ABSTRACT
The management of osteoporotic acetabular fractures in the elderly remains a challenging issue. Nonoperative treatment is selected when there is no gross pelvic deformity and subluxation of the hip joint is not an issue. Open reduction and internal fixation remains the workhorse of reconstruction, but high failure rates have been reported in patients with advanced osteoporosis. Acute total hip arthroplasty (THA) yields satisfactory results, if the fracture pattern is thoroughly evaluated, the patient risk and prognostic factors are properly assessed, and the right implant is selected. Delayed THA has the advantage of a consolidated fracture and a defined bone stock, but difficulties could be anticipated due to scar tissue, higher risk of bleeding, necessity to remove in situ metalwork, heterotopic ossification, and potential presence of low-grade infection.
Ideally, treatment should be individualized for every patient, taking into consideration comorbidities and the ability of the patient to undergo a prolonged procedure.
