What fracture involving the acetabulum is commonly seen in the elderly?

Oct 17, 2025 3 min read •

Geriatrics Orthopedics Fracture

According to orthopedic studies, the incidence of acetabular fractures in the elderly is rising significantly due to increasing life expectancy and activity levels. This guide explains what fracture involving the acetabulum is commonly seen in the elderly and the contributing factors.

Quick Summary

The anterior column and posterior hemitransverse fracture is a common acetabulum fracture pattern in the elderly, often resulting from low-energy trauma and complicated by osteoporosis.

Key Points

Anterior Column and Posterior Hemitransverse Fracture (ACPHT): This is the most common acetabulum fracture pattern seen in older adults, typically caused by low-energy falls.
Low-Energy Trauma is Key: Unlike younger patients who experience high-impact injuries, elderly individuals are susceptible to these fractures from simple falls due to underlying osteoporosis.
Comminution and Impaction: Poor bone quality often leads to more complex, multi-fragment fractures and impacted joint surfaces, particularly the superomedial dome (known as the "gull sign").
Tailored Treatment Approach: Management depends on the patient's overall health and fracture severity, ranging from conservative non-operative care to surgical options like ORIF or acute total hip arthroplasty.
High Risk for Complications: Older patients face significant risks, including pneumonia, blood clots, and post-traumatic arthritis, making early mobilization and comprehensive care crucial.
Diagnosis is Challenging: Occult fractures can be missed on standard X-rays, often requiring CT scans for accurate assessment due to potentially masked symptoms.
Multidisciplinary Care is Crucial: Successful outcomes depend on collaboration between orthopedic surgeons, geriatricians, physical therapists, and other specialists.

Understanding Acetabular Fractures in the Elderly

Acetabular fractures in older adults differ significantly from those in younger, high-energy trauma patients. While young patients often sustain these injuries in high-impact events, elderly patients with compromised bone quality are vulnerable to fractures from minor falls.

The most commonly seen acetabular fracture in the elderly is the anterior column and posterior hemitransverse (ACPHT) fracture. This pattern is specifically adapted to low-energy falls, the most frequent cause of injury in this population. A fall onto the greater trochanter transmits an anteromedial force to the acetabulum, resulting in this complex fracture pattern.

The Role of Osteoporosis and Comminution

Osteoporosis is a major contributing factor. With age, decreased bone density allows a simple fall to produce fractures with greater comminution (breaking into multiple small pieces) and impaction, making treatment challenging.

Key features common in geriatric acetabular fractures include:

Anterior column involvement: Due to the anteromedial force vector.
Quadrilateral plate fracture: The medial wall often fractures and displaces inwards.
Superomedial dome impaction (Gull Sign): The femoral head can displace anteromedially, impacting the bone at the top-inside of the hip socket, indicating significant articular damage.

Challenges in Diagnosis and Treatment

Symptoms in older adults might be less clear, making early diagnosis difficult. Pain, swelling, and difficulty bearing weight are common, but occult fractures can be missed on initial X-rays. A CT scan with 3D reconstruction is often needed for accurate diagnosis and planning.

Treatment is highly individualized based on the patient's health, fracture pattern, and bone quality. A multidisciplinary approach is often recommended.

Comparison of Management Options for Geriatric Acetabular Fractures


Treatment Option	Suitable For	Key Considerations
Non-operative Management	Minimally displaced or stable fractures; medically unfit patients.	Risk of complications from immobility.
Open Reduction and Internal Fixation (ORIF)	Displaced fractures in patients with good bone quality.	Risk of fixation failure due to osteoporosis; post-traumatic arthritis risk.
Acute Total Hip Arthroplasty (THA)	Displaced fractures, severe comminution, or articular impaction (e.g., Gull Sign).	Allows early mobilization; better outcomes for complex fractures.
Minimally Invasive Fixation	Selected simple fractures.	Less invasive but technically demanding; long-term outcomes comparable to open methods.

Potential Complications

Elderly patients have a higher risk for complications due to co-morbidities. Common issues include:

Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE): Increased risk from immobility.
Post-Traumatic Osteoarthritis: Can develop over time, potentially requiring hip replacement.
Avascular Necrosis: Disrupted blood supply can cause bone tissue death.
Infection: A risk with surgical interventions.
Medical Complications: Pneumonia and urinary tract infections are more common with bedridden patients.

Rehabilitation and Recovery

Rehabilitation is critical for early mobilization and preventing complications. This involves:

Pain Management: Essential for allowing therapy.
Physical Therapy: Focuses on regaining mobility and preventing muscle atrophy.
Occupational Therapy: Helps with daily tasks.
Nutritional Support: Important for healing.

A personalized plan is essential for a positive outcome, considering the patient's overall health and fracture characteristics. Managing expectations regarding functional independence is also key, as some may require more care post-recovery.

For more detailed medical information, consult a resource like the American Academy of Orthopaedic Surgeons (AAOS): https://www.aaos.org.

Conclusion

The anterior column and posterior hemitransverse fracture is a common acetabulum fracture in the elderly, often caused by low-energy falls and complicated by osteoporosis. The weakened bone quality in seniors frequently results in more complex fracture patterns. Treatment requires a carefully tailored approach, considering options from non-operative care to surgery like total hip arthroplasty. Early mobilization is crucial to improve outcomes and prevent serious complications.

Frequently Asked Questions

The primary cause is typically a low-energy fall, such as a simple fall from standing height. This is in stark contrast to the high-energy trauma that causes these fractures in younger individuals.

A low-energy fall often results in an impact to the side of the hip (the greater trochanter). This transmits a specific force vector that damages the front and medial parts of the hip socket, leading to anterior column involvement.

The "gull sign" refers to an impaction fracture of the superomedial dome of the acetabulum. It is a common feature in geriatric acetabular fractures and indicates significant articular damage and potential poor outcomes with internal fixation.

No, surgery is not always required. Non-operative management may be an option for minimally displaced, stable fractures or for patients who are medically unfit for surgery.

Besides the fracture itself, major risks include complications from immobility, such as blood clots, pneumonia, and bedsores. They also face a higher risk of post-traumatic arthritis and reoperation.

Osteoporosis weakens the bone quality, which increases the likelihood of a fracture from less force. It also results in more comminuted (fragmented) fractures and makes achieving stable internal fixation more challenging for surgeons.

Treatment options vary widely based on the patient's health and fracture pattern. They can include non-operative management, internal fixation, or acute total hip arthroplasty, especially for complex fractures.

References

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.