The aging population has contributed to a rising incidence of acetabular fractures in older patients, yet current evidence guiding surgical treatment is limited by small sample sizes. This study used a nationwide database to investigate outcomes in older patients undergoing open reduction and internal fixation (ORIF) versus acute total hip arthroplasty (THA).

The PearlDiver database was queried for patients aged 60 years and older with an acute acetabular fracture who underwent ORIF or acute THA (2010 to 2021). ORIF patients were matched 1:1 to THA patients based on age, sex, US region, insurance plan, and Charlson Comorbidity Index score. Patients with less than 2 years of follow-up were excluded. The primary outcome was revision surgery.

Of 120,032 patients with an acetabular fracture, 3,768 (3.1%) underwent surgical treatment: 1,482 (39.3%) THA and 2,286 (60.7%) ORIF. Mean age was 71.0 ± 6.51 years. Mean follow-up duration was 5.2 ± 2.1 years. THA patients were slightly older (72.4 versus 70.2 years), had higher Charlson Comorbidity Index scores (3.3 versus 2.7), and had a higher percentage of female patients (62.5% versus 32.2%). After matching, 962 ORIF and 962 THA patients were included. ORIF patients had longer LOS (10.7 versus 8.1 days). ORIF patients were less likely to experience joint infections and periprosthetic fractures, but more likely to experience transfusions. The overall revision surgery rate within 10 years was 14.8% in the ORIF cohort and 6.2% in the THA cohort. In the ORIF cohort, 13.5% of patients had a delayed conversion to THA.

In this large national database, acute with or without internal fixation for geriatric acetabular fractures was associated with lower rates of revision surgery within 10 years when compared with a matched cohort undergoing ORIF. ORIF was associated with increased LOS, increased transfusion risk, and lower risk of joint infection and periprosthetic fracture.

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