Pelvic and acetabular fracture surgeries

Acetabular (hip socket) fractures are serious orthopedic injuries, usually resulting from significant trauma. Acetabular fracture surgery realigns and stabilizes the displaced joint surfaces while allowing the patient to avoid traction and prolonged bedrest.

Acetabular fractures vary. For example, the bone can break straight across the socket or shatter into many pieces. When the acetabulum is fractured, the femoral head may no longer fit firmly into the socket, and the cartilage surface of both bones may be damaged.

If the joint remains irregular or unstable, ongoing cartilage damage to the surfaces may lead to arthritis.

Causes

An acetabular fracture results when a force drives the head of the femur against the acetabulum. This force can be transmitted from the knee (such as hitting the knee against the dashboard in a head-on car collision) or from the side (such as falling off a ladder directly onto the hip). Depending upon the direction of the force, the head of the femur is sometimes pushed out of the hip socket, an injury called hip dislocation.

When the fracture is caused by high-energy impact, patients often experience extensive bleeding and have other serious injuries that require urgent attention.

Acetabular fractures are sometimes caused by weak or insufficient bone. This is most common in older patients whose bones have become weakened by osteoporosis. Although these patients do not often have other injuries, they may have complicating medical problems, such as heart disease or diabetes.

Symptoms

A fractured acetabulum is almost always painful. The pain is worsened with movement.

If nerve damage has occurred with the injury, the patient may feel numbness, weakness, or a tingling sensation down the leg.

Surgical Treatment

Patients with acetabular fractures often require an Open Reduction with Internal Fixation (ORIF), especially those patients who also have displacement of the joint. The surgeon realigns or reduces the bones as precisely as possible to prevent the development of post-injury related problems, especially arthritis. The bones are rigidly fixed with plates and screws to prevent future displacement and allow for rehabilitation to begin as quickly as possible.

Fractures of the acetabulum are usually not treated for 5-10 days following the injury. Because the patient experiences significant bleeding with this fracture, the orthopaedic surgeon must wait for the patient’s own clotting mechanisms to go into effect–usually within 3-5 days. During this period the patient may be in traction to prevent additional injury. In skeletal traction, a metal pin is implanted in the femur or tibia bone. Weights attached to the pin gently pull on the leg, keeping the broken bone fragments in as normal a position as possible. For many patients, skeletal traction also provides some pain relief.

Total Hip Replacement

In some cases, the acetabulum is so damaged that repair or reconstruction is unlikely to provide a good long-term result. In this situation, your doctor may recommend total hip replacement. In this procedure, the damaged bone and articular cartilage are removed and replaced with artificial parts (prosthesis).