Is there any difference between open reduction and internal fixation vs combined hip procedure after geriatric acetabular fracture?: A randomized controlled trial.

BACKGROUND

Acetabular fractures in geriatric patients are challenging due to poor bone quality and increased risk of postoperative complications. While open reduction and internal fixation (ORIF) remains a common approach, combining ORIF with total hip arthroplasty has emerged as an alternative and is referred to as the combined hip procedure (CHP). This study aimed to compare clinical, radiological, and functional outcomes between CHP and ORIF in patients aged over 65 years.

METHODS

In this prospective, randomized, single-blind clinical trial, aged > 65 years with acetabular fractures were allocated to receive either ORIF or CHP between 2018 and 2022. Functional outcomes were assessed using Parker mobility, Harris hip, The Western Ontario and McMaster Universities Arthritis Index (WOMAC), Oxford hip, and Short-Form12(SF-12) scores. Radiological evaluation and postoperative complications, including reoperation and osteoarthritis development were also analyzed.

RESULTS

24 patients participated in the study. 14 of the participants received ORIF and 10 received CHP. The mean follow-up period was 45.3 months. No statistically significant differences were observed between groups in terms of functional scores or complication rates. In the evaluation between the groups, P = .463 for WOMAC hip score, P = .442 for Oxford hip score, P = .410 for Harris hip score, P = .461 for SF-12 physical, P = .169 for Parker mobility test. Although CHP was associated with a significantly longer operative time (P = .002), it did not increase complication rates. The revision rate was lower in the CHP group, and immediate or partial weight-bearing was more frequently permitted. Posttraumatic osteoarthritis developed in 11 of the 14 ORIF patients, whereas only 1 patient in the CHP group required revision during follow-up.

CONCLUSION

Both ORIF and CHP yielded comparable functional outcomes in elderly patients with acetabular fractures. CHP may offer a lower revision rate and allow earlier mobilization, making it a favorable option in selected patients with negative prognostic factors. Larger, long-term studies are warranted to confirm these findings.