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This study was set up to identify the role of open reduction and internal fixation of acetabular fractures in persons of old age.<\/jats:p>\n<jats:p>We retrospectively reviewed the medical charts and radiological data of all patients older than 65\u00a0years, who suffered an isolated acetabular fracture and were admitted in our Department between 2010 and 2014 (5-year period). Complications, outcome and mortality were recorded. Of all surviving patients, quality of life (QoL), mobility and independence were graded with European Quality of Life 5 Dimensions 3 Level (EQ-5D-3L), European Quality of Life 5 Dimensions Visual Analogue Scale (EQ-5D-VAS), Numeric Rating Scale (NRS), Elderly Mobility Scale (EMS) and Tinetti Mobility Test (TMT).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Seventy patients could be identified. There were 52 men (74%) and 18 women (26%) with a median age of 79.0\u00a0years (range: 65\u2013104\u00a0years). Forty-six patients (66%) had been treated with open reduction and internal fixation (ORIF), 24 (34%) conservatively. There were negative predictive factors\u2014subchondral impaction, damage to the femoral head and multiple fragments\u2014in 54% of the operative group. With ORIF, an anatomical reduction could be achieved in 27 patients (59%), an acceptable in 18 (39%) and a poor in one (2%). At follow-up, 18 patients (26%) had died and 23 (33%) were not able to participate. The follow-up rate of the surviving operatively treated patients was 77%. Eleven of 46 operated patients (24%) needed a conversion to a total hip arthroplasty (THA). All patients undergoing conversion had imperfect reduction after surgery. No patient in the non-operative group underwent conversion to THA during follow-up. The median follow-up time of operatively treated patients without conversion (<jats:italic>n<\/jats:italic>\u2009=\u200917) was 30\u00a0months (range, 16\u201373\u00a0months), of patients with THA (<jats:italic>n<\/jats:italic>\u2009=\u20099) 30\u00a0months after conversion (range, 17\u201355\u00a0months). Quality of reduction correlated to QoL, mobility and independence in all recorded parameters. Patients with secondary THA had similar good outcomes as patients after ORIF without later conversion. Men had better outcome than women.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>ORIF of acetabular fractures in patients of old age results in excellent outcomes at short-term follow-up when anatomical reduction can be achieved. In case of negative predictive factors, ORIF cannot be regarded as a definitive solution, rather as the construction of a stable socket for secondary THA. The decision of therapy should be made dependent on pre-operative radiographic parameters.<\/jats:p>\n<\/jats:sec>","DOI":"10.1007\/s00264-020-04672-0","type":"journal-article","created":{"date-parts":[[2020,7,30]],"date-time":"2020-07-30T22:06:25Z","timestamp":1596146785000},"page":"2123-2130","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Open reduction and internal fixation of acetabular fractures in patients of old age"],"prefix":"10.1007","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5175-3876","authenticated-orcid":false,"given":"Pol Maria","family":"Rommens","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Schwab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin","family":"Handrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Arand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Wagner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Hofmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,7,30]]},"reference":[{"key":"4672_CR1","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1097\/00003086-199307000-00009","volume":"292","author":"E Letournel","year":"1993","unstructured":"Letournel E (1993) The treatment of acetabular fractures through the ilioinguinal approach. 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