Variation in treatment of displaced geriatric acetabular fractures among 15 Level-I trauma centers

Objectives: To document the initial treatment of displaced acetabular fractures among older adults across multiple trauma centers and to investigate the factors that influence the decision to operate and the choice of operative procedure [open reduction internal fixation (ORIF) vs. total hip arthroplasty (THA)]. Design: Retrospective observational study. Setting: Fifteen US level-I trauma centers participating in the Major Extremity Trauma Research Consortium. Patients/Participants: Overall, 269 patients aged 60 years or older admitted for the treatment of a displaced acetabular fracture. Intervention: None. Main Outcome Measurements: Treatment. Results: Sixty percent of fractures (n 162) were treated operatively. Younger age (<80 years), injury from high-energy mechanism, fractures with femoral head impaction, and fractures without hip congruency were significantly associated with receiving operative treatment (P < 0.05). Significant site variation in operative versus nonoperative treatment occurred even after accounting for these factors (P 0.0044). Among operatively treated patients, 88% (n 142) received ORIF and 12% (n 20) received THA as the initial treatment. Women were more likely to be treated with initial THA compared with men; of the known risk factors for poor outcomes with ORIF (ie, dome or roof impaction, femoral head impaction, or posterior wall involvement), only dome impaction was significantly associated with receiving initial THA (P < 0.05). Conclusions: Currently, no treatment guidelines exist for acetabular fractures in older adults, which likely explains the significant site variation in operative versus nonoperative treatment. This study identifies patient and injury factors that drive treatment decisions, which will be important in planning and designing future trials needed to determine the best treatment for these fractures.