Acute total hip replacement combined with open reduction internal fixation (ORIF) for the management of acetabular fracture in the elderly

The elderly patient with an acetabular fracture presents a unique surgical challenge because of medical comorbidities, decreased physiological reserve, reduced healing capacity, osteopenic bone, and atypical fracture patterns. Goals include rapid mobilization, early weight bearing, and a pain-free functional hip. Treatment options include initial nonoperative management with delayed total hip arthroplasty (THA), open reduction and internal fixation (ORIF), minimally invasive osteosynthesis, and acute total hip replacement combined with ORIF. Advantages of acute THA combined with ORIF in the elderly patient include the potential for 1-stage treatment with faster recovery and the avoidance of problems that can occur with delayed arthroplasty. Disadvantages include major technical challenges of simultaneously obtaining both implant and fracture stability. This review discusses the indications, contraindications, technique, and results of acute THA combined with ORIF for the management of acetabular fractures in the elderly. The technique for combined surgical treatment of an associated posterior wall/posterior column acetabular fracture with an ipsilateral femoral neck fracture is described.