Operative Techniques in Orthopaedics RSS feed: Current Issue. Operative Techniques in Orthopaedics is an innovative, richly illustrated resource that keeps practitioners informed of significant advances in all areas of surgical management. Each issue of this atlas-style journal explores a single topic, often offering alternate approaches to the same procedure. Its current, definitive information keeps readers in the forefront of their specialty. http://www.optechorthopaedics.com/?rss=yesElsevier Inc.en © 2011 Published by Elsevier Inc. Operative Techniques in Orthopaedics1048-6666214December 2011 © 2011 Published by Elsevier Inc. healthpermissions@elsevier.comhttp://www.optechorthopaedics.com/article/PIIS1048666611001030/abstract?rss=yesThis issue of Operative Techniques in Orthopaedics is dedicated to thoughtful care of the geriatric patient with acetabular fracture. Our invited contributors discuss their expertise managing these injuries with standard as well as innovative internal fixation and arthroplasty strategies. An individualized plan of care is emphasized in an effort to match the appropriate treatment method to the particular acetabular fracture and host.IntroductionIvan S. Tarkin10.1053/j.oto.2011.09.001Operative Techniques in Orthopaedics 21, 4 (2011)2011-12-01Operative Techniques in Orthopaedics2011-12-01214S1048-6666(11)X0005-8261264http://www.optechorthopaedics.com/article/PIIS1048666611001066/abstract?rss=yes The treatment of acetabular fractures in geriatric patients provides a unique set of challenges to the orthopaedic surgeon. Treatment strategies often differ from those employed to treat younger patients with acetabular fractures in order to minimize morbidity and mortality following these injuries. Treatment strategies to address these injuries include a repertoire of innovative methods for percutaneous or limited-open reduction and fixation in addition to traditional non-operative or open reduction and internal fixation methods. The purpose of this article is to discuss the challenges associated with the management of acetabular fractures in geriatric patients and to highlight current surgical techniques that can be applied to treat these patients. Percutaneous Fixation of Geriatric Acetabular FracturesAndrew R. Evans, Hans C. Pape10.1053/j.oto.2011.09.004Operative Techniques in Orthopaedics 21, 4 (2011)2011-12-01Operative Techniques in Orthopaedics2011-12-01214S1048-6666(11)X0005-8265271http://www.optechorthopaedics.com/article/PIIS1048666611001194/abstract?rss=yes Geriatric acetabular fractures pose unique challenges to the orthopedic trauma surgeon. A common insufficiency fracture pattern includes femoral head medialization through quadrilateral plate fracture. Adequate reduction and fixation of this unstable fracture pattern can be quite difficult. The Stoppa exposure, however, allows for excellent access to the intrapelvic portion of acetabulum. Fracture of the medialized quadrilateral plate can be directly reduced and buttressed with internal fixation using an infrapectineal plate. This technique is heralded for the limited dissection and surgical morbidity compared with traditional acetabular exposures/techniques. However, this approach limits access to the anterior or posterior columns of the acetabulum, and surgical pitfalls include the potential for neurovascular and bladder injury. Open Reduction of Geriatric Acetabulum Fractures Using a Stoppa ExposureSteven S. Sands, Henry C. Sagi10.1053/j.oto.2011.10.002Operative Techniques in Orthopaedics 21, 4 (2011)2011-12-01Operative Techniques in Orthopaedics2011-12-01214S1048-6666(11)X0005-8272275http://www.optechorthopaedics.com/article/PIIS1048666611001054/abstract?rss=yes The intrapelvic approach is ideally suited for selected geriatric acetabular fractures with quadrilateral plate involvement. Infrapectineal plating is biomechanically advantageous to buttress the fractured quadrilateral surface. As a technical tip, plate fixation posteriorly into the sciatic buttress is reliable. However, anterior fixation is inconsistent. Usage of locking screws or cabling technique is preferable. Treatment of Low-Energy Geriatric Acetabular Fractures With ProtrusioPeter A. Siska10.1053/j.oto.2011.09.003Operative Techniques in Orthopaedics 21, 4 (2011)2011-12-01Operative Techniques in Orthopaedics2011-12-01214S1048-6666(11)X0005-8276279http://www.optechorthopaedics.com/article/PIIS1048666611000838/abstract?rss=yes Geriatric acetabulum fractures commonly occur because of low-energy falls. The decision-making and treatment strategies can be difficult independent of the fracture pattern. Elementary fracture patterns in the elderly are more commonly treated with open reduction and internal fixation versus acute total hip arthroplasty. Osteopenia further challenges surgeons' ability to obtain and maintain the reduction of these fractures. We present techniques regarding open reduction and internal fixation of elementary type acetabulum fractures in the elderly/geriatric population. Geriatric Elementary-Type Acetabulum Fractures: Open Reduction and Internal Fixation TechniquesJustin C. Siebler, Matthew A. Mormino10.1053/j.oto.2011.07.002Operative Techniques in Orthopaedics 21, 4 (2011)2011-12-01Operative Techniques in Orthopaedics2011-12-01214S1048-6666(11)X0005-8280285http://www.optechorthopaedics.com/article/PIIS1048666611001182/abstract?rss=yes Management of complex acetabular fractures in the geriatric patient requires a better understanding of a different spectrum and frequency of fracture patterns, surgical techniques, and even treatment principles than in younger patients. Although joint replacement plays a role in certain elderly patients with acetabular fractures, open reduction internal fixation is the preferred treatment strategy, and must be executed even when combined with arthroplasty. Patient baseline functional status must be considered in choosing treatment goals, as well as their frailty and comorbidities. There are typical injury characteristics that must be recognized which require treatment-specific strategies. Lengthy reconstructions in this fragile patient population are to be avoided, and therefore single nonextensile approaches limiting blood loss are most appropriate, considering that the patient's physiological reserve is lesser than younger counterparts. Although obtaining an anatomic reduction of the acetabulum is of paramount importance in the physiologically young who can withstand greater demands of surgery and who will require greater functional demands, the physiologically old patient requires stability to allow mobility and a surgery to mitigate their surgical risks. Open Reduction and Internal Fixation of Complex Geriatric Acetabular FractureBoris A. Zelle, Peter A. Cole10.1053/j.oto.2011.10.001Operative Techniques in Orthopaedics 21, 4 (2011)2011-12-01Operative Techniques in Orthopaedics2011-12-01214S1048-6666(11)X0005-8286292http://www.optechorthopaedics.com/article/PIIS1048666611000826/abstract?rss=yes 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. Acute total hip replacement combined with open reduction internal fixation (ORIF) for the management of acetabular fracture in the elderlyAndrew J. Marcantonio, Richard Iorio, Lawrence M. Specht, Michael S. Kain10.1053/j.oto.2011.07.001Operative Techniques in Orthopaedics 21, 4 (2011)2011-12-01Operative Techniques in Orthopaedics2011-12-01214S1048-6666(11)X0005-8293297http://www.optechorthopaedics.com/article/PIIS104866661100084X/abstract?rss=yes Geratric patients who are treated operatively or nonoperatively for acetabular fractures may develop posttraumatic arthritis. Performing delayed total hip arthroplasties (THAs) in this patient population may be more technically challenging. Previous operative reports, radiographs, and computed tomography scans may help with preoperative planning. Scarring of the sciatic nerve from previous surgeries may warrant the use of nerve monitoring. Special surgical considerations include choosing a surgical approach, especially through preexisting incisions; deciding whether or not to remove hardware; and removing heterotopic ossification (HO). Multiple fixation options should be available in light of possible acetabular deficiency, including autograft, allograft, structural augments, and acetabular cups offering different fixation options. The postoperative management may differ from primary THAs performed for osteoarthritis because these patients may require protection of weight-bearing status and may require HO prophylaxis. By using the techniques described in this article, delayed THAs after acetabular fractures have demonstrated good outcomes in the geriatric patient population. Delayed Total Hip Replacement for Posttraumatic Arthritis in the Geriatric Patient After Fractured AcetabulumAntonia F. Chen, Edward J. McClain, Brian A. Klatt10.1053/j.oto.2011.06.007Operative Techniques in Orthopaedics 21, 4 (2011)2011-12-01Operative Techniques in Orthopaedics2011-12-01214S1048-6666(11)X0005-8298305http://www.optechorthopaedics.com/article/PIIS1048666611001042/abstract?rss=yes Elderly adults currently represent the most rapidly growing segment of the patient population. As the number of geriatric patients increases, the incidence of acetabular fractures in this population can be expected to increase as well. Optimal management of these injuries is controversial. Patient factors, such as preinjury functional level, medical comorbidities, and poor bone quality, can confound the treatment plan, as can injury characteristics, such as fracture pattern and articular damage. Although open reduction and internal fixation has been advocated as the gold standard for any displaced acetabular fracture, in the elderly patient alternatives, including percutaneous fixation and total hip arthroplasty, either acute or delayed, should be considered. Exact indications for each of these options are often unclear. Although it is helpful to follow a logical algorithm in determining the best management for the geriatric acetabular fracture, the importance of individualizing treatment cannot be overemphasized. Individualized Plan of Care for the Geriatric Patient With Acetabular FractureMeelan N. Patel, Ariel T. Goldman10.1053/j.oto.2011.09.002Operative Techniques in Orthopaedics 21, 4 (2011)2011-12-01Operative Techniques in Orthopaedics2011-12-01214S1048-6666(11)X0005-8306311