Einfluss des Operationszeitpunktes auf den klinischen Verlauf sowie die Mortalität bei Acetabulumfrakturen geriatrischer Patienten

The incidence of acetabular fractures has remained unchanged over the years. However, there has been a 2.4-fold increase in the proportion of geriatric patients with acetabular fracture. The low-energy trauma mechanism leading to acetabular fractures in geriatric patients differs significantly from the high-energy trauma in which young patients usually sustain such a fracture. The recommendations for the treatment of pelvic fractures refer to the "classic" pelvic fractures resulting from high-energy trauma. The ,,window of opportunity" (5th-10th day after trauma) is indicated as a suitable time for surgical treatment of the fractures, since the organism has stabilized at this time. However, since the trauma mechanism of geriatric acetabular fractures is more similar to that of proximal femoral fractures (in geriatric patients), the aim of this work was to investigate whether the treatment of geriatric acetabular fractures can be guided by the guidelines for proximal femoral fractures, which recommend early surgical fracture treatment after trauma. Data collection took place from 09/2019 to 05/2020, which was then used to perform a retrospective statistical analysis. Only patients who sustained their fracture in the course of a low-energy trauma were included in the analysis. Patients were divided into three comparable groups according to the time of surgery and examined with respect to clinical course and mortality. Fifty-two (49.5%) of the 105 patients were female, and 53 (50.5%) were male. The median age of all patients was 83.06 years. Analysis of the data demonstrated an association between the timing of surgical care and the incidence of urinary tract infection. There was an increase in the incidence of urinary tract infection with increasing duration between fall and surgery. It was also found that patients whose surgical treatment was performed at a later time were more frequently treated by means of a prosthesis. In addition, there was a difference in the length of stay in the intensive care unit during the course (unplanned admission to intensive care unit after postoperative treatment in normal ward) between group 1 and group 2. The treatment interval in the intensive care unit during the course was significantly longer in patients of group 1 than in patients of group 2. Furthermore, no influence of the time of surgery on the total length of stay and the length of stay in the intensive care unit and intermediate care unit, surgical treatment, perioperative complications, or mortality could be demonstrated. With regard to the question of whether geriatric acetabular fractures can be treated according to the guidelines for proximal femoral fractures (in geriatric patients), it was shown that geriatric patients with acetabular fractures can be treated surgically early after trauma without a higher complication rate. Care at a later time increases the risk for complications associated with prolonged immobilization. Thus, in accordance with the guidelines for the management of hip-related fractures in geriatric patients, early surgical treatment of geriatric acetabular fractures is recommended.