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.
Characteristics of hip socket fracture
Acetabular (hip socket) fractures can result from falls, automobile accidents or other traumatic events. The fracture causes pain in the hip area and the inability to walk without assistance.
Types
Acetabular fractures occur in ten common fracture patterns and other more unique patterns.
Similar conditions
Injuries to the hip area such as a significant contusion (or a "deep bruise") may be confused with acetabular fracture. However, because of the associated pain severity, most acetabular fractures are not confused with other conditions.
Incidence and risk factors
Acetabular fractures are not common injuries. They typically occur in adults, especially those with active lifestyles. Driving an automobile (or motorcycle) and falling from a significant height are risk factors for acetabular fracture.
Diagnosis
The patient usually cannot walk on the affected lower limb. Attempted hip movement produces muscle spasm and pain. The best diagnostic exams to confirm acetabular fracture are pelvic X-rays and CAT scans.
Medications
Analgesic (pain reliever) medications are somewhat helpful initially.
Possible benefits of hip socket fracture surgery
Displaced and unstable acetabular fractures are improved by surgery in many ways. The fracture fragments are realigned during the operation and then secured using plates and screws. Accurate fracture realignment promotes improved bone and cartilage healing which in turn improves long term results. Early fracture stability allows comfortable hip movement. Acetabular motion similarly improves joint cartilage healing. Also the patient can be out of bed and ambulatory using crutches.
Nondisplaced but unstable fractures can be stabilized with surgery prior to fracture displacement.
Types of surgery recommended
Acetabular (hip socket) fracture operations usually require surgical exposures in order to clean the fracture sites, realign the fracture fragments and apply plates and screws to secure the fracture.
Who should consider hip socket fracture surgery?
Patients with displaced and/or unstable acetabular fractures should strongly consider having surgery. The decision to have surgery should be discussed by the patient and physician.
What happens without surgery?
After an acetabular fracture, fragments of bone may be scattered within the body. If surgery is not used to fix this, these displaced fragments heal in poorly aligned locations. Consequently, the acetabular cartilage surfaces remain incongruous and postraumatic arthritic changes occur in the acetabulum.
Surgical options
A variety of surgical options exist for acetabular fractures. The specific operation is selected based on the patient and their specific fracture. Some fracture patterns are amenable to percutaneous (small wound) surgical techniques while others require open surgical treatment.
Urgency
Acetabular fractures are easier to repair when the surgery takes place within the first week after the injury. Early surgery also avoids prolonged bedrest for the patient. Delaying the operation complicates the surgical tactic.
Risks
The risks associated with treating acetabular fractures are numerous and unfortunately not uncommon. These exist for both surgical and nonsurgical treatments and include deep vein blood clots and pneumonia among others. Surgical risks include but are not limited to wound infection, nerve injury and scarring.
Managing risk
Risks are best managed by being aware of their possibility and trying to prevent them. Deep vein clots are treated with anticoagulation (blood thinner) medications. Infections require subsequent surgeries to cleanse the wound. An experienced surgeon should be able to handle not only the surgery but its complications too.
Preparation
Patients are evaluated before surgery by medical anesthesiology and surgical consultants as needed. The patient is educated regarding their injury, the treatment options and the risks of both nonoperative and surgical treatments. An educated patient is a prepared patient.
Timing
Surgery soon after the injury allows for the best treatment of the fracture and the patient. Waiting longer than one week makes the operation more difficult for both the patient and the surgeon.
Surgical team
Acetabular (hip socket) surgery is best performed by an experienced hip socket surgeon. If the surgeon is experienced, it is more likely that the fracture realignment will heal well. Moreover an acetabular operation performed by an experienced surgeon will likely have fewer complications. Many factors affect the final result; yet it's no secret that an experienced surgeon is a smart start toward a good result.
Acetabular fractures are unusual and complex orthopedic injuries. Most urban trauma centers have one or two orthopedic trauma surgeons designated as their "Pelvic and Acetabular Team." These individuals have a special interest in such injuries and provide care for the patients with acetabular and pelvic ring fractures. The operations are performed at the trauma center hospital.
Technical details
During the surgery the acetabular (hip socket) fracture is exposed using surgical wounds. The fracture fragments are cleansed and the fractures are realigned. Next the fracture sites are stabilized with screws and plates.
Anesthetic
General anesthesia is recommended for most patients undergoing acetabular fracture surgery.
Length of hip socket fracture surgery
The duration of surgery varies according to the complexity of the fracture. Usually 3 to 6 hours are needed. Complex fractures may take much longer.
Pain and pain management
Acetabular (hip socket) fracture surgery stabilizes the previously displaced and unstable fracture fragments. Fracture pain is diminished by the surgery. The surgical wounds are painful and require medication.
Use of medications
At first analgesic (pain relievers) medications are administered intravenously (directly into the blood stream). As patients begin to feel less pain, they are weaned to oral (administered by mouth) analgesics followed by other less addictive medications as needed.
Effectiveness of medications
The analgesic medication provides comfort which facilitates early rehabilitation.
Important side effects
Narcotic analgesic medications are potentially addictive and may produce a variety of side effects.
Recovery and rehabilitation in the hospital
The recovery period encompasses three individual three-month periods. During the first six weeks after surgery activities are well restricted. More aggressive range of motion and strengthening exercises begin during the second six weeks period. Strengthening conditioning and flexibility activities increase thereafter.
Hospital discharge
Patients without other complicatons are discharged after they regain normal bowel and bladder functions, they are comfortable on oral analgesics and the physical therapist approves the patient's rehabilitation efforts.
Most patients are able to walk after surgery using crutches to protect their acetabular reconstructon. Some require hip movement restrictions according to the specific fracture patterns.
Convalescent assistance
Crutch assisted ambulatory patients with supportive families can be discharged to home. Those patients with numerous extremity injuries may require the services of a convalescent facility.
Physical therapy
At first, isometric and gentle range of motion exercises are supervised by a physical therapist. After 6 weeks, hip motion and strengthening activities are increased. Weight bearing restrictions relax as hip strength is achieved. Aquatic programs may be beneficial for some patients.
Can rehabilitation be done at home?
After the patient is educated regarding his/her specific rehabilitation, they may begin a home exercise program.
Risks
Not following the prescribed rehabilitation program can have catastrophic results such as fixation failure and others.
Duration of rehabilitation
After fracture healing, a home exercise program is encouraged for life.
Returning to ordinary daily activities
Patients return to their routine daily activities depending on their injuries and activities. Sedentary workers can usually return to work much sooner than heavy laborers.
Long-term patient limitations
After acetabular surgery, high impact activities are discouraged so as to protect the hip joint. Most patients do whatever their hip comfort and function allow.
Summary of hip socket fracture surgery for hip socket fracture
Acetabular (hip socket) fractures are unusual and complex orthopedic injuries. Patients with displaced and/or unstable acetabular fractures are treated with surgery to realign and stabilize the joint surfaces. Early operative intervention by an experienced acetabular team improves patient outcomes.
