Open Reduction and Internal Fixation (ORIF) for Acetabular Fractures in the Elderly: A Systematic Review and Meta-Analysis

Abstract

Objectives: To evaluate the outcomes of open reduction and internal fixation (ORIF) in older adults with acetabular fractures, with a focus on postoperative complications, mortality, and conversion to total hip arthroplasty (THA). Methods: We systematically reviewed studies published between September 2013 and February 2025 in Web of Science, PubMed, Embase, Scopus, and the Cochrane Library. Studies reporting postoperative outcomes of ORIF in elderly patients aged ≥65 years were included. Data extraction and quality assessment were performed independently by two reviewers. Statistical analyses were conducted using Comprehensive Meta-Analysis software, version 3.0. Results: Twenty-one studies involving 2,410 patients were included in the analysis. Follow-up duration ranged from 12 to 96 months. The pooled mortality rate after ORIF was 11.0% (95% CI: 7.0%--16.7%). The pooled complication rate was 26.5% (95% CI: 21.3%--32.4%), and the pooled rate of conversion to THA was 20.0% (95% CI: 15.2%--26.0%). The pooled infection rate was 5.8% (95% CI: 4.2%--7.9%). Fixation failure occurred in 12.6% of patients (95% CI: 9.8%--15.9%) and was primarily attributed to secondary loss of reduction, implant loosening, or hardware breakage, often requiring revision surgery or conversion to THA. Conclusion: ORIF in elderly patients with acetabular fractures is associated with substantial risks, including a high complication rate and a notable likelihood of conversion to THA. Alternative treatment strategies, such as primary THA or nonoperative management, should be considered in selected patients.