O3294 PERCUTANEOUS STABILISATION OF ACETABULAR FRACTURES IN ELDERLY PATIENTS

Background: We evaluate the role of percutaneous þxation of Acetabular fractures in a selected group of patients in which conservative management seemed unlikely to yield a satisfying outcome. Method: Between July 1998 and July 2001, 17 consecutive patients having suffered an Acetabular fracture underwent suoroscopic guided percutaneous þxation to stabilize the fracture. The mean age of the patients was 81 years (range 67 to 90). In all cases the fracture was non-displaced or minimally displaced (<2 mm). The operative indication was based on our experience that these patients would have a less favorable outcome with conservative management due to their diminished general health and important associated morbidity. Percutaneous þxation was performed at a mean of four days post injury (range 2–6). In all cases, 2 cannulated cancellous 7.3 mm were used, one to þx the anterior column and the other, inserted in a retrograde fashion to stabilize the posterior column. Bed to armchair transfer began after 24 hours. Weight bearing as tolerated was allowed at 4 weeks from surgery. Two patients died of unrelated causes in the postoperative period and one patient was lost to follow-up, leaving fourteen patients who could be followed for a mean of 1,5 years (range 6 months-3 years). Results: Soft tissue dissection was minimal. There were no intra-operative or post-operative complications. At latest follow-up there was no evidence radiographically of displacement of fragments, degenerative changes or screw failure. Fracture union was achieved at a mean period of 12 weeks (range, 8–15 weeks) after surgery. In one case the tip of the posterior screw penetrated the sacroiliac joint, but no clinical adverse effects were noted. Clinical results was satisfactory in thirteen patients, and fair in one patient, as assessed by the Matta modiþcation of the rating system described by dOAubigne and Postel. Conclusion: Our results show that the percutaneous þxation is a valid therapeutic option in selected Acetabular fractures, and in the future broader indications may be found for this technique.