Description
In this presentation, JF Keating discusses the evolution of surgical approaches to the acetabulum, particularly in older patients with acetabular fractures. Over the past 30 years, the demographics of these injuries have shifted, with an increasing proportion of elderly patients and greater complexity of fractures. Initially, most injuries occurred in males around 48 years old, predominantly involving posterior wall and both-column fractures. However, there's been a rise in female patients, particularly within the older age groups, resulting in a higher average age and increased fracture complexity due to osteoporosis and medical comorbidities.
Keating emphasizes the shift from traditional surgical techniques like the Kocher-Langenbeck and ilioinguinal approaches to more modern and less invasive techniques, such as the stop approach. This transition is driven by better imaging technology, which allows for improved preoperative planning and intraoperative navigation. The advantages of the stop approach include reduced surgical time, lower blood loss, and minimized complications, while being particularly effective for older patients.
The talk also highlights the importance of recognizing specific fracture patterns and complications common in older patients, such as marginal and femoral head impaction, that impact surgical outcomes. Keating shares data from his unit indicating a rising trend in early total hip replacements, especially in cases with significant marginal impaction, reflecting a proactive approach to managing these complex injuries and minimizing the need for later conversions to hip arthroplasty. Overall, the presentation outlines the need for adapting surgical strategies to meet the changing demographics and complexities of acetabular fractures in elderly patients.