complex fractures that were treated through the triradiate approach with a minimum 2 years follow-up included in the study. The mean patient age was 43 years. There were 10 both column, 9 T shaped, 2 anterior column – posterior hemitransverse, 4 transverse with comminuted roof area, 5 posterior wall with comminuted roof area and 1 posterior column posterior wall fractures. Associated injuries were 2 full-thickness chondral injury of the head, one Pipkin type II fracture, 5 posterior and one central dislocation of the ipsilateral femoral head; and in 4 hips acetabular marginal impaction. The average follow-up was 63.2 months. The postoperative reduction was graded as excellent in 72.4 % and imperfect in 6.9 % of the patients. The hips were evaluated functionally according to the modified Postel D’Aubigne score and rated as excellent in 10 patients (34.5 %), good in 14 patients (48.2 %), fair in 3 patients (10.3 %) and poor in 2 patients (6.9 %). There were 2 deep infections (6.9 %), 2 avascular necrosis of the head (6.9 %), and 4 (13.8 %) non-disabling heterotopic ossification. We beleive that triradiate approach provides good visualization for anatomical reduction of the complex acetabular fractures, but the surgeon should be aware of its possible complications

Aims

To describe the epidemiology of acetabular fractures including patient characteristics, injury mechanisms, fracture patterns, treatment, and mortality.

The ultimate goal of surgery for acetabular fractures is hip joint preservation for the rest of the patient’s life. However, besides Letournel’s series, long term survi-vorship in this predominantly young patient group has never been published in a very large series. The aim of this study was to determine the cumulative 20-year sur-vivorship of the hip after fixation of acetabular fractures and to identify factors predicting the need for total hip arthroplasty. A Kaplan-Meier survivorship analysis of 1218 consecutive surgically treated acetabular fractures was carried out. 816 fractures were available for analysis with a mean follow up of 10.3 years (range 2–29 years). All the surgeries were performed by a single surgeon in accordance to an established treatment protocol based on Letournel’s principles. Inclusion criteria were a minimum follow-up of two years or failure at any time. Failure was defined as conversion to total hip arthroplasty of hip arthrodesis. A Cox-regression analysis identified significant risk factors predicting the need for total hip arthroplasty. Analyzed parameters comprised data on patient history, preoperative clinical examination, associated injuries, fracture pattern, radiographic and intra-operative features, and the accuracy of reduction. The cumulative 20-years survivorship was 79% (95% CI, 76–81%). Statistically significant factors influencing the need for artificial hip replacement/arthrodesis were: age over 40 years (Hazard ratio [HR] 2.4), femoral head damage (HR 2.6), acetabular impaction (HR 1.5), postoperative incongruence of the acetabular roof (2.9), involvement of the posterior wall (HR 1.6), anterior dislocation (5.9), initial displacement > 20mm (HR 1.6), and a malreduction with residual displacement > 1mm (HR 3.0). There was a significantly different survivorship of the individual fracture types. The worst survivorship occurred in anterior wall fractures (34% at 20 years) and the best survivorship in both column fractures (87% at 20 years). The accuracy of reduction improved significantly over time. In summary, the hip joint can be successfully preserved and prosthetic replacement avoided in 79% of displaced acetabular fractures at 20 years. Many of the factors influencing the long term prognosis are already determined at the time of injury. The factors that can be influenced by the surgeon are anatomic reduction, achievement of congruency of the acetabular roof and correction of marginal impaction. The presented unique results even exceed Letournel’s series in size and follow up. Therefore, they provide benchmark data for any type of comparative evaluation studies dealing with surgical treatment of acetabular fractures in future

The purpose of this study was to review the clinical and radiographic outcome in THRs done following acetabular fractures (fx). All patients undergoing conversion THR after previous acetabular fx between 1990 and 2006 at a single institution were identified. Clinical evaluation was done using the Harris hip scale. Radiographic evaluation was done using the system proposed by the Hip society. THRs as part of initial treatment for acute acetabular fx were excluded. There were 90 THRs (90 patients) performed in patients previously treated for an acetabular fracture. At the time of their acetabular facture, 67 had been treated with ORIF, 12 were treated with closed or limited open reduction and percutaneous fixation, and 11 were treated without surgery. The mean age at injury was 43.7 years, (range, 14–79). 68 patients sustained their fx from a high-energy mechanism (MVC, MPC, or MCC). Three patterns accounted for 52% of the fx: transverse posterior wall (20), both column (18), and T-Type (9). Associated pelvic fractures were present in 14 patients. Associated ipsilateral proximal femur fractures were present: femoral head (four), femoral neck (five), and femoral shaft (three). Among those treated with ORIF, marginal impaction was noted in 31 and osteo-chondral head damage in 32 hips. The mean interval between injury and THR was 42 months (range, two months to 32 years). Cement-less fixation was used in 81 of the 90 cups. Similarly, cementless stems were used in 80 stems. Bone graft was necessary in 26 patients (17 autograft, nine allograft). Two cases each required pelvic augments and reinforcement cage, respectively. Additional findings at THR included: femoral head erosion (53 hips), femoral head osteonecrosis (37 hips), osteonecrosis of the acetabulum (22 hips), and fx non-union (six hips). The average cup abduction angle was 440 (range, 28 to 60), the average cup height was 24 mm (range, 10 to 42), and the average medialization distance was 23 mm (range, 5 to 48). The mean EBL was 810 ml and mean operative time was 195 minutes. The mean F/U was 36 months (range, 6 months to 17 years). The median Harris hip score was 89 at the most recent F/U. Fifteen revisions (16%) have been done: aseptic loosening (seven hips), recurrent dislocation (six hips) and infection (two hips). Five of the six revisions for recurrent dislocation were performed in patients who had a posterior approach for both their acetabular fracture treatment and their THR. No revision was done in those who had been initially with percutaneous fixation. There was no infection in those who had been initially with percutaneous fixation either from the fx treatment or the THR. In contrast, 14 ORIF patients were complicated by infection. One of these developed infection following THR. Our data support the clinical efficacy and mid-term durability of THR in this patient group. Aseptic loosening and recurrent dislocation remain the primary reasons for revision surgery

Aims

Acetabular fractures in older adults lead to a high risk of mortality and morbidity. However, only limited data have been published documenting functional outcomes in such patients. The aims of this study were to describe outcomes in patients aged 60 years and older with operatively managed acetabular fractures, and to establish predictors of conversion to total hip arthroplasty (THA).

Aims

Currently, the US Center for Medicaid and Medicare Services (CMS) has been testing bundled payments for revision total joint arthroplasty (TJA) through the Bundled Payment for Care Improvement (BPCI) programme. Under the BPCI, bundled payments for revision TJAs are defined on the basis of diagnosis-related groups (DRGs). However, these DRG-based bundled payment models may not be adequate to account appropriately for the varying case-complexity seen in revision TJAs.