Acetabular Fractures in the Elderly

Acetabular fractures in elderly patients are an increasingly frequent consequence of population aging. Although commonly caused by low-energy falls, they are associated with high morbidity and mortality, approaching 20% at one year, largely due to patient frailty and comorbidities. Fracture patterns typically involve the anterior column with posterior hemitransverse and acetabular dome injury, with medial protrusion and superomedial impaction (gull sign), features that predict poor outcomes with conventional reconstruction. Management requires a multidisciplinary orthogeriatric approach focused on early stabilization, pain control, and individualized treatment selection. Conservative management is reserved for stable or minimally displaced fractures and high-risk surgical candidates, avoiding perioperative complications but carrying the risk of functional limitation and late conversion to total hip arthroplasty (THA). Open reduction and internal fixation (ORIF) offer good results when anatomic reduction is achieved, though with high complication and reoperation rates. In recent years, combined fixation with acute arthroplasty (fix and replace) has gained support for complex osteoporotic fractures, reducing reoperations and providing comparable function to ORIF. Overall, outcomes depend more on achieving pain-free hip stability than on the specific technique. Treatment should be individualized, balancing surgical risk, fracture anatomy, and patient condition to optimize mobility and quality of life.