Mid-term outcomes of acetabular fractures treated with acute fix and replace versus ORIF in the elderly: a multicentric study with minimum 5-year follow-up

PurposeAcetabular fractures in elderly patients are increasing and present complex management challenges. This multicentric retrospective study compares mid-term clinical and radiographic outcomes of acute "fix and replace" versus ORIF, focusing on implant survival, complications, and functional performance at a minimum five-year follow-up, addressing the current lack of extended outcome data.MethodsThis study is an update of a previously published multicentric retrospective cohort including patients aged >= 60 years with acetabular fractures treated surgically at three hospitals in central Italy between 2013 and 2025. Patients received either acute "fix and replace" (ORIF combined with acute THA) or ORIF alone, with a minimum clinical and radiographic follow-up of five years. Functional outcomes were assessed using PROMs (SF-12, PDI) and clinician-based scores (HHS, Modified Merle d'Aubign & eacute; and Postel). Radiographs were reviewed for healing, implant integrity, osteolysis, loosening, osteoarthritis, and heterotopic ossifications. Complications and implant survival were analyzed using Kaplan-Meier curves with revision surgery as the endpoint.ResultsA total of 41 patients (21 ORIF, 20 CHP) completed a minimum five-year follow-up. No significant differences were found between groups regarding age, BMI, or follow-up duration. Two revisions to total hip arthroplasty occurred in the ORIF group, with no revisions in the CHP group. Radiographic findings, including heterotopic ossifications and implant loosening, were comparable. Functional scores (HHS, MAPM, SF-12 PCS and MCS) showed no significant differences between groups at both two and five years. The CHP group, however, demonstrated significantly lower pelvic discomfort index (PDI) scores at 60 months (p = 0.04). No significant intra-group variations were observed over time.ConclusionBoth ORIF and CHP provide satisfactory mid-term outcomes in elderly patients with acetabular fractures. However, CHP demonstrated fewer reoperations and better pelvic discomfort scores at five years. These findings support the growing evidence favoring acute fix-and-replace strategies in this population.