Occult Acetabular Fracture in Elderly Patients

Enrique Guerado*, Juan Ramón Cano, Encarnación Cruz
Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol, University of Malaga, Marbella (Malaga), Spain

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© Guerado et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol, University of Malaga, 29603, Marbella (Malaga), Spain; Tel: 34-951976222; Fax: 34-952823219;


Acetabular fractures in the elderly are increasingly common; however, an antecedent of trauma may not be known, and the diagnosis easily missed. Early identification and prompt management are needed in order to minimise morbidity rates, but little has been published on occult acetabular fracture.

In this paper we present three cases of occult acetabular fracture in patients older than 75 years. All three are females and had previously been operated on the ipsilateral hip with an implant (two proximal femur fractures treated with a proximal intramedullary femoral nail, and one case of total joint replacement); these acetabular fractures could be related to the existence of a stress shielding mechanism.

We believe that whenever an elderly patient feels groin pain, and anteroposterior pelvis X-rays are normal, oblique Judet projections (obturator and iliac) should be obtained. In any case, displacement will make any fracture evident within a few weeks.

Keywords: Acetabular fracture, elderly, fracture, hip arthroplasty, occult, missed diagnosis, total hip replacement.