Geriatric Acetabular Fractures Avoid Complications Adam Starr, MD - PowerPoint PPT Presentation

Geriatric Acetabular Fractures Avoid Complications Adam Starr, MD Chief, Orthopaedic Surgery Parkland Memorial Hospital Professor and Executive Vice Chair Department of Orthopaedic Surgery UT Southwestern Medical Center Dallas, Texas

69 year old male • Slipped and fell while trying to put his boat on a trailer. • Painful L hip, unable to walk. • Currently working delivering televisions.

Early Management • Traction pin placed L leg • Remainder of work-up negative • Taken to OR 2 days after admission.

Operating Room • Limited open reduction/percutaneous screw fixation • Pecten pubis fragment reduced. • Bleeding slightly more than usual during sub- iliacus dissection. • Patient remained hemodynamically stable.

Post-op Course • Hemoglobin and hematocrit trended slowly down. • Remained hemodynamically stable. • Transfused 4 units PRBCs. • Abd CT scan revealed hematoma and possible arterial extravasation • Pelvic arteriogram done – L obturator artery branches embolized with gelfoam and coils • Hemoglobin and hematocrit stable afterwards. • At 5 months, patient healed and returned to work delivering TVs.

Risks of Acetabular Fracture Management in the Elderly • Infection – obviated with perc technique • Nonunion – rare in well vascularized bone – No risk of pelvic discontinuity • Post-traumaic arthritis – Easily addressed with THA if it arises • Excess scar, HO and hardware. – Obviated with perc technique

Thank You